From the Guidelines
X-ray therapy (radiation therapy) is a recommended treatment option for basal cell carcinoma (BCC), particularly for patients who are not good surgical candidates or have tumors in cosmetically sensitive areas, as stated in the guidelines of care for the management of basal cell carcinoma 1.
Treatment Overview
The typical treatment regimen involves fractionated doses of radiation delivered over multiple sessions, usually 5-7 weeks with treatments given 3-5 times weekly. Total radiation doses generally range from 45-55 Gy for small, uncomplicated BCCs, with higher doses (60-65 Gy) sometimes needed for larger or recurrent tumors.
Key Considerations
- Radiation therapy is particularly useful for elderly patients, those with medical conditions that make surgery risky, or for tumors in difficult locations like eyelids, nose, or ears where surgery might cause cosmetic or functional impairment.
- Side effects include skin redness, irritation, and sometimes permanent changes in skin pigmentation or texture in the treated area.
- Long-term cure rates are good (85-95% for primary BCCs), though slightly lower than with surgical excision, as noted in the NCCN clinical practice guidelines in oncology 1.
Patient Care
Patients should expect regular follow-up appointments to monitor for recurrence and potential late effects of radiation.
Treatment Guidelines
The guidelines of care for the management of basal cell carcinoma recommend considering radiation therapy as a treatment option when surgical therapy is not feasible or preferred, especially for low-risk tumors 1. Some key points to consider when evaluating treatment options for BCC include:
- The goal of primary treatment is the cure of the tumor and the maximal preservation of function and cosmesis.
- Surgical approaches often offer the most effective and efficient means for accomplishing cure, but considerations of function, cosmesis, and patient preference may lead to choosing radiation therapy as primary treatment.
- Nonsurgical treatments, such as cryosurgery, topical therapy, and photodynamic therapy, can be considered when tumors are low risk, with the understanding that the cure rate may be lower.
From the Research
X-ray Treatment for Basal Cell Carcinoma
- X-ray treatment, also known as radiotherapy, is a viable option for the treatment of basal cell carcinoma (BCC) in select patients 2.
- A study published in the Journal of the American Academy of Dermatology found that superficial x-ray therapy resulted in low recurrence rates, with cumulative recurrence rates of 1.9% and 5.0% at 2 and 5 years, respectively 2.
- Another study published in Strahlentherapie und Onkologie found that external beam radiotherapy provided high tumor control rates and good cosmetic results in the treatment of BCC, with a complete tumor remission rate of 99% and a local recurrence rate of 2% 3.
- The treatment of BCC using radiotherapy is also supported by a review published in The British Journal of Dermatology, which found that radiotherapy provided a high rate of local control with low rates of complications comparable to surgery 4.
- The use of radiotherapy for BCC is also discussed in a comprehensive review published in the AJR. American Journal of Roentgenology, which highlights the importance of radiology in the evaluation and staging of locally advanced and metastatic BCC 5.
- A study published in Current Treatment Options in Oncology notes that while surgical excision and Mohs surgery are the most commonly used treatments for BCC, radiotherapy is a viable option for patients where surgical intervention is declined, unadvisable, or potentially associated with significant cosmetic or functional limitations 6.