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Guideline Updates

ASTRO Releases Recommendations for Skin Cancer Radiation Therapy

December 11, 2019

The American Society for Radiation Oncology (ASTRO) published a new guideline for the use of definitive and postoperative radiation therapy in patients with basal cell carcinoma and cutaneous squamous cell carcinoma.

The task force convened by ASTRO sought to address five key questions focused on indications for radiation therapy in the definitive and postoperative settings for these skin cancer types, as well as dose-fractionation schemes, target volumes, basic aspects of treatment planning, choice of radiation modality, and the role of systemic therapy in combination with radiation.

The guideline was published in Practical Radiation Oncology (online December 9, 2019; doi:10.1016/j.prro.2019.10.014).

The resulting guideline recommends definitive radiation therapy as primary treatment for patients with basal cell carcinoma or cutaneous squamous cell carcinoma who are not surgical candidates. The guideline also conditionally recommends radiation therapy with an emphasis on shared decision-making in situations in which adequate resection can lead to a less-than-satisfactory cosmetic or functional outcome.

In the postoperative setting, multiple indications for radiation therapy after an adequate resection are provided and distinguish the strength of recommendations between the skin cancer types.

A range of appropriate dose-fractionation schemes for treatment of primary and nodal volumes in definitive and postoperative scenarios are listed. Furthermore, the guideline recommends against the use of carboplatin concurrently with adjuvant radiation therapy and conditionally recommends the use of systemic therapies for unresectable primaries where treatment may require escalation.

"There is significant variation in practice about when and how radiation should be used for non-melanoma skin cancers, largely because few randomized studies have compared modern treatment options head-to-head," stated Phillip Devlin, MD, FASTRO, chair of the guideline task force and radiation oncologist, Brigham and Women's Hospital (Boston, MA), in a press release (December 10, 2019).

Authors of the guideline encourage enrolling patients in prospective clinical trials and approaching care from a multidisciplinary standpoint when appropriate.—Zachary Bessette

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