Evaluation of the utility of localized adjuvant radiation for node-negative primary cutaneous squamous cell carcinoma with clear histologic margins - 09/01/20
Abstract |
Background |
Though the National Comprehensive Cancer Network recommends consideration of localized adjuvant radiation after clear-margin surgery for cutaneous squamous cell carcinoma (cSCC) with large-caliber (≥0.1-mm) nerve invasion (LCNI) and other high-risk features, only a single small study has compared surgery plus adjuvant radiation therapy (S+ART) to surgical monotherapy (SM) for cSCC.
Objective |
Compare S+ART to SM for primary cSCCs with LCNI and other risk factors.
Methods |
Matched retrospective cohort study of primary cSCCs (matched on sex, age, immune status, type of surgery, diameter, differentiation, depth, and LCNI) treated with S+ART versus SM. A subgroup analysis of cSCCs with LCNI was performed.
Results |
In total, 62 cSCCs were included in matched analysis (31 S+ART and 31 SM) and 33 cSCCs in the LCNI analysis (16 S+ART and 17 SM). There were no significant differences in local recurrence, metastasis, or death from disease in either analysis. Risk of local recurrence was low (8%, 7/89), with 3 of the local recurrences being effectively treated upon recurrence.
Limitations |
Single academic center and nonrandomized design.
Conclusion |
Adjuvant radiation did not improve outcomes compared with SM due to a low baseline risk of recurrence, although adjuvant radiation for named nerve invasion and LCNI of ≥3 nerves has been shown to improve outcomes in a prior study. Randomized studies are needed to define the subset of cSCC for whom adjuvant radiation has utility.
Le texte complet de cet article est disponible en PDF.Key words : adjuvant therapy, cutaneous squamous cell carcinoma, Mohs micrographic surgery, nonmelanoma skin cancer, perineural invasion, radiation therapy
Abbreviations used : AJCC, ART, BWH, CCPDMA, cSCC, LCNI, LR, NM, PNI, S+ART, SM
Plan
| Funding sources: Supported by a Dermatology Foundation Career Development Award (to Dr Ruiz). |
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| Conflicts of interest: None disclosed. |
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| IRB approval status: Approved by the Partners Human Research Office. |
Vol 82 - N° 2
P. 420-429 - février 2020 Retour au numéro
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