Journal
JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY
Volume 87, Issue 1, Pages 87-94Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.jaad.2022.03.044
Keywords
cutaneous squamous cell carcinoma; radiation; recurrence
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Funding
- Melvin Markey Discovery Fund at Cleveland Clinic
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This study evaluated the impact of adjuvant radiation therapy on high T-stage cutaneous squamous cell carcinomas following clear margin surgery. Results showed that adjuvant radiation therapy significantly reduced the risk of local recurrence and locoregional recurrence.
Background: Although adjuvant radiation (ART) following clear margin surgery is recommended for select high-risk cutaneous squamous cell carcinomas, efficacy data are limited. Objective: To evaluate the impact of ART on outcomes following clear margin surgery for high T-stage cutaneous squamous cell carcinomas. Methods: A 20-year retrospective cohort study at 2 academic centers of high T-stage cutaneous squamous cell carcinomas (Brigham and Women's Hospital T2b or T3) with negative histologic margins post resection. Local recurrence (LR) and locoregional recurrence (LRR) were compared by whether tumors received ART or observation. Results: A total of 508 tumors were included, of which 96 underwent ART (ART(+)). ART(+) had a lower 5-year cumulative incidence of LR (ART(+), 3.6% [95% CI, 1.6%-7.7%] vs ART(-), 8.7% [95% CI, 6.3%-12.0%]) and LRR (ART(+), 7.5% [95% CI, 4.4%-11.9%] vs ART(-), 15.3% [95% CI, 11.9%-22.1%]). Recurrent tumors >= 6 cm or Brigham and Women's Hospital T3 tumors were classified as high-risk due to a higher 5-year cumulative incidence of LRR (High-risk, 26.3% [95% CI, 19.0%-35.7%]). High-risk tumors treated with ART had a lower 5-year cumulative incidence of LRR (ART(+), 17.2% [95% CI, 11.9%-26.4%] vs ART(-), 31.0% [95% CI, 26.1%-40.8%]). Limitations: Retrospective design, heterogeneous population, variations in radiation protocols. Conclusion: ART following clear margin surgery for high T-stage cutaneous squamous cell carcinomas resulted in half the risk of LR and LRR.
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