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ASTRO Clinical Practice Guideline for Radiation Therapy for Basal Cell and Squamous Cell Skin Cancers

By: Lauren Harrison, MS
Posted: Friday, January 3, 2020

The American Society for Radiation Oncology (ASTRO) released new guidelines regarding the treatment of basal cell carcinoma and cutaneous squamous cell carcinoma, detailing when radiation therapy should be used alone or in conjunction with surgical approaches. The evidence for the use of definitive and postoperative radiation therapy in patients with these skin cancers was explored in an executive summary of these guidelines published in Practical Radiation Oncology.

“For this guideline, we drew on the consensus of a multidisciplinary group of leading experts, as well as a systematic review of the evidence, to help physicians understand when radiation is most likely to benefit their patients and to encourage informed discussion about treatment options," said Anna Likhacheva, MD, MPH, of Sutter Medical Center in Sacramento, California, in an ASTRO press release.

The task force that complied the guidelines aimed to address five key questions regarding indications for radiation therapy in both basal and squamous cell carcinomas: dose-fractionation schemes, target volumes, basic aspects of treatment planning, choice of radiation modality, and the role of systemic therapy in combination with radiation.

Definitive radiation therapy is recommended as the primary therapy in patients with either basal cell or squamous cell carcinoma who may not be surgical candidates. In patients for whom surgery may lead to a less-than-satisfactory cosmetic or functional outcome, radiation therapy can be conditionally recommended, with an emphasis on shared decision-making.

The guidelines suggest that radiation therapy should be initiated postoperatively in patients with a high risk of cancer recurrence, especially if the tumor has spread to the nerves. Patients with disease that has spread to regional lymph nodes should undergo surgical removal of the lymph nodes followed by radiation therapy. The guideline recommends against the use of carboplatin with concurrent adjuvant radiation therapy but does recommend systemic therapies for unresectable primary tumors.

Disclosure: For full disclosures of study authors, visit

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