What is the role of radiation therapy for the management of basal cell carcinoma?

Updated: Mar 02, 2020
  • Author: Robert S Bader, MD; Chief Editor: William D James, MD  more...
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Basal cell carcinomas (BCCs) are usually radiosensitive, and radiation therapy (RT) can be used for advanced and extended lesions and in those patients for whom surgery is not suitable (eg, because of allergy to anesthetics, current anticoagulant therapy, a tendency to form keloids, [86] or facial tumors). In a retrospective analysis of 1715 histologically confirmed primary cutaneous carcinomas (712 BCCs, 994 SCCs, nine tumors with distinct BCC and SCC characteristics) treated with superficial radiation therapy, recurrence rates for BCC at 2 and 5 years were 2% and 4.2%, respectively. Recurrence rates for SCC at 2 and 5 years were 1.8% and 5.8%, respectively. [87] Postoperative radiation can also be a useful adjunct when patients have aggressive tumors that were treated surgically or when surgery has failed to clear the margins of the tumor. [8]  The treatment of locally advanced basal cell carcinomas may result in complete remission in approximately 70% of patients. [88]

In the past, RT was a common treatment modality because of its high cure rate (97% for primary tumors). It is now used sparingly, because it is time consuming and extremely expensive. With the advancement in surgical techniques and other treatment modalities, RT is a reasonable treatment choice for recurrent tumors. It may be reserved for primary lesions requiring difficult or extensive oculoplastic surgery. It also eliminates the need for skin grafting when surgery would result in an extensive defect.

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