What are the American Society for Radiation Oncology guidelines on radiation therapy for basal cell carcinoma (BCC)?

Updated: Mar 02, 2020
  • Author: Robert S Bader, MD; Chief Editor: William D James, MD  more...
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Answer

In 2020, the American Society for Radiation Oncology published clinical practice guidelines on definitive and postoperative radiation therapy (RT) for basal and squamous cell cancers of the skin. [110] Recommendations regarding definitive radiation therapy for BCC are as follows:

  • RT is recommended as curative treatment in patients with BCC who cannot undergo or who decline surgical resection.
  • RT is conditionally recommended as curative treatment in patients with BCC in anatomic locations where surgery can endanger function or cosmesis.
  • RT is conditionally not recommended for patients with BCC who have genetic diseases that predispose to increased radiosensitivity.

Postoperative RT is recommended in cases of gross perineural spread that is apparent clinically or radiologically. Postoperative RT is conditionally recommended in the following clinical scenarios:

  • BCC with narrow or positive margins that is refractory to further surgical correction owing to morbidity or adverse cosmetic outcome
  • BCC associated with recurrence after a previous margin-negative resection
  • BCC associated with locally advanced or neglected tumors that involve bone or those infiltrating muscle

Recommendations for cutaneous BCC that has metastasized to clinically apparent regional lymph nodes are as follows:

  • Therapeutic lymphadenectomy followed by adjuvant RT (Exception: Patients with a single, small (< 3 cm) cancerous cervical lymph node, without extracapsular extension)
  • Definitive RT only recommended if patient is medically inoperable or surgically unresectable

Conditional recommendations for cutaneous BCC in patients who are at high risk of regional nodal metastasis are as follows:

  • Imaging and sentinel lymph node biopsy, in order to guide the need for and target of lymph node basin RT
  • If tumor thickness is greater than 6 mm, elective lymph node basin RT only in patients undergoing RT on the primary site, with overlap of the adjacent nodal basin

The recommended radiation dose for patients with cutaneous BCC who are undergoing adjuvant RT after therapeutic lymphadenectomy is 6000-6600 cGy (conventional fractionation [180-200 cGy/fx]).

Recommended radiation techniques/dose-fractionation schedules for patients with BCC who are receiving RT in a definitive setting are as follows:

  • Conventional (180-200 cGy/fx): BED10 (biologically effective dose assuming an α/β = 10) 70-93.5 (delivered 5 days/wk)
  • Hypofractionation (210-500 cGy/fx): BED10 56-88 (delivered daily or 2-4 times/wk)

Recommended dose-fractionation schedules for patients with BCC who are receiving RT in a postoperative setting are as follows:

  • Conventional (180-200 cGy/fx): BED10 59.5-79.2 (delivered 5 days/wk)
  • Hypofractionation (210-500 cGy/fx): BED10 56-70.2 (delivered daily or 2-4 times/wk)

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