Surgical monotherapy versus surgery plus adjuvant radiotherapy in high-risk cutaneous squamous cell carcinoma: A systematic review of outcomes

Anokhi Jambusaria-Pahlajani, Christopher J. Miller, Harry Quon, Nananamibia Smith, Rhonda Quain Klein, Chrysalyne Delling Schmults

Research output: Contribution to journalArticle

Abstract

Background Adjuvant radiotherapy (ART) has been recommended for squamous cell carcinoma (SCC) with a high risk of recurrence, particularly perineurally invasive disease. The utility of ART is unknown. This study compares reported outcomes of high-risk SCC treated with surgical monotherapy (SM) with those of surgery plus ART (S+ART). METHODS The Medline database was searched for reports of high-risk SCC treated with SM or S+ART that reported outcomes of interest: local recurrence, regional or distant metastasis, or disease-specific death. Results There were no controlled trials. Of the 2,449 cases of high-risk SCC included, 91 were treated with S+ART. Tumor stage and surgical margin status before ART were generally unreported. In 74 cases of perineural invasion (PNI), outcomes were statistically similar between SM and S+ART. In 943 high-risk SCC cases in which clear surgical margins were explicitly documented, risks of local recurrence, regional metastasis, distant metastasis, and disease-specific death were 5%, 5%, 1%, and 1%, respectively. ConclusionS High cure rates are achieved in high-risk cutaneous SCC when clear surgical margins are obtained. Current data are insufficient to identify high-risk features in which ART may be beneficial. In cases of PNI, the extent of nerve involvement appears to affect outcomes, with involvement of larger nerves imparting a worse prognosis. The authors have indicated no significant interest with commercial supporters.

Original languageEnglish (US)
Pages (from-to)574-585
Number of pages12
JournalDermatologic Surgery
Volume35
Issue number4
DOIs
StatePublished - Apr 2009
Externally publishedYes

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Adjuvant Radiotherapy
Squamous Cell Carcinoma
Skin
Neoplasm Metastasis
Recurrence
Databases

ASJC Scopus subject areas

  • Dermatology
  • Surgery

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Surgical monotherapy versus surgery plus adjuvant radiotherapy in high-risk cutaneous squamous cell carcinoma : A systematic review of outcomes. / Jambusaria-Pahlajani, Anokhi; Miller, Christopher J.; Quon, Harry; Smith, Nananamibia; Klein, Rhonda Quain; Schmults, Chrysalyne Delling.

In: Dermatologic Surgery, Vol. 35, No. 4, 04.2009, p. 574-585.

Research output: Contribution to journalArticle

Jambusaria-Pahlajani, Anokhi ; Miller, Christopher J. ; Quon, Harry ; Smith, Nananamibia ; Klein, Rhonda Quain ; Schmults, Chrysalyne Delling. / Surgical monotherapy versus surgery plus adjuvant radiotherapy in high-risk cutaneous squamous cell carcinoma : A systematic review of outcomes. In: Dermatologic Surgery. 2009 ; Vol. 35, No. 4. pp. 574-585.
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AB - Background Adjuvant radiotherapy (ART) has been recommended for squamous cell carcinoma (SCC) with a high risk of recurrence, particularly perineurally invasive disease. The utility of ART is unknown. This study compares reported outcomes of high-risk SCC treated with surgical monotherapy (SM) with those of surgery plus ART (S+ART). METHODS The Medline database was searched for reports of high-risk SCC treated with SM or S+ART that reported outcomes of interest: local recurrence, regional or distant metastasis, or disease-specific death. Results There were no controlled trials. Of the 2,449 cases of high-risk SCC included, 91 were treated with S+ART. Tumor stage and surgical margin status before ART were generally unreported. In 74 cases of perineural invasion (PNI), outcomes were statistically similar between SM and S+ART. In 943 high-risk SCC cases in which clear surgical margins were explicitly documented, risks of local recurrence, regional metastasis, distant metastasis, and disease-specific death were 5%, 5%, 1%, and 1%, respectively. ConclusionS High cure rates are achieved in high-risk cutaneous SCC when clear surgical margins are obtained. Current data are insufficient to identify high-risk features in which ART may be beneficial. In cases of PNI, the extent of nerve involvement appears to affect outcomes, with involvement of larger nerves imparting a worse prognosis. The authors have indicated no significant interest with commercial supporters.

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