the management of basal cell carcinoma
Radiotherapy
Radiotherapy (RT) is an extremely efficient form of treatment, but faces the same problem of accurately identifying tumour margins as standard excisional surgery. RT includes a range of treatments using different types of equipment, each with its own specific indications and side-effects. It is therefore best performed by specialized dermatological centers or by clinical oncologists with a specialist interest in skin cancer.
Careful patient selection can result in very high cure rates; in a series of 412 BCCs treated with RT, 5-year cure rates of 90.3% were achieved. 18 In a prospective trial, where 93 patients with BCC were randomized to receive either cryosurgery or radiation therapy; the 2-year cure rate for the RT group was 96%. 52 A review of all studies published since 1947 suggested an overall 5-year cure rate of 91.3% following RT for primary BCC and a review of all studies published since 1945 suggested an overall 5-year cure rate of 90.2% following RT for recurrent BCC.
Radiotherapy can be used to treat many types of BCC, even those overlying bone and cartilage, although it is probably less suitable for the treatment of large tumours in critical sites, as very large BCC masses are often both resistant and require radiation doses that closely approach tissue tolerance. However, surgery should be preferred for BCC of the face measuring < 4cm in diameter.
Radiotherapy is also not indicated for BCCs on areas subject to repeated trauma such as the extremities or trunk and for young patients as the late-onset changes of cutaneous atrophy and telangiectasis may result in a cosmetic result inferior to that following surgery. It can also be difficult to use RT to re-treat BCCs that have recurred following RT. Modern fractionated dose therapy has many advantages but requires multiple visits to a specialist centre. Late-onset fibrosis may cause problems such as epiphora and ectropion following treatment of lower eyelid and inner canthal lesions, where cataract formation is also a recognized risk, although this can be minimized by the use of protective contact lenses.
There is some suggestion that BCCs recurring following RT may behave in a particularly aggressive and infiltrative fashion, although this may simply reflect that these lesions were of an aggressive, high-risk type from the very beginning.
Radiotherapy
Radiotherapy (RT) is an extremely efficient form of treatment, but faces the same problem of accurately identifying tumour margins as standard excisional surgery. RT includes a range of treatments using different types of equipment, each with its own specific indications and side-effects. It is therefore best performed by specialized dermatological centers or by clinical oncologists with a specialist interest in skin cancer.
Careful patient selection can result in very high cure rates; in a series of 412 BCCs treated with RT, 5-year cure rates of 90.3% were achieved. 18 In a prospective trial, where 93 patients with BCC were randomized to receive either cryosurgery or radiation therapy; the 2-year cure rate for the RT group was 96%. 52 A review of all studies published since 1947 suggested an overall 5-year cure rate of 91.3% following RT for primary BCC and a review of all studies published since 1945 suggested an overall 5-year cure rate of 90.2% following RT for recurrent BCC.
Radiotherapy can be used to treat many types of BCC, even those overlying bone and cartilage, although it is probably less suitable for the treatment of large tumours in critical sites, as very large BCC masses are often both resistant and require radiation doses that closely approach tissue tolerance. However, surgery should be preferred for BCC of the face measuring < 4cm in diameter.
Radiotherapy is also not indicated for BCCs on areas subject to repeated trauma such as the extremities or trunk and for young patients as the late-onset changes of cutaneous atrophy and telangiectasis may result in a cosmetic result inferior to that following surgery. It can also be difficult to use RT to re-treat BCCs that have recurred following RT. Modern fractionated dose therapy has many advantages but requires multiple visits to a specialist centre. Late-onset fibrosis may cause problems such as epiphora and ectropion following treatment of lower eyelid and inner canthal lesions, where cataract formation is also a recognized risk, although this can be minimized by the use of protective contact lenses.
There is some suggestion that BCCs recurring following RT may behave in a particularly aggressive and infiltrative fashion, although this may simply reflect that these lesions were of an aggressive, high-risk type from the very beginning.
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