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Consensus: IGSRT Is Safe and Effective for First-line Treatment of NMSCs

Image-guided superficial radiation therapy (IGSRT) is a safe and effective first-line treatment for nonmelanoma skin cancer (NMSC), according to expert consensus recommendations published in SKIN: The Journal of Cutaneous Medicine.

 IGSRT utilizes high-resolution dermal ultrasound (HRDUS) in conjunction with SRT to visualize tumors before, during, or after treatment.

 For the report, six dermatologists with expertise in managing NMSC reviewed 12 published studies on IGSRT.  The panel unanimously voted to adopt eight statements, with an additional two statements receiving five out of six votes for adoption.

 The panel unanimously agreed that:

  • SRT is a well-established modality for treating NMSC, dependent on individual patient characteristics. ISGSRT adds US visualization that can help evaluate the depth and breadth of the tumor.
  • IGSRT is a safe and effective treatment option for NMSC.
  • Dermatologists are the most appropriate clinicians to direct and administer SRT, including IGSRT.
  • SRT, including IGSRT, can be considered a first-line treatment for NMSC for appropriately selected patients
  • SRT, including IGSRT, may be the optimal treatment for certain patients depending on individual patient factors, such as age, comorbidity, patient preferences, tumor location, tumor histology, and other factors
  • SRT, including IGSRT, may not be medically optimal in certain clinical situations
  • Patients with NMSC need to be offered all appropriate treatment options and should be a part of the decision-making process
  • Based on available data, SRT, including IGSRT, provides superior outcomes overall to electron beam.

The experts point out that studies have not investigated SRT, including IGSRT’s efficacy for high-risk stage 3 or stage 4 tumors, and there is no data available on its use for recurrent NMSCs.

 The panelists similarly stress that the mean follow-up duration of approximately 70 weeks may not be long enough to capture all recurrences.

 “Given the importance of shared decision making, they emphasized the need to discuss the risks and benefits of all available options when creating a treatment plan, incorporating patient preferences, patient history, and tumor characteristics into the final management decision,” the study authors conclude.

 

 “Given our organization’s commitment to empowering people to be proactive in their approach to prevention, early detection and treatment of skin cancer, I am proud to have participated in this thoughtful, scientifically sound evaluation of the literature on IGSRT, which offers promise for those who are diagnosed with NMSC and who are unwilling or unable to undergo Mohs surgery,” adds Deborah S. Sarnoff, M.D., a panelist and president of The Skin Cancer Foundation, in a news release.

The Dermatology Association of Radiation Therapy (DART) Chairman Jacob Scott, MD, who was not involved in the project, says, “The expert panel did a superb job analyzing the existing research and providing critical guideposts for the use of IGSRT in dermatology practices. Of particular value is their highlighting of those cases in which IGSRT can be considered optimal as first-line therapy for NMSC, as well as cases in which it is not recommended or contraindicated. In line with DART’s philosophy of ensuring that all patients be fully informed of treatment options, the panel emphasized the need to discuss the risks and benefits of all available options when creating a treatment plan, ‘incorporating patient preferences, patient history, and tumor characteristics into the final management decision.’”