Surgical monotherapy versus surgery plus adjuvant radiotherapy in high-risk cutaneous squamous cell carcinoma: a systematic review of outcomes.
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.
Division of Dermatologic Surgery, Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Anokhi
A
Jambusaria-Pahlajani
Christopher J
CJ
Miller
Harry
H
Quon
Nananamibia
N
Smith
Rhonda Quain
RQ
Klein
Chrysalyne Delling
CD
Schmults
D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D009361:Neoplasm Invasiveness; D018714:Radiotherapy, Adjuvant; D012867:Skin / Q000294:innervation / Q000473:pathology*; D012878:Skin Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D016896:Treatment Outcome