The State of the Art of Image Guided Superficial Radiation Therapy Treatment of Non-melanoma Skin Cancer in Outpatient Dermatology Clinics in the United States and Review of the Literature

Peyton M Harris; Aaron S Farberg; Janine Hopkins; Liqiao Ma; Donna Serure; Blake Robbins; Candace Osborne; Luis Bravo; Pauline Lausser; Amanda Boatner

doi:10.1007/s40487-024-00310-6

The State of the Art of Image Guided Superficial Radiation Therapy Treatment of Non-melanoma Skin Cancer in Outpatient Dermatology Clinics in the United States and Review of the Literature

Oncol Ther. 2024 Nov 21. doi: 10.1007/s40487-024-00310-6. Online ahead of print.

Authors

Peyton M Harris¹, Aaron S Farberg^{2

3

4}, Janine Hopkins⁵, Liqiao Ma⁶, Donna Serure⁷, Blake Robbins⁶, Candace Osborne⁸, Luis Bravo⁹, Pauline Lausser¹⁰, Amanda Boatner¹¹

Affiliations

¹ Texas A&M College of Medicine, Dallas, TX, USA. peyton.harris@tamu.edu.
² Texas A&M College of Medicine, Dallas, TX, USA.
³ Bare Dermatology, Dallas, TX, USA.
⁴ Baylor Scott & White Health System, Dallas, TX, USA.
⁵ Hopkins Dermatology, Monroe, LA, USA.
⁶ Tru-Skin Dermatology, Austin, TX, USA.
⁷ Laserderm Dermatology, Smithtown, NY, USA.
⁸ Tru-Skin Dermatology, Hallettsville, TX, USA.
⁹ University of Texas MD Anderson Cancer Center, Houston, TX, USA.
¹⁰ Heights Dermatology, Rosenberg, TX, USA.
¹¹ SkinCure Oncology, Burr Ridge, IL, USA.

PMID: 39572513
DOI: 10.1007/s40487-024-00310-6

Abstract

Introduction: Image guided superficial radiation therapy (IGSRT) is a novel technology which combines traditional superficial radiation therapy (SRT) with high resolution dermal ultrasound (HRDUS) to treat non-melanoma skin cancers (NMSC). Since development, IGSRT use has expanded dramatically in outpatient clinics. We review the IGSRT literature and state-of-the-art operating principles in US dermatologic practices.

Methods: A literature search of electronic databases (Medline, Pubmed, Cochrane Library, Science Direct) combined with various authors' published and unpublished documents, procedures, and clinical experience with IGSRT were synthesized for this paper.

Results: Studies have demonstrated IGSRT consistently delivers high cure rates (> 99%) with low complications for early stage (stage 0, I, or II) squamous cell and basal cell carcinomas. Control rates are statistically superior to non-image guided SRT and external beam radiation (XRT) as well as Mohs micrographic surgery (MMS). This improvement is attributed to in vivo dermal tumor visualization via HRDUS and using an interdisciplinary approach to deliver care. IGSRT use in the dermatologic clinic for early stage NMSCs has become common practice and continues to expand.

Conclusion: While the safety and cosmetic benefits of SRT/XRT have been long documented, IGSRT represents a significant leap forward in efficacy (statistically significant) by adding in vivo dermal tumor imaging. Results rival and appear on one study to surpass tumor control obtained with MMS. A contributing factor to the success may be the availability and use of an interdisciplinary team approach that includes dermatologists, radiation therapists, radiation oncologists, and medical physicists. The high tumor control rates, minimal side effects, favorable cosmesis, and ability to treat multiple lesions per session using IGSRT are establishing this modality as a standard first-line therapy for early stage NMSCs in dermatology clinics. IGSRT may represent the most effective option for the non-surgical treatment of early stage NMSC to date.

Keywords: Basal cell carcinoma; Image guided superficial radiation therapy; Mohs micrographic surgery; Non-melanoma skin cancer; Squamous cell carcinoma.

Publication types

Review