Superficial radiation advances as option for NMSC treatment

David J. Goldberg, MD, JD, points out the benefits of SRT during “New and Emerging Therapies for Non-Melanoma Skin Cancers.”

David J. Goldberg, MD, JD, examined the genesis of the evolution of superficial radiation therapy (SRT) during “New and Emerging Therapies for Non-Melanoma Skin Cancers,” part of “New Emerging Therapies” (S022). Dr. Goldberg is a dermatologic surgeon at Skin Laser and Surgery Specialists of New York/New Jersey.

NMSC is rising at a rate of 4-8 percent annually, with a five-year survival rate of 95 percent. The most common forms are basal cell carcinoma and squamous cell carcinoma. Both have cure rates of 90 percent or higher when using simple surgical excision, radiotherapy, cryotherapy, electrodesiccation and curettage, and Mohs surgery.

“It is clear that Mohs does better than anything else in 2001 data,” Dr. Goldberg said, noting that its cure rates are 99 percent for BCC and 96.9 percent for SCC. “Mohs is my treatment of choice. We are still treating the majority of lesions with Mohs.”

Increasingly, though, elderly patients prefer to avoid surgery, and other patients are poor surgical candidates, so SRT is an option because it has advanced with the development of better equipment.

SRT uses low-energy photon X-rays operating at variable peak voltages of 50, 70, and 100 kVp. It is easy to administer, and it easily targets and treats lesions while delivering gentle, indirect radiation that does not penetrate and impact underlying healthy tissue, Dr. Goldberg said.

The cure rate for 1,715 primary nonaggressive NMSCs treated with the SRT-100 machine approved by the Food and Drug Administration was 98 percent in a 2012 study. A benefit of SRT is that it eradicates the tumor while maintaining or improving the quality of life, he said.

The indications for patients best suited to treatment with SRT are that they are medically unfit for surgery or have a limiting disease, they have contraindications for anesthesia, and they have the potential to have significant cosmetic, neural, or functional limitations postoperatively, Dr. Goldberg said.

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