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Aggressive surgery appears to achieve negative margins, intensify radiation volume in CSCC

The use of salvage limited-field irradiation in aggressive cutaneous squamous cell carcinoma with microscopic residual disease resulted in a progression rate of more than 80%, which is much higher than the usual failure rate for high-risk cutaneous squamous cell carcinoma, according to findings published in JAMA Dermatology.

“Radiation therapy can aid in local control of tumors when histologic negative margins cannot be achieved but may be limited in overall disease control in those with [American Joint Committee on Cancer] or [Brigham Women’s Hospital] high-stage tumors,” Emily Stamell Ruiz, MD, MPH, of the department of dermatology at Brigham and Women’s Hospital and associate professor at Harvard Medical School, and colleagues wrote.

Eleven patients (three women) with primary cutaneous squamous cell carcinoma (CSCC) diagnosed at Brigham and Women’s Hospital were treated with salvage limited-field irradiation for microscopic residual disease after surgery. Salvage radiation therapy was completed on the primary tumor only.

The researchers staged tumors via the Brigham Women’s Hospital (BWH) staging system and the American Joint Committee on Cancer 8th edition (AJCC8). Tumors at BWH stage T3 or AJCC8 T4a/T4b were excluded. Ten patients had high-stage tumors based on one or both staging systems.

Nine patients (82%) had CSCC-related poor outcomes, of which the disease-free interval ranged from 0 to 34 months with a mean of 19 months, according to researchers.

Four patients (36%) had a local recurrence, seven (64%) developed nodal metastasis, two (18%) developed distant metastasis and three (36%) died of CSCC.

Of two patients with no evidence of disease, one died from follicular lymphoma 8 months after treatment.

“This small series underscores the importance of aggressive surgery to achieve negative margins whenever feasible, and the need to intensify radiation volume and consider incorporating systemic therapies,” Ruiz and colleagues wrote. – by Abigail Sutton

Disclosures: Ruiz is supported by a Dermatology Foundation Career Development Award. Please see the study for all other authors’ relevant financial disclosures.