Xstrahl In Action: Hypofractionated radiotherapy in older patients with non-melanoma skin cancer
Radiotherapy remains one of many treatment options available for patients diagnosed with non-melanoma skin cancer (NMSC). NMSC is a radiation-responsive cancer and patients treated with definitive radiotherapy can expect excellent local control rates of >90–95%. Typical prescription is 2 – 3 Gy fractions delivered on consecutive weekdays over 4 – 5 weeks. Such treatment schedules might be logistically difficult for elderly, often unwell, patients with poor performance status, who can benefit from the so-called hypofractionated radiotherapy, delivering less than 10 fractions either daily, on alternative days or once a week.
In the study “Hypofractionated radiotherapy in older patients with non-melanoma skin cancer: Less is better” Michael Veness put together an evidence base documenting the efficacy of the hypofractionated radiotherapy approach.
They present three cases of patients (86, 95 and 75 years old) treated with hypofrcationated radiotherapy, which highlight the excellent outcome of this approach. They discuss the trend that hypofractionated radiotherapy is a more favoured option in select patients thanks to concerns regarding the late tissue consequences of using large fractions, such as skin, soft tissue or cartilage necrosis, which appear to be unfounded.
In conclusion in older patients with even moderately advanced NMSC, a shorter, or hypofractionated, course of radiotherapy does not disadvantage them in regard to outcome and should be considered an efficacious and tolerable treatment option.