COVID-19 and Non-Melanoma Skin Cancer: Revisiting Hypofractionated Radiotherapy
Posted: Friday, July 10, 2020
According to a report published in the Journal of Medical Imaging and Radiation Oncology, hypofractionation may be a beneficial method of radiotherapy delivery for patients with non-melanoma skin cancer during and after the COVID-19 pandemic. Michael J. Veness, MBBS, of the University of Sydney, reviewed previously published literature to determine the efficacy and feasibility of this approach given the limitations imposed by the ongoing pandemic.
Multiple professional organizations and treatment centers have released guidelines for the treatment of non-melanoma skin cancers during the COVID-19 pandemic. Recommended strategies include delaying consultations or skipping radiotherapy courses in favor of alternative treatments such as excision. However, the strained resources of other specialty areas, such as dermatology, are making it difficult to access alternative treatments. Therefore, many treatment centers are utilizing hypofractionated radiotherapy for non-melanoma skin cancer.
The use of hypofractionated radiotherapy limits patient and staff exposure to COVID-19 and protects linear accelerator time. The Royal College of Radiologists in the United Kingdom has recommended lowering the number of overall fractions in radiotherapy for non-melanoma skin cancer. These recommendations are likely to continue after the COVID-19 pandemic ends due to an anticipated unprecedented increase in the number of referrals to radiotherapy.
Recommendations for hypofractionation schedules are supported by the literature. One review of publications accounting for 12,000 patients with non-melanoma skin cancer treated with hypofractionation found that patients received a mean total dose of 38 Gy at 8 Gy per fraction three times per week. Of the 40 publications reviewed, 29 observed a local control rate of at least 90%. For older patients or those with comorbidities, a single large fraction may be considered. A previous study found that fractions higher than 20 Gy tended to be associated with a higher risk of skin necrosis, whereas fractions of between 15 and 18 Gy may be reasonably considered.
Disclosure: The study authors reported no conflicts of interest.
