Skin in the game.
The NCCN footnote on “consider adjuvant radiation” in the setting of a margin-negative resection of a high-risk cutaneous squamous cell carcinoma (with extensive perineural invasion of >0.1mm or of a named nerve) reads: “The outcome benefit of adjuvant radiation following resection of any cSCC with negative surgical margins in unclear.” This meta-analysis aims to clear things up. Across 33 studies of over 3800 resected cSCC, while numerically better, there were no statistically significant improvements in cancer control rates without → with adjuvant radiation: local recurrence 15% → 9%, regional mets 12% → 4%, distant mets were 3% → 2%. Disease-specific deaths were 8% without RT v 20% with–alluding to the fact that most studies in the analysis were retrospective with the potential bias towards radiation in higher risk patients. | Kim, J Am Acad Dermatol 2021