Surgery plus radiotherapy no better than surgery alone in cutaneous squamous cell carcinoma

Poor outcomes are not significantly different in between patients with high-risk cutaneous squamous cell carcinomas treated with margin-negative resection only and those who underwent surgery with adjuvant radiotherapy, reveals a study.

This systematic review and meta-analysis examined the risk of poor outcomes in patients treated with surgery alone or surgery and adjuvant radiotherapy. The researchers did a comprehensive search of articles in PubMed, Embase, and the Cochrane Database. They then performed random-effects meta-analyses.

Thirty-three studies, including a total of 3,867 high-risk cutaneous squamous cell carcinomas, met the eligibility criteria. No statistically significant differences were seen in poor outcomes between the surgery-only group and surgery with adjuvant radiotherapy group.

Estimates for the surgery-alone group compared with the surgery with adjuvant radiotherapy group were as follows: 15.2 percent (95 percent confidence interval [CI], 6.3‒27) vs 8.8 percent (95 percent CI, 1.6‒20.9) for local recurrence; 11.5 percent (95 percent CI, 7.2‒16.7) vs 4.4 percent (95 percent CI, 0‒18) for regional metastases; 2.6 percent (95 percent CI, 0.6‒6) vs 1.7 percent (95 percent CI, 0.2‒4.5) for distant metastases; and 8.2 percent (95 percent CI, 1.2‒20.6) vs 19.7 percent (95 percent CI, 3.8‒43.7) for disease-specific deaths.

“Randomized controlled trials are necessary to define the benefit of adjuvant radiotherapy in this setting,” the authors said.

The study was limited by the retrospective nature of most included studies and the lack of sufficient patient-specific data.