Procedure
Radiation therapy (also known as radiotherapy) is used for skin cancer in the various stages of the disease, either as the sole therapy or together with surgery as post-operative treatment, to achieve a cure for the disease(curative radiotherapy). Radiotherapy focuses high-energy X-rays on the tumor or remaining tumor cells in order to kill them in a targeted manner.
Radiotherapy can also be used if the cancer has already spread: radiotherapy can then prevent or alleviate symptoms caused by metastases, e.g. in the bones(palliative radiotherapy).
Radiation therapy is performed as an outpatient treatment, is non-invasive (i.e. does not require anesthesia) and can thus be easily integrated into everyday private and professional life. However, fractionated treatment is usually necessary for skin cancer. This means that the total dose is divided into individual treatment sessions and the treatment is usually carried out over a period of 4-5 weeks. The individual treatment concept is determined according to the type of tumor, the stage of the tumor, whether radiation is given 2, 3 or 5 times a week, depending on the type and extent of the cancer and the patient’s general condition. Palliative treatment to alleviate symptoms/treat metastases, on the other hand, can be significantly shorter depending on the situation and may only extend over 1-10 sessions. Your doctor will discuss with you which regimen is most suitable for you. Close and personal support is a matter of course for us.
The Department of Radiation Oncology at the USZ uses only the most modern techniques for the precise irradiation of skin tumors with few side effects. Standard techniques in our clinic include intensity-modulated radiotherapy (IMRT) and the technical advancement VMAT (volumetric modulated arc therapy), “fast” high-energy electrons, high-dose-rate (HDR) brachytherapy, and image-guided adjustment and irradiation (IGRT). Your attending physician will inform you which options are possible in your case and advise you accordingly. They are supervised by internationally recognized experts in the research and treatment of skin cancer.
For many patients, we are already offering the treatment of tomorrow: in clinical trials, we are continuously working on improving the treatment of white skin cancer to make it even more effective and tolerable. To the overview of currently open studies.
Targeted and state-of-the-art radiation planning and treatment, such as with high-energy electrons or HDR brachytherapy, ensures that healthy tissue is very well protected. This enables us to minimize the side effects of treatment in these cases. In addition, we can also reach deeper tumor extensions with these methods, which is not possible with low-energy X-rays or superficial application of medication.
The individualized treatment of various skin tumors, based on histological and biological characteristics, is a research focus of PD Dr. Balermpas and the Clinics for Dermatology and Radiation Oncology at the USZ.
In the following, we will describe radiotherapy for the different types (histologies) and stages of non-melanomatous (“white”) skin cancer.
Postoperative treatment
In the case of localized white skin cancer, surgical removal of the tumour is always recommended. Depending on the extent of the tumor, the involvement of lymph nodes or nerves, as well as incomplete removal, there is a very high risk of recurrence despite successful surgery. In such cases, postoperative (“adjuvant”) radiotherapy helps to eliminate any remaining microscopic tumor remnants. This reduces the risk of relapse and improves the chances of recovery. In principle, basal cell carcinomas and spinocellular carcinomas are usually only irradiated postoperatively in the presence of high-risk nerve involvement. In contrast, postoperative radiotherapy is almost always recommended for the more aggressive Merkel cell carcinoma. Your attending physician will discuss with you whether post-operative radiotherapy is recommended in your case.
Primary, definitive treatment (without surgery) for localized, superficial tumours
If a localized white skin cancer cannot be operated on, surgery is too risky or is not desired, then direct, primary radiotherapy is the best alternative to surgery. In the case of basal cell carcinoma, for example, several studies have demonstrated the superiority of radiotherapy over other non-surgical procedures such as cryotherapy or Imiquimod. Both the tolerability and the cosmetic results of these smaller tumors are very good.
Primary, definitive treatment (without surgery) for locoregionally advanced or inoperable tumors
In the case of advanced tumors, surgery may not be technically feasible or would be associated with major restrictions in terms of cosmetics, function and quality of life. In these cases, and in order not to lose cosmetically and functionally important organs and structures such as eyes, ears and nerves, primary, definitive radiotherapy is the treatment of choice.
Metastases of white skin cancer, e.g. in the brain or bones
White skin cancer is an aggressive type of cancer that often forms metastases during the course of the disease: this is called metastasis. Common sites of metastasis are the lung, adrenal gland, bones, liver or brain. Radiotherapy is a highly effective method with few side effects to prevent or treat symptoms caused by metastases. This is usually done in combination with chemotherapy, immunotherapy or other targeted therapy. The smaller the metastases are and the earlier they are irradiated, the better the results. Today, metastases in the body can be treated in a focused manner in just a few effective radiation sessions.
For tumor foci in the abdominal area, e.g. liver or upper abdomen, we carry out body stereotactic radiotherapy (SBRT) on our MRI hybrid accelerator. State-of-the-art radiation technology is combined with MRI images. The radiation is thus carried out under MRI monitoring of the tumor, so that the highest precision is combined with the best imaging. Our clinic was the first in Switzerland to introduce this technology back in 2019. We are still the only clinic in German-speaking Switzerland to offer the highest level of expertise in this field.
Today, brain metastases are treated at our center in most patients by means of a single high-dose radiation treatment: this is called radiosurgery. Metastases at other locations in the body can now also be treated in a focused manner in just a few effective radiation sessions.
Metastatic white skin cancer is a clinical and scientific focus of our clinic. We pass on our knowledge in a large number of international courses and congresses. We are active as international experts in guideline commissions. State-of-the-art equipment and experienced medical physicists and MTRAs contribute to treatment of optimum quality and safety. At the same time, we work closely with our colleagues in medical oncology to guarantee “one-stop” treatment. We also consult with our colleagues in palliative medicine at an early stage.
In clinical trials, we are continuously trying to improve the treatment of white skin cancer in order to make it even more effective and tolerable. To the overview of currently open studies.
