The role of adjuvant radiation following surgery with negative margins for high-risk cutaneous squamous cell carcinomas remains unknown. For a study, researchers sought to conduct a comprehensive review and meta-analysis to compare the risk of poor outcomes in individuals treated with surgery alone vs. surgery with adjuvant radiotherapy.

A systematic search of papers in PubMed, Embase, and the Cochrane Database was conducted. There were random-effect meta-analyses performed.

There were 33 studies totaling 3,867 high-risk cutaneous squamous cell carcinomas. There were no statistically significant differences in bad outcomes between the surgery-only and surgery-plus-adjuvant-radiotherapy groups. Estimates for local recurrence for the surgery alone group versus the surgery with adjuvant radiotherapy group were 15.2% (95% CI, 6.3% -27%) versus 8.8% (95% CI, 1.6% -20.9%); for regional metastases, 11.5% (95% CI, 7.2% -16.7%) versus 4.4% (95% CI, 0% -18%); and for distant metastases, 2.6% (95% CI, 0.6%-6%) versus 1.7% (95% CI, 0.2%-4.5%); and for disease-specific deaths, 8.2% (95% CI, 1.2%-20.6%) versus 19.7% (95% CI, 3.8%-43.7%), respectively.

There were no significant differences in bad outcomes between the surgery-only group and the surgery plus adjuvant radiation group for patients with high-risk cutaneous squamous cell carcinomas treated with margin-negative resection. To determine the effectiveness of adjuvant radiation in this scenario, randomized controlled studies are required.

Reference: jaad.org/article/S0190-9622(21)02952-2/fulltext