Radiotherapy Treatment for Skin Cancer

Treatment Schedules

The National Comprehensive Cancer Network recommends ultra-hypofractionated regimens, such as 35 Gy in 5 fractions over 5 days, for small tumors (<2 cm) 1
The British Journal of Dermatology suggests moderately hypofractionated regimens, such as 50 Gy in 15 fractions over 3 weeks, for small tumors (<2 cm) 2
The British Journal of Dermatology also recommends standard hypofractionated regimens, such as 55 Gy in 20 fractions over 4 weeks, for small tumors (<2 cm) 2
Conventional fractionation regimens, such as 64 Gy in 32 fractions over 6-6.4 weeks, are also used for small tumors (<2 cm) 2
For larger tumors (≥2 cm), the British Journal of Dermatology recommends 55 Gy in 20 fractions over 4 weeks 2
The Annals of Oncology suggests 66 Gy in 33 fractions over 6-6.6 weeks for larger tumors (≥2 cm) 3

Each individual treatment session involves only brief radiation exposure, typically 1-5 minutes of actual beam-on time, though the entire appointment may take 15-30 minutes 1, 3
Protracted fractionation schedules are associated with improved cosmetic results compared to hypofractionated regimens, particularly in cosmetically sensitive areas like the face 1
For palliative treatment or cutaneous lymphomas, single fractions of 7-8 Gy can be effective and convenient, though they limit re-treatment options 2
Low-dose palliative regimens, such as 12 Gy in 3 fractions for symptomatic tumors, can be used for palliative treatment 4
Radiation therapy is generally reserved for patients over 60 years due to concerns about long-term sequelae in younger patients 5

The choice between hypofractionated and conventional fractionation should balance convenience (fewer sessions) against cosmetic outcomes (better with more fractions) and the patient's ability to attend daily treatments 1