Do you ever recommend concurrent chemotherapy for high risk squamous cell skin cancer radiation?

Yes.

The dose of radiation depends on the treatment scenario (adjuvant vs definitive). I generally follow NCCN guidelines, and give the same dose whether or not chemo is given. For bulky tumors, I might use a higher radiation dose if no chemotherapy is given. In general, the radiation dose is relatively similar to the doses used for mucosal SCC of head and neck.

Use and choice of chemotherapy is extrapolated from mucosal SCC of the head and neck and limited data from small studies.

In the adjuvant setting, the recently completed Trans-Tasman Radiation Oncology Group 05.01 study will help better define the appropriate use of concurrent chemotherapy during radiotherapy for cutaneous SCC. This study randomized patients with resected high ris...

We generally do not add platinum concurrent chemotherapy to radiotherapy for high-risk cutaneous squamous cell carcinoma off trial. Most patients are treated postoperatively. The TROG 05.01 randomized trial reported no significant difference in locoregional control, metastasis, or survival by adding weekly carboplatin (Porceddu et al., JCO 2018). However, the study had a better than predicted outcome in the radiotherapy alone arm and carboplatin was used instead of cisplatin, either or both of which may have narrowed differences between arms. Current NCCN guidelines list adding carboplatin or cisplatin as category 3 (there is major disagreement that doing so is appropriate).

Among younger patients with good performance status and locally-adv...