For marginal recurrences of skin cancers after prior hypofractionated radiation therapy (i.e., 30 Gy/5 fx, 55 Gy/20 fx) where there is concern for overlapping fields, could reirradiation with a hypofractionated course be considered?

For a marginal recurrence of a cutaneous malignancy after definitive hypofractionated RT, I would not necessarily offer reirradiation. I would have my plastic/dermatologic surgeon see the patient for consideration of surgical salvage, which may likely require an advanced reconstruction. If the patient refused or was not considered an appropriate surgical candidate, it would be reasonable to have the patient see medical oncology for consideration of immunotherapy (cemiplimab may be discussed). If no options work for the patient or the physicians, I would consider referring the patient to a center that offers orthovoltage therapy (we do not have that modality) for retreatment with as little overlap as possible.

As Dr. @Dr. First Last suggested, cut the failure out; likely it is small, so the cosmetic defect is likely minimal or could be reconstructed. Assess for further radiotherapy from that resection's pathology and consider adjuvant systemic therapy. The C-POST Trial, a phase 3, randomized, placebo-controlled study, might apply. It evaluated the use of adjuvant cemiplimab. It assessed 415 patients after surgery and adjuvant radiotherapy at risk for recurrence. It showed that adjuvant cemiplimab provided superior DFS, with only 12% of treated patients suffering relapse versus 32% of placebo-treated patients.

Its inclusion criteria were as follows:

High risk of recurrence was defined as at least one of the following features:

• Nodal Features:
  • Extra...