Bobby N. Koneru

Objectives: To critically analyze the current evidence for the use of radiotherapy in the treatment of Peyronie Disease (PD). Methods: A systematic review of the literature was designed using the Population, Intervention, Comparator, Outcome, Timing and Study Design (PICOTS) framework and was assessed using Cochrane and PRISMA methodology. Eligible studies included prospective and retrospective studies published between January 1, 1970 and June 24, 2026. Clinical variant cases were developed as examples to illustrate practical applications of consensus recommendations. RAND-UCLA consensus methodology (modified Delphi) was used to rate the appropriateness of the treatment options. Results: Evidence to support the use of radiotherapy treatment of PD is limited by poor quality evidence, which is based on older studies, heterogenous patient cohorts, inconsistent radiation dose fractionation schedules, and lack of objective measurable outcomes and long-term follow-up. Data suggests that radiotherapy may result in faster resolution of pain for patients with acute-phase PD; however, this observation does not take into account the possibility that any improvement may be due to the natural disease course as some patients experience spontaneous symptom resolution. Radiotherapy is not useful in the treatment of erectile dysfunction or penile deformity or in chronic-phase PD. Conclusions: Current literature contains insufficient evidence to recommend the routine use of RT for the treatment of PD. RT for treatment of PD should not be considered outside of a clinical trial.

Objectives: To summarize the current evidence for low-dose radiation therapy (LDRT) in the treatment of inflammatory periarticular disorders (PAD) (tendinitis, enthesitis, fasciitides, and bursitis), including patient selection, optimal RT technique, and associated risks. Methods: A systematic literature review was designed using the Population, Intervention, Comparator, Outcome, Timing, and Study Design (PICOTS) framework and was assessed using the Cochrane and PRISMA methodologies. Eligible studies included prospective and retrospective studies published between January 1, 1996, and January 1, 2026. Clinical variant cases were developed as examples to illustrate practical applications of consensus recommendations. RAND-UCLA consensus methodology (modified Delphi) was used to rate the appropriateness of the treatment options. Results: LDRT is considered an appropriate treatment as a second-line treatment of chronic plantar fasciitis refractory to other therapies. LDRT may be an appropriate second-line treatment for other types of chronic, refractory PAD not associated with tendon full-thickness tears. LDRT is not usually appropriate as first-line treatment for early-stage PAD or in cases with complete tendon tears. Conclusions: The level of evidence to support the use of LDRT for the treatment of inflammatory PAD is limited. Based on the available evidence, LDRT may be considered for second-line treatment in appropriately selected patients.

Objectives: To summarize the evidence for adjuvant radiation therapy (RT) in the prevention of recurrent hypertrophic scars and keloids, including patient selection, optimal RT technique, and associated risks. Methods: This multi-specialty–led committee includes radiation oncology, plastic surgery, and dermatology physicians. Using the Population, Intervention, Comparator, Outcome, Timing, and Study Design (PICOTS) framework, evidence regarding treatment outcomes was assessed using Cochrane and PRISMA methodology. Eligible studies included prospective and retrospective studies published between January 1, 1980 and November 5, 2026, from the Ovid Medline database. Of the 165 articles identified using the search strategy, 87 were selected for inclusion as evidence, including 3 well-designed studies (phase II randomized and phase III), 23 moderately well-designed studies that account for most common biases (matched cohort and phase II studies), 50 studies with design limitations (retrospective reviews), 4 supplemental studies (not useful as primary evidence), and 7 meta-analyses. Eight additional studies were included to provide context and were not used to guide recommendations. Well-established RAND-UCLA consensus methodology (modified Delphi) was used to rate the appropriateness of the treatment options. Results: The results of this analysis demonstrate that RT is an effective and safe treatment strategy to reduce the risk of recurrent hypertrophic scars and keloids following surgery in appropriately selected patients. Conclusions: This systematic review provides consensus guidelines for the use of adjuvant RT for the prevention of recurrent hypertrophic scars/keloids based on the available peer-reviewed evidence in the literature.

Non-melanoma skin cancers (NMSCs), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are highly prevalent and a significant cause of morbidity. Image-guided superficial radiation therapy (IGSRT) uses integrated high-resolution dermal ultrasound to improve lesion visualization, but it is unknown whether efficacy varies by histology. This large retrospective cohort study was conducted to determine the effect of tumor histology on freedom from recurrence in 20,069 biopsy-proven NMSC lesions treated with IGSRT, including 9928 BCCs (49.5%), 5294 SCCs (26.4%), 4648 SCCIS cases (23.2%), and 199 lesions with ≥2 NMSCs (1.0%). Freedom from recurrence at 2, 4, and 6 years was 99.60%, 99.45%, and 99.45% in BCC; 99.58%, 99.49%, and 99.49% in SCC; and 99.96%, 99.80%, and 99.80% in SCCIS. Freedom from recurrence at 2, 4, and 6 years following IGSRT did not differ significantly comparing BCC vs. non-BCC or SCC vs. non-SCC but were slightly lower among SCCIS vs. non-SCCIS (p = 0.002). There were no significant differences in freedom from recurrence when stratifying lesions by histologic subtype. This study demonstrates that there is no significant effect of histology on freedom from recurrence in IGSRT-treated NMSC except in SCCIS. These findings support IGSRT as a first-line therapeutic option for NMSC regardless of histology.

Non-melanoma skin cancers (NMSCs), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are highly prevalent and a significant cause of morbidity. Image-guided su-perficial radiation therapy (IGSRT) uses integrated high-resolution dermal ultrasound to improve lesion visualization, but it is unknown whether efficacy varies by histology. This large retro-spective cohort study was conducted to determine the effect of tumor histology on freedom from recurrence in 20,069 biopsy-proven NMSC lesions treated with IGSRT, including 9,928 BCC (49.5%), 5,294 SCC (26.4%), 4,648 SCCIS (23.2%), and 199 lesions with ≥2 NMSCs (1.0%). Freedom from recurrence at 2, 4, and 6 years was 99.60%, 99.45%, and 99.45% in BCC; 99.58%, 99.49%, and 99.49% in SCC; and 99.96%, 99.80%, and 99.80% in SCCIS. Freedom from recurrence at 2, 4, and 6 years following IGSRT did not differ significantly comparing BCC vs. non-BCC or SCC vs. non-SCC but were slightly lower among SCCIS vs. non-SCCIS (p = 0.002). There were no significant differences in freedom from recurrence when stratifying lesions by histologic subtype. This study demonstrates that there is no significant effect of histology on freedom from recurrence in IGSRT-treated NMSC except in SSCIS. These findings support IGSRT as a first-line therapeutic option for NMSC regardless of histology.