The SCC-AFTER research study aims to find out whether it is better to use radiotherapy or not to prevent high-risk skin cancer from coming back after it has been removed by surgery

Plain English summary of protocol

Background and study aims
Some squamous cell cancers are called ‘high-risk’, meaning that there is a higher chance that they could come back after surgery compared to other skin cancers. Around 3 out of 10 people with high-risk skin cancer may experience their cancer coming back within 3 years of the surgery. Radiotherapy (x-ray treatment) is sometimes given to people with high-risk skin cancer after surgery to try and reduce the chances of the cancer coming back. This is called ‘post-operative’ or ‘adjuvant radiotherapy’. It is given to the area of the skin where the cancer was removed. It works by using X-rays to destroy any cancer cells that might be left behind in that area. However, there is no certainty that radiotherapy does stop high-risk skin cancers from coming back. The alternative to radiotherapy is to start a close clinical follow-up to monitor if the skin cancer shows signs of coming back and to treat it if it does. This study aims to find out whether using radiotherapy in people who have had high-risk squamous cell cancer removed by surgery reduces the chances of their skin cancer coming back, or whether radiotherapy is not necessary and only close clinical follow-up is required. The study will also find out what impact it has on quality of life.

Who can participate?
People aged 18 years old and over who have had this type of high-risk skin cancer removed with surgery

What does the study involve?
The study will have two groups of patients:
Radiotherapy and close clinical follow-up:
• Will receive treatment with radiotherapy every weekday for 2-6 weeks, starting within 4 months of the surgery that removed the cancer.
• Will be followed up closely for 3 years to see if the skin cancer shows signs of returning.
• Will be unlikely to have radiotherapy again in the future if the skin cancer does return to the same place.

Close clinical follow-up:
• Will be followed up closely for 3 years to see if the skin cancer shows signs of returning.
• May be able to have radiotherapy in the future if the skin cancer does return to the same place.

There is a linked study that wants to find out more about how patients feel about taking part in the trial. It will involve somebody asking patients questions about their experience and these will be recorded.

What are the possible benefits and risks of participating?
Possible benefits of Radiotherapy followed by close clinical follow-up:
• Radiotherapy may lower the risk of a patient's cancer coming back.

Possible benefits of Close clinical follow-up:
• Patients will not need to attend for daily radiotherapy or experience the side effects that may come with radiotherapy.
• Radiotherapy has not been proven to lower the risk of a patient's cancer coming back.
• Patients may be able to have radiotherapy at a later date if their cancer does come back.

Possible risks of Radiotherapy followed by close clinical follow-up:
• Radiotherapy has not been proven to lower the risk of a patient's cancer coming back.
• Patients would not be able to have further radiotherapy in the same area if the cancer comes back in the same place and would therefore need different treatment.
• Radiotherapy is generally very well tolerated, however, there are possible short-term and long-term side effects from radiotherapy:
Short term: Skin redness, irritation, itching, flaking, peeling, scaling and dryness in the treatment area. The skin may scab over or break down in the treatment area. General tiredness during the treatment period. Some side effects can be specific, such as potential interactions with other medicines a patient may take or with a pacemaker. This may affect the radiotherapy. These will be discussed with the medical team.
Long-term: Permanent skin texture changes in the treatment area are possible and include thicker or thinner skin, skin colour change and rarely a more long-term non-healing ulcer that may require further treatment such as dressings or surgery. If radiotherapy is given to an area on the body where hair grows such as the scalp, it can sometimes cause permanent hair loss.

Possible risks of Close clinical follow-up:
• The cancer may come back even though a patient has had surgery and may require further treatment, such as surgery or radiotherapy.

Where is the study run from?
The study is being co-ordinated by the Centre for Trials Research on behalf of Cardiff University.

When is the study starting and how long is it expected to run for?
January 2024 to January 2031

Who is funding the study?
National Institute for Health and Care Research (NIHR)

Who is the main contact?
SCCAFTER@cardiff.ac.uk

Contact information

Ms Ann White
Public, Scientific

Centre for Trials Research (CTR) – Cancer Group
College of Biomedical & Life Sciences
Cardiff University
6th Floor, Neuadd Meirionnydd
Heath Park
Cardiff
CF14 4YS
United Kingdom

ORCID ID	0000-0001-7317-6304
Phone	+44 (0)2920687465
Email	SCCAFTER@cardiff.ac.uk

Prof Catherine Harwood
Principal investigator

The Royal London Hospital
Barts Health NHS Trust
London
E1 1BB
United Kingdom

ORCID ID	0000-0002-1375-0965
Phone	+44 (0)20 7882 2332
Email	SCCAFTER@cardiff.ac.uk

Prof Agata Rembielak
Principal investigator

The Christie NHS Foundation Trust
Wilmslow Road
Manchester
M20 4BX
United Kingdom

ORCID ID	0000-0003-2351-7179
Phone	+44 (0)161 446 8583
Email	SCCAFTER@cardiff.ac.uk

Study information

Eligibility

Locations

Countries of recruitment

• United Kingdom
• England
• Northern Ireland
• Scotland
• Wales

Study participating centres

Results and Publications

Study outputs

Additional files

45567_PROTOCOL_V1.1_18Mar24.pdf

Protocol

Editorial Notes

11/11/2025: Study participating centres added.
23/05/2025: Trial participating centres were added.
12/12/2024: Kings Mill Hospital was added as a study participating centre.
05/06/2024: Study's existence confirmed by Health Research Authority (HRA) (UK).