Head and neck non-melanoma skin cancer treated by superficial x-ray therapy: An analysis of 1021 cases

Daniel Grossi Marconi, Bruno Da Costa Resende, Erick Rauber, Paula De Cassia Soares, Jose Maria Fernandes, Niraj Mehta, Andre Lopes Carvalho, Patrick A. Kupelian, Allen Chen

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12 Scopus citations

Abstract

Introduction: To report a single-institutional experience with the use of Superficial X-Ray Therapy (SXRT) for head and neck non-melanoma skin cancer (N-MSC) and to compare outcomes by prescribed fractionation schedules. Materials and Methods: The medical records of 597 patients with 1021 lesions (720 BCC, 242 SCC, 59 SCC in situ) treated with kilovoltage radiation from 1979-2013 were retrospectively reviewed. The majority of patients were treated according to 1 of 3 institutional protocols based on the discretion of the radiation oncologist: 1) 22 x 2.5 Gy; 2) 20 x 2.5 Gy; 3) 30 x 2.0 Gy. "T" stage at first presentation was as follows: Tis (59); T1 (765); T2 (175); T3 (6), T4 (9); Tx, (7). All patients were clinical N0 and M0 at presentation. Chi-square test was used to evaluate any potential association between variables. The Kaplan-Meier method was used to analyze survival with the Log Rank test used for comparison. A Cox Regression analysis was performed for multivariate analysis. Results: The median follow up was 44 months. No significant difference was observed among the 3 prescribed fractionation schemes (p = 0.78) in terms of RTOG toxicity. There were no failures among SCC in situ, 37 local failures (23 BCC, 14 SCC), 5 regional failures (all SCC) and 2 distant failures (both SCC). For BCC, the 5-year LC was 96% and the 10-year LC was 94%. For SCC the corresponding rates of local control were 92% and 87%, respectively (p = 0.03). The use of >2.0 Gy daily was significantly associated with improved LC on multivariate analysis (HR: 0.17; CI 95%: 0.05-0.59). Conclusion: SXRT for N-MSC of the head and neck is well tolerated, achieves excellent local control, and should continue to be recommended in the management of this disease. Fractionation schedules using >2.0 Gy daily appear to be associated with improved LC.

Original languageEnglish (US)
Article numbere0156544
JournalPLoS One
Volume11
Issue number7
DOIs
StatePublished - Jul 1 2016
Externally publishedYes

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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    Marconi, D. G., Da Costa Resende, B., Rauber, E., De Cassia Soares, P., Fernandes, J. M., Mehta, N., Carvalho, A. L., Kupelian, P. A., & Chen, A. (2016). Head and neck non-melanoma skin cancer treated by superficial x-ray therapy: An analysis of 1021 cases. PLoS One, 11(7), [e0156544]. https://doi.org/10.1371/journal.pone.0156544