International Journal of Radiation Oncology*Biology*Physics
Clinical investigationRadiotherapy for locally advanced basal cell and squamous cell carcinomas of the skin
Introduction
Basal cell and squamous cell carcinomas constitute the largest group of cutaneous epithelial cancers. For decades, radiotherapy has been used successfully to treat these cancers with excellent results. However, with advancement in surgical techniques, the population of patients with these cancers treated by radiotherapy has changed. Today, patients with basal cell and squamous cell carcinomas are often referred for radiotherapy only when the tumors are advanced and the patient is not a surgical candidate. The typical patient treated with radiation is an elderly individual with locally advanced disease or nodal disease. The results of radiotherapy in treating these patients are not well described in the literature. The purpose of this study is to examine the outcomes in patients treated with radiotherapy for locally advanced squamous and basal cell carcinomas in the province of British Columbia.
Section snippets
Patients
The B.C. Cancer Agency (BCCA) is the only institution providing radiotherapy services in the Canadian province of British Columbia (population 4.5 million). A retrospective review of all patients treated with radical radiotherapy for squamous cell carcinoma or basal cell carcinoma from 1994 to 1998 in the BCCA was undertaken. Patients had histologically proven disease and must have had locally advanced disease by satisfying one of the following criteria: (1) T2 or above (tumor size > 2 cm or
Survival
There were no deaths attributable to basal cell carcinoma. Thirty-seven of the 121 patients with squamous cell carcinoma died of their cancer. The Kaplan-Meier estimate of disease-specific survival at 4 years for squamous cell carcinoma is 60% (Fig. 1). The population is very elderly, and deaths from other causes far outweigh deaths from cancer. The Kaplan-Meier estimates of overall survival at 4 years for patients with basal cell carcinomas and squamous cell carcinomas are 76% and 27%,
Discussion
The current publication is the largest series on patients treated with radiotherapy for more advanced epithelial skin cancers and provides valuable information on the outcomes of such patients who are more and more commonly seen in a modern day radiotherapy practice. Our series shows that basal cell carcinomas and squamous cell carcinomas have different clinical behaviors. Basal cell carcinomas recur late (median, 40 months in this report), do not spread to regional nodes even upon recurrence,
Conclusions
Basal cell carcinomas can be well controlled with radiotherapy even when locally advanced. Squamous cell carcinomas have a much poorer outcome and can recur quickly after radiotherapy. Locoregional failure remains the predominant cause of death in recurrent squamous cell carcinomas of the skin, and future efforts should be directed to improve the locoregional control rate in this group of patients.
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