Long-Term Recurrence Rate of Large and Difficult to Treat Cutaneous Squamous Cell Carcinomas after Superficial Radiotherapy

Abstract

Background: Surgical excision is the gold standard for cutaneous squamous cell carcinoma (cSCC), however its application is limited in specific cases. Superficial radiotherapy (RTx) is an alternative treatment option, but long-term follow-up data are limited. Objective: To determine the outcome of superficial RTx of cSCC in correlation to histological differentiation grade and tumor localization. Methods: The outcome of 180 large cSCCs after superficial RTx between 1960 and 2004 was retrospectively reviewed. Results: Mean tumor size was 3.5 cm² (SD 7.5) and mean follow-up period was 4.9 years (SD 4.7). Relapse-free survival was 95.8 and 80.4% after 1 and 10 years. Two-year relapse-free survival was 94.8% for good, 88.9% for moderate and 85.7% for poor differentiated tumors. Five-year relapse-free survival was highest in cSCCs located around the eyes (100%) and cheeks (90.9%). Conclusion: Superficial RTx is an effective alternative for cSCC if surgery is difficult due to localization or concomitant disease.

A programme of research to set priorities and reduce uncertainties for the prevention and treatment of skin disease

“…547,581,584 In one study, location in the ear and scalp region was found to be significantly associated with relapse of tumour compared with other sites (p = 0.025). 591 Age and tumour size were also significantly correlated with risk of relapse in this study (p = 0.012 and p < 0.0001, respectively), with a trend towards better outcome with well-differentiated tumours, although statistical significance was not reached (p = 0.1). Two studies (with 155 patients in total) assessed only nasal SCCs, with a pooled average local recurrence of 5.6% (95% CI 2.6% to 9.7%).…”

“…Regional lymph node failure was also reported in three studies (comprising 272 patients in total), 547,585,591 giving an average regional recurrence of 2.6% on pooled analysis (95% CI 0.04% to 8.9%; I 2 = 70%) ( Figure 41). In both larger studies, 585,591 which included patients with SCCs of the nose and at various sites, respectively, the mean duration of follow-up was between 2 and 5 years.…”

“…Interestingly, average regional recurrence was lower, although these data were generated from just two studies, 585,591 with other studies not specifying whether the recurrences they reported were local or regional failures, so the true significance of this is unclear. The lower local recurrence rates from the studies in which brachytherapy was used may be a reflection of the more superficial, lower risk nature of the included SCCs treated by this method, although patients numbers were generally small and limited follow-up of only a few months in some of the studies may be inadequate to detect later recurrences.…”

“…542,547,554,[581][582][583][584][585][586][587][588][589][590][591] Seven studies (comprising 761 patients) reported local recurrence after external radiotherapy, with pooled average local recurrence of 6.4% (95% CI 3.0% to 11.0%; I 2 = 76%) 542,547,581,582,584,585,591 (see Appendix 8 and Figure 40). Three studies were included in the sensitivity analysis, 582,585,591 with no significant effect on local recurrence (7.3%, 95% CI 2.1% to 15.4%; I 2 = 87%).…”

“…In both larger studies, 585,591 which included patients with SCCs of the nose and at various sites, respectively, the mean duration of follow-up was between 2 and 5 years. In the third study, there were only two eligible patients with SCC of the pinna, one of whom developed metastasis.…”