Radiation Therapy of Cutaneous Carcinomas: Indications in Specific Anatomic Regions

Abstract

Cutaneous carcinomas involving the nose and perinasal area are common; statistics from a large group of patients indicate that 20-25% of all facial cutaneous carcinomas occur in this anatomic region.' Several therapeutic modalities can be used effectively for these cancers. In our experience, the cosmetic and functional improvements following X-ray therapy of certain cancers of the nose are among the most gratifying results of dermatologic radiotherapy.Most dermatologists have seen poor cosmetic results after simple excision with primary side-to-side closure because this method may bring about asymmetrical changes in the overall contour of the nose. Curettage and electrodesiccation may also yield unsatisfactory results because the nose has a stronger tendency to develop unsightly depressed scars than other facial regions. Dermatologists who are aware of these therapeutic problems often refer patients with large cancers of the nose to plastic surgeons or to specially trained dermatologic surgeons for more extensive surgical procedures, including flaps, skin grafts, cryosurgery, or chemosurgery. There is no doubt that these procedures can yield excellent results in skilled hands. However, in a good number of patients with medium-sized tumors, radiotherapy offers a valuable alternative which should be considered, and discussed with the patient, before extensive surgical procedures are contemplated. Radiotherapy is especially useful in patients with medical problems that could interfere with surgery, in patients who refuse surgery, and in patients whose carcinomas have recurred following surgical treatment.Reprints are not available ARTICLE Compared with complicated surgical techniques, radiotherapy is relatively easy to administer and is not associated with any major discomfort during or after treatment. Patients do not require hospitalization or anesthesia, nor do they require sophisticated reconstructive procedures. Cosmetic results are often excellent, primarily because radiotherapy does not change the contour of the treated area and it preserves the normal surrounding Surgery often requires the removal of fairly large lateral and deep margins which can preclude a good cosmetic result.6 In radiotherapy the uninvolved margin can be as large as desired without significant cosmetic consequences; since carcinomas are more radiosensitive than normal tissue, only the tumor itself is eliminated and not the normal surrounding skin. Cosmetically disturbing radiation sequelae are uncommon in this anatomic region when proper radiation techniques are used. This was not the case several decades ago when carcinomas of the skin overlying nasal cartilages were treated with high doses of poorly fractionated and unnecessarily penetrating X rays. These obsolete radiation techniques sometimes resulted in painful chondritis or chondronecrosis and other undesirable sequelae. Modern radiotherapy with relatively soft X rays delivered in properly fractionated doses has reduced these problems to a minimum. Indications for Radiotherapy TYP...

Soft x-ray therapy for cutaneous basal cell and squamous cell carcinomas

“…Published cumulative 5 year recurrence rates for subgroups agree with our results. 23 Our findings confirm results of earlier studies: higher cure rates of BCCs compared with SCCs, 8,9,15,18,36 of previously untreated tumors compared with previously treated and recurrent ones, 8,9,15,23,[34][35][36] and of smaller malignancies or those with a lower T-class or stage. y Tumor thickness (half-value depth) and field size had a different influence on recurrences and ulcerations after treatment of BCCs compared with SCCs.…”

“…Moreover, biopsies may be useful for tumors with a larger subclinical extension, for example, fibrosing BCCs with a diameter greater than 20 mm 49 and SCCs with a diameter greater than 20 mm on the scalp, ears, eyelids, and lips. 50 Compared with other investigators, 8,17,25 our total doses are often higher. Does this result in a higher frequency of ulcerations in the irradiated fields during the follow up period?…”

“…Some authors use fractionation schedules with definite total doses; others vary the total dose. 8,9,32,34 The tumor regression under treatment 15 or the development of erythema 23 is taken into account. Some drawbacks of our approach have to be admitted; we cannot monitor the complete degeneration of the tumor under treatment with exact precision.…”

Basal cell carcinoma of the face: surgery or radiotherapy? Results of a randomized study

“…More relapses occurred with brachytherapy in our study (8.8% failure rate at 4 years) than published in the literature, in which failure rates are less than 5% (Daly et al, 1984;Pierquin et al, 1987;Mazeron et al, 1989;Crook et al, 1990 (Chahbazian and Brown, 1980;Goldsmith and Sherwin, 1983;Brady et al, 1987;Pierquin et al, 1987;Mazeron et al, 1989;Morrison et al, 1993;Fleming et al, 1995).…”

“…The other major residual abnormalities were, as expected, dyspigmentations and telangiectasia. The rate of good cosmetic results appears to be lower than those published, but comparison was difficult because of the wide range of published rates of good aesthetic results (60-93%) assessed by patients or physicians (Chahbazian and Brown, 1980;Goldsmith and Sherwin, 1983;Brady et al, 1987;Pierquin et al, 1987;Mazeron et al, 1989;Crook et al, 1990;Lovett et al, 1990;Silverman et al, 1992b). The deterioration of the cosmetic appearance with time with radiotherapy confirms the previous results of Silverman (1992b) and the small study of Cooper (1988).…”