Abstract
BackgroundIn patients at high risk for regional node metastasis from squamous cell carcinoma (SCC) of the skin of the face, ear, or scalp, radiotherapy to the regional nodes is an alternative to parotid or neck surgery. Data on the efficacy of elective nodal radiotherapy in this setting are scarce such that there is no publication specifically addressing the subject. The purpose of our study is to fill this void in the skin cancer literature.MethodsThis is a single-institution study of outcomes following elective nodal radiotherapy in 71 consecutively treated adults with SCC of the face, ears, or scalp. Primary site stage distribution per the American Joint Committee on Cancer, 7th Edition, was as follows: T1, 15 %; T2, 34 %; T3, 1 %; and T4, 50 %. Other disease characteristics included the following: clinical perineural invasion, 13 %; pathological perineural invasion, 78 %; recurrent disease, 32 %; and positive or close margin, 67 %. The median radiation dose to the first- and second-echelon nodal area was 50 Gy. Acute and late toxicity were graded per the Common Terminology Criteria for Adverse Events, version 4.0. Regional control was assessed using the Kaplan-Meier product limit method.ResultsMedian followup was 4.5 years for all patients. The actuarial regional control rate at 5 years was 96 %. There were no (0 %) grade 3 or higher complications from elective nodal irradiation.ConclusionsElective nodal irradiation in patients with high-risk SCC of the face, ears and scalp is safe and effective.
Highlights
In patients at high risk for regional node metastasis from squamous cell carcinoma (SCC) of the skin of the face, ear, or scalp, radiotherapy to the regional nodes is an alternative to parotid or neck surgery
Major risk factors found at the primary site that predispose to nodal metastasis from squamous cell carcinoma (SCC) of the skin include the following: tumor diameter > 2 cm, tumor thickness > 5 mm, poor differentiation, tumor location within ear, age > 70 years, perineural invasion (PNI), history of recurrence, and immunosuppression [1, 2]
Under the approval of the University of Florida Institutional Review Board, we reviewed the medical records of 71 patients with SCC of the skin of the face, ears, or scalp treated at our institution with radiation therapy (RT) to the primary site and regional lymphatics between 1985 and 2012
Summary
In patients at high risk for regional node metastasis from squamous cell carcinoma (SCC) of the skin of the face, ear, or scalp, radiotherapy to the regional nodes is an alternative to parotid or neck surgery. Data on the efficacy of elective nodal radiotherapy in this setting are scarce such that there is no publication addressing the subject. Major risk factors found at the primary site that predispose to nodal metastasis from squamous cell carcinoma (SCC) of the skin include the following: tumor diameter > 2 cm, tumor thickness > 5 mm, poor differentiation, tumor location within ear, age > 70 years, perineural invasion (PNI), history of recurrence, and immunosuppression [1, 2]. An alternative to elective neck surgery is elective nodal irradiation (ENI) since many of the cancers in which neck management is indicated. The purpose of this study is to fill this void in the skin cancer literature
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