Radiotherapy alone for squamous cell carcinoma of the nasal vestibule: Management of the primary site and regional lymphatics

Abstract

Purpose : To examine patterns of failures and complications in invasive squamous cell carcinoma of the nasal vestibule treated with radiotherapy alone. Methods and Materials : Thirty-nine patients are reported with two-year minimum follow-up. Twenty-nine patients had tumors that were previously untreated; 10 were recurrent after prior surgical resection. Twelve patients received external beam alone, 18 had external beam followed by a radium implant, and nine had radium implant alone. Results : Local control in patients eligible for analysis was as follows: Tl, 11 of 13; T2, 6 of 6; and T4, 12 of 17 (1988 AJCC skin cancer staging classification). Previously untreated tumors and tumors recurrent after surgical excision alone had similar local control, stage for stage. Among T4 tumors, local control with radiotherapy was achieved in 11 of 13 lesions measuring <4 cm in diameter versus 1 of 4 of those measuring ≥ 4 cm. Of 37 patients with clinically negative regional nodes at presentation, 32 were managed with observation alone; of those eligible for 1-year minimum follow-up, 4 (15%) of 27 developed disease in the regional lymphatics. All regional node failures have been salvaged. In general, cosmesis was very good and complications were minimal. Conclusion : Radiotherapy in this series proved to be an effective and cosmetically favorable alternative to surgery for nasal vestibule carcinoma. Elective treatment of the regional lymphatics is not warranted in early stage, previously untreated patients, but should be considered for selected advanced and recurrent lesions.