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Recurrent Basal Cell Carcinoma Treated With Radiation Therapy

Recurrent Basal Cell Carcinoma Treated With Radiation Therapy Abstract • A retrospective study was performed of 61 recurrent basal cell carcinomas treated with radiation therapy between 1974 and 1990 at the University of Arizona College of Medicine or at Southwestern Radiation Oncology, Tucson, Arizona. The median length of follow-up was 57 months. Applying the American Joint Committee on Cancer staging system to these recurrent tumors, 36 were stage I,19 were stage II, five were stage III, and one was stage IV. Kaplan-Meier methods were used to estimate the 5-year complete remission rates. The Mantel-Haenszel Test and the Cox Proportional Hazards Model were used to determine if tumor size, stage, histologic subtype, anatomic site, age, sex, dose, number of radiation therapy treatments, length of time over which the radiation therapy was administered, or type of radiation beam used (orthovoltage x-rays vs megavoltage electrons) affected the 5-year complete remission rates. Only tumor size and stage had a statistically significant effect on the complete remission rates. The Kaplan-Meier estimates of the 5-year complete remission rates for 0.5- to 1.0-cm tumors vs tumors larger than 1.0 cm were 96% (95% confidence interval, 88% to 100%) and 81% (95% confidence interval, 64% to 99%), respectively. The Kaplan-Meier estimates of the 5-year complete remission rates for stage I/II tumors vs stage III/IV tumors were 93% (95% confidence interval, 85% to 100%) and 42% (95% confidence interval, 8% to 84%), respectively. Functional and cosmetic results were frequently good to excellent at 5 years. Soft-tissue necrosis developed in two of 61 cases, and was successfully managed in both. This article, combined with a review of the literature, suggests that radiation therapy is an effective method of treating recurrent basal cell carcinomas. (Arch Dermatol. 1991;127:1668-1672) References 1. MacDonald EJ, Bubendorf E. Some epidemiologic aspects of skin cancer . In: Cumley RW, McCay J, Aldridge D, et al, eds. Tumors of the Skin . St Louis, Mo: Mosby—Year Book; 1964:23-65. 2. Silverberg E, Lubera JA. Cancer statistics . CA . 1989;39:3-20. 3. Rowe DE, Carroll RJ, Day CL Jr. Long-term recurrence rates in previously untreated (primary) basal cell carcinoma: implications for patient follow-up . J Dermatol Surg Oncol . 1989;15:315-328.Crossref 4. Rowe DE, Carroll RJ, Day CL Jr. Mohs surgery is the treatment of choice for recurrent (previously treated) basal cell carcinoma . J Dermatol Surg Oncol . 1989;15:424-431.Crossref 5. Ward GE, Hendrick JW. Malignant epithelial tumors of the skin of the head and neck . Am J Surg . 1950;79:771-786.Crossref 6. Freeman RG, Duncan WC. Recurrent skin cancer . Arch Dermatol . 1973;107:395-399.Crossref 7. Dellan AL. Histologic study of recurrent basal cell carcinoma . Plast Reconstr Surg . 1985;75:853-859.Crossref 8. Swanson NA, Grekin RC, Baker SR. Mohs surgery: techniques, indications and applications in head and neck surgery . Head Neck Surg . 1983;6:683-692.Crossref 9. Cotran RS. Metastasizing basal cell carcinoma . Cancer . 1961;14:1036-1040.Crossref 10. Wermuth BM, Fajardo LF. Metastatic basal cell carcinoma . Arch Pathol . 1970;90:458-462. 11. Menn H, Robins P, Kopf AW, Bart RS. The recurrent basal cell epithelioma: a study of 100 cases of recurrent, re-treated basal cell epitheliomas . Arch Dermatol . 1961;103:628-631.Crossref 12. Sakura CY, Calamel PM. Comparison of treatment modalities for recurrent basal cell carcinoma . Plast Reconstr Surg . 1979;63:492-495.Crossref 13. Thackray AC. Histological classification of rodent ulcers and its bearing on their prognosis . Br J Cancer . 1951;5:213-224.Crossref 14. Cobb GM, Thompson GA, Allt WEC. Treatment of basal cell carcinoma of the eyelids by radiotherapy . Can Med Assoc J . 1964;91:743-748. 15. Rank B. Surgery and skin cancer . Ann R Coll Surg Engl. 1973;52:148-164. 16. Dubin N, Kopf A. Multivariate risk score for recurrence of cutaneous basal cell carcinoma . Arch Dermatol . 1983;119:373-377.Crossref 17. Lovett RD, Perez CA, Shapiro SJ, Garcia DM. External irradiation of epithelial skin cancer . Int J Radiat Oncol Biol Phys. 1990;19:235-242.Crossref 18. Mendenhall WM, Parsons JT, Mendenhall NP, Million RR. T2-T4 carcinoma of the skin of the head and neck treated with radical irradiation . Int J Radiat Oncol Biol Phys. 1987;13:975-981.Crossref 19. Lawless JF. Statistical Models and Methods for Lifetime Data . New York, NY: John Wiley & Sons Inc; 1982. 20. Fitzpatrick PJ. Skin cancer of the head: treatment by radiotherapy . J Otolaryngol. 1984;13:261-266. 21. Petrovich Z, Parker RG, Luxton G, Kuisk H, Jepson J. Carcinoma of the lip and selected sites of head and neck skin: a clinical study of 896 patients . Radiother Oncol . 1987;8:11-17.Crossref 22. Anderson NP, Anderson HE. Development of basal cell epithelioma as a consequence of radiodermatitis . Arch Dermatol Syphilol . 1951;63:586-596.Crossref 23. Cornelius CE III. Bone: a site of metastatic basal cell carcinoma . Arch Surg . 1972;104:848-850.Crossref 24. Metcalf PB Jr. Carcinoma of the pinna . N Engl J Med. 1954;251:91-95.Crossref 25. Fredericks S. External ear malignancy . Br J Plast Surg. 1956;9:136-160.Crossref 26. Schewe EJ Jr, Pappalardo C. Cancer of the external ear . Am J Surg. 1962;104:753-755.Crossref 27. Petrovich Z, Kuisk H, Langholz B, et al. Treatment of carcinoma of the skin with bone and/or cartilage involvement . Am J Clin Oncol. 1988;11:110-113.Crossref 28. Avila J, Bosch A, Aristizabal S, Frias Z, Marcial VC. Carcinoma of the pinna . Cancer . 1977;40:2891-2895.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Recurrent Basal Cell Carcinoma Treated With Radiation Therapy

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1991.01680100068006
Publisher site
See Article on Publisher Site

Abstract

Abstract • A retrospective study was performed of 61 recurrent basal cell carcinomas treated with radiation therapy between 1974 and 1990 at the University of Arizona College of Medicine or at Southwestern Radiation Oncology, Tucson, Arizona. The median length of follow-up was 57 months. Applying the American Joint Committee on Cancer staging system to these recurrent tumors, 36 were stage I,19 were stage II, five were stage III, and one was stage IV. Kaplan-Meier methods were used to estimate the 5-year complete remission rates. The Mantel-Haenszel Test and the Cox Proportional Hazards Model were used to determine if tumor size, stage, histologic subtype, anatomic site, age, sex, dose, number of radiation therapy treatments, length of time over which the radiation therapy was administered, or type of radiation beam used (orthovoltage x-rays vs megavoltage electrons) affected the 5-year complete remission rates. Only tumor size and stage had a statistically significant effect on the complete remission rates. The Kaplan-Meier estimates of the 5-year complete remission rates for 0.5- to 1.0-cm tumors vs tumors larger than 1.0 cm were 96% (95% confidence interval, 88% to 100%) and 81% (95% confidence interval, 64% to 99%), respectively. The Kaplan-Meier estimates of the 5-year complete remission rates for stage I/II tumors vs stage III/IV tumors were 93% (95% confidence interval, 85% to 100%) and 42% (95% confidence interval, 8% to 84%), respectively. Functional and cosmetic results were frequently good to excellent at 5 years. Soft-tissue necrosis developed in two of 61 cases, and was successfully managed in both. This article, combined with a review of the literature, suggests that radiation therapy is an effective method of treating recurrent basal cell carcinomas. (Arch Dermatol. 1991;127:1668-1672) References 1. MacDonald EJ, Bubendorf E. Some epidemiologic aspects of skin cancer . In: Cumley RW, McCay J, Aldridge D, et al, eds. Tumors of the Skin . St Louis, Mo: Mosby—Year Book; 1964:23-65. 2. Silverberg E, Lubera JA. Cancer statistics . CA . 1989;39:3-20. 3. Rowe DE, Carroll RJ, Day CL Jr. Long-term recurrence rates in previously untreated (primary) basal cell carcinoma: implications for patient follow-up . J Dermatol Surg Oncol . 1989;15:315-328.Crossref 4. Rowe DE, Carroll RJ, Day CL Jr. Mohs surgery is the treatment of choice for recurrent (previously treated) basal cell carcinoma . J Dermatol Surg Oncol . 1989;15:424-431.Crossref 5. Ward GE, Hendrick JW. Malignant epithelial tumors of the skin of the head and neck . Am J Surg . 1950;79:771-786.Crossref 6. Freeman RG, Duncan WC. Recurrent skin cancer . Arch Dermatol . 1973;107:395-399.Crossref 7. Dellan AL. Histologic study of recurrent basal cell carcinoma . Plast Reconstr Surg . 1985;75:853-859.Crossref 8. Swanson NA, Grekin RC, Baker SR. Mohs surgery: techniques, indications and applications in head and neck surgery . Head Neck Surg . 1983;6:683-692.Crossref 9. Cotran RS. Metastasizing basal cell carcinoma . Cancer . 1961;14:1036-1040.Crossref 10. Wermuth BM, Fajardo LF. Metastatic basal cell carcinoma . Arch Pathol . 1970;90:458-462. 11. Menn H, Robins P, Kopf AW, Bart RS. The recurrent basal cell epithelioma: a study of 100 cases of recurrent, re-treated basal cell epitheliomas . Arch Dermatol . 1961;103:628-631.Crossref 12. Sakura CY, Calamel PM. Comparison of treatment modalities for recurrent basal cell carcinoma . Plast Reconstr Surg . 1979;63:492-495.Crossref 13. Thackray AC. Histological classification of rodent ulcers and its bearing on their prognosis . Br J Cancer . 1951;5:213-224.Crossref 14. Cobb GM, Thompson GA, Allt WEC. Treatment of basal cell carcinoma of the eyelids by radiotherapy . Can Med Assoc J . 1964;91:743-748. 15. Rank B. Surgery and skin cancer . Ann R Coll Surg Engl. 1973;52:148-164. 16. Dubin N, Kopf A. Multivariate risk score for recurrence of cutaneous basal cell carcinoma . Arch Dermatol . 1983;119:373-377.Crossref 17. Lovett RD, Perez CA, Shapiro SJ, Garcia DM. External irradiation of epithelial skin cancer . Int J Radiat Oncol Biol Phys. 1990;19:235-242.Crossref 18. Mendenhall WM, Parsons JT, Mendenhall NP, Million RR. T2-T4 carcinoma of the skin of the head and neck treated with radical irradiation . Int J Radiat Oncol Biol Phys. 1987;13:975-981.Crossref 19. Lawless JF. Statistical Models and Methods for Lifetime Data . New York, NY: John Wiley & Sons Inc; 1982. 20. Fitzpatrick PJ. Skin cancer of the head: treatment by radiotherapy . J Otolaryngol. 1984;13:261-266. 21. Petrovich Z, Parker RG, Luxton G, Kuisk H, Jepson J. Carcinoma of the lip and selected sites of head and neck skin: a clinical study of 896 patients . Radiother Oncol . 1987;8:11-17.Crossref 22. Anderson NP, Anderson HE. Development of basal cell epithelioma as a consequence of radiodermatitis . Arch Dermatol Syphilol . 1951;63:586-596.Crossref 23. Cornelius CE III. Bone: a site of metastatic basal cell carcinoma . Arch Surg . 1972;104:848-850.Crossref 24. Metcalf PB Jr. Carcinoma of the pinna . N Engl J Med. 1954;251:91-95.Crossref 25. Fredericks S. External ear malignancy . Br J Plast Surg. 1956;9:136-160.Crossref 26. Schewe EJ Jr, Pappalardo C. Cancer of the external ear . Am J Surg. 1962;104:753-755.Crossref 27. Petrovich Z, Kuisk H, Langholz B, et al. Treatment of carcinoma of the skin with bone and/or cartilage involvement . Am J Clin Oncol. 1988;11:110-113.Crossref 28. Avila J, Bosch A, Aristizabal S, Frias Z, Marcial VC. Carcinoma of the pinna . Cancer . 1977;40:2891-2895.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Nov 1, 1991

References