Epithelian skin cancer
Efficacy of a hypofractionated schedule in electron beam radiotherapy for epithelial skin cancer: Analysis of 434 cases

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Abstract

Background and purpose

Efficacy of radiotherapy for epithelial skin cancer was evaluated and treatment outcomes of two electron beam fractionation schedules were compared.

Materials and methods

Outcome data of 434 epithelial skin cancers in 333 patients were analysed; 332 were basal cell carcinomas (BCCs) and 102 squamous cell carcinomas (SCCs). Patients were treated with electron beam, and received either 54 Gy in 18 fractions (n = 159) or 44 Gy in 10 fractions (n = 275). Local recurrence free (LRF) rates were analysed as well as metastases free rates, cancer specific survival (CSS) and cosmetic result.

Results

Median follow-up was 42.8 months. For BCC, actuarial 3-year LRF rates were 97.6% for tumours treated with 54 Gy and 96.9% for 44 Gy. In SCC 3-year LRF rates were 97.0% for 54 Gy and 93.6% for 44 Gy (n.s.).

T stage was found to be the only significant factor for recurrence (p = 0.036). Three-year CSS was 98% for SCC and 100% for BCC.

Conclusions

Electron beam irradiation is a safe and effective treatment modality for epithelial skin cancer. In view of a similar efficacy and patient convenience of the hypofractionated schedule, 44 Gy in 10 fractions can be regarded the radiation schedule of choice.

Section snippets

Patients

A total of 434 biopsy-proven epithelial skin tumours in 333 patients treated in our centre from January 2001 to December 2006 were retrospectively analysed. A total of 332 (76.5%) basal cell carcinomas and 102 (23.5%) squamous cell carcinomas were treated. Patients were referred for primary treatment after a biopsy (n = 386) or after surgical treatment in case of residual disease (n = 48). The median age of patients with BCC was 74.8 years (range 38.4–95.5 years), median age of patients with SCC was

Results

Median follow-up for patients alive was 42.8 months (range 1.4–87.6); 64.4 months (range 19.2–87.6) in the 54 Gy group and 31.9 months (1.4–71.9) in the 44 Gy group.

Discussion

In this large retrospective study two fractionation schedules (44 Gy in 10 fractions and 54 Gy in 18 fractions) for electron beam irradiation of epithelial skin cancer were evaluated. Both fractionation schedules were found to be effective. Actuarial 3-year local recurrence free rates were 97.5% and 96.1% for 54 and 44 Gy, respectively. Local control was similar for BCC and SCC. In the 44 Gy group LRF rate for SCC was slightly lower with 93.6% versus 96.9% for BCC, this difference was not

Conclusions

Electron beam irradiation is an excellent treatment modality for epithelial skin cancer, especially in cosmetically sensitive areas for which surgery is less favourable and for postoperative treatment in case of residual or recurrent disease. In view of a similar efficacy and the patient convenience of the hypofractionated schedule, 44 Gy in 10 fractions can be regarded optimal therapy for T1–T2 BCC and SCC.

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