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

Abstract

Summary Basal cell carcinomas (BCCs) are very frequent cutaneous cancers, often located on the face. Cure rates with surgery and radiotherapy are high, but these treatments have never been compared prospectively. A randomized trial was initiated in 1982 to compare surgery and radiotherapy in the treatment of primary BCC of the face measuring less than 4 cm. The primary end point was the failure rate (persistent or recurrent disease) after 4 years of follow-up. The secondary end point was the cosmetic results assessed by the patient, the dermatologist and three persons not involved in the trial. In the course of the trial, 347 patients were treated. Of the 174 patients in the surgery group, 71% had local anaesthesia and 91% frozen section examination. Of the 173 patients in the radiotherapy group, 55% were treated with interstitial brachytherapy, 33% with contactherapy and 12% with conventional radiotherapy. The 4-year actuarial failure rate (95% Cl) was 0.7% (0.1-3.9%) in the surgery group compared with 7.5% (4.2-13.1%) in the radiotherapy group (log-rank P= 0.003). The cosmetic results assessed by four of the five judges were significantly better after surgery than after radiotherapy. Eighty-seven per cent of the surgery-treated patients and 69% of the radiation-treated patients considered the cosmetic result as good (P < 0.01). Thus, in the treatment of BCC of the face of less than 4 cm in diameter, surgery should be preferred to radiotherapy.

Guidelines of care for the management of basal cell carcinoma

“…3 Multiple RCTs comparing standard surgical excision of BCC with topical medical therapy, C&E, photodynamic therapy (PDT), cryotherapy, radiation therapy, and MMS have been published. 32,[34][35][36][37][38][39] All the studies consistently reported low recurrence rates after standard excision of BCC with predominantly nonaggressive histologic growth patterns. Excision of nodular or superficial BCC with 3-to 4-mm margins in low-risk anatomic locations was associated with 2% to 4% recurrence rates after 3 to 5 years.…”

“…24,34,46,62,88,100,101 Several different types of radiotherapy can be used to treat BCC, including superficial radiation therapy, isotope-based brachytherapy (interstitial or topical contact), and external electron beam radiation. Primary or adjuvant radiation is an effective treatment option for selected patients with BCC, resulting in good tumor control and cosmesis, with the understanding that cure rates may be lower.…”

“…Primary or adjuvant radiation is an effective treatment option for selected patients with BCC, resulting in good tumor control and cosmesis, with the understanding that cure rates may be lower. 23,34,46,62,88,100,101 One RCT demonstrated that in terms of long-term cosmesis, surgery is superior to radiotherapy for primary BCCs of the face smaller than 4 cm. 34 The radiation technique is modified depending on the site, size, shape, and depth of the tumor.…”

“…23,34,46,62,88,100,101 One RCT demonstrated that in terms of long-term cosmesis, surgery is superior to radiotherapy for primary BCCs of the face smaller than 4 cm. 34 The radiation technique is modified depending on the site, size, shape, and depth of the tumor. Superficial radiation therapy uses rays that are more energetic than Grenz rays but less so than orthovoltage external beam radiation.…”

Current Advances in the Treatment of Basal Cell Carcinoma

“…Radyoterapi uygulanan hastalarda sık karşılaşılan komplikasyonlar uygulanan alana bağlı olarak göz kuruluğu, xerostomi, alopesi, hiperpigmentasyon ve cilt nekrozu olarak sıralanabilir [33][34][35][36] .…”