Predictors of Recurrence after Radiotherapy for Non-Melanoma Skin Cancer

Abstract

present study was to determine predictive factors for recurrence in patients treated with radiotherapy for nmsc. METHODSAt the Odette Cancer Centre multidisciplinary clinic, patients are jointly assessed by a dermatologist, a plastic surgeon, and a radiation oncologist. Patients receiving radiotherapy for bcc or scc between January 2007 and December 2011 were included in the study. Approval was obtained from the Sunnybrook Health Sciences Centre Research Ethics Board.The clinic's prospective database records patient and tumour factors at initial consultation and treatment outcomes at follow-up. Patient factors recorded include age; tumour size; site; pathology; and whether the disease is primary, recurrent, or treated postoperatively. Any immunosuppressantrelated predisposing conditions-including but not limited to chronic lymphocytic leukemia, solid organ transplantation, hiv infection, and lymphoma-are recorded. Treatment factors recorded include dose and fractionation, biologic equivalent dose in 2-Gy fractions (eqd 2 ), and treatment modality.Radiotherapy was delivered using orthovoltage X-rays, electrons, or megavoltage photons. Orthovoltage energies used were 100 kV, 180 kV, 250 kV, and 300 kV (dose prescribed at skin surface, with a focus-to-skin distance of 30 cm or 50 cm). Electron energies used included 6 MeV, 9 MeV, 12 MeV, 14 MeV, 15 MeV, and 18 MeV, with dose prescribed to 95%. Bolus was used to ensure a full skin dose. Photons were delivered in a 1-or 2-field technique, with intensity-modulated radiotherapy used in selected cases. The choice of treatment modality and energy depended on the tumour size, depth, and location. For tumours thicker than 1 cm or larger than 3 cm, electrons or photons were used. Clinical mark-up was used to define the gross tumour volume in most cases, with computed tomography planning reserved for deep-seated tumours. The treatment volume included ABSTRACTPredictive factors of recurrence were examined in 448 non-melanoma skin cancers (72% basal cell carcinoma, 28% squamous cell carcinoma) treated with radiotherapy. The overall recurrence rate was 15.8% at a median follow-up of 18.4 months. In multivariate analysis, significant factors for recurrence were age (p = 0.0197), tumour size 2 cm or greater (p = 0.0095), immunosuppression (p = 0.0082), and treatment modality (p = 0.0009).

Guidelines of care for the management of basal cell carcinoma

“…On the basis of the best available literature, the most useful stratification of BCC is provided by the National Comprehensive Cancer Network (NCCN) Guidelines (for recommendation, see Table II; for level of evidence/strength of recommendation, see Table III). 2,3,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] The NCCN stratification, listed in Table IV, takes both clinical and pathologic parameters into account and is based on a combination of available evidence and expert multidisciplinary opinion, including representatives from dermatology, dermatopathology, head and neck surgery, plastic surgery, and surgical, radiation, and medical oncology. Treatment recommendations throughout the current guidelines are based on this stratification.…”

“…When the clinician is submitting biopsy tissue for histopathologic diagnosis, the work group recommends that whenever possible and appropriate, key elements of patient demographics, clinical presentation, and clinical history should be provided to the pathologist (see Table VI; for level of evidence/ strength of recommendations, see Table III). These include patient age and biologic sex, [17][18][19][20][21][22][23][24][25] anatomic location, [17][18][19][20][22][23][24][25][26] and any history of treatment at the same anatomic site. 17,18,22,23 Additional desirable relevant information includes the clinical size of the lesion 17,18,[20][21][22][23][24][25][26] and whether the patient currently, or previously encountered additional risk factors, such as immunosuppression, radiation treatment, or solid organ transplantation.…”

“…17,18,22,23 Additional desirable relevant information includes the clinical size of the lesion 17,18,[20][21][22][23][24][25][26] and whether the patient currently, or previously encountered additional risk factors, such as immunosuppression, radiation treatment, or solid organ transplantation. 21,27 The pathology report provided to the clinician confirms the diagnosis of BCC and provides additional information to guide therapeutic decision making. Reporting of biopsy specimens may include relevant pathologic features that can help distinguish between low-and high-risk categories, especially histologic subtype.…”

Evaluation of Post Wide Excision Non-Melanoma Skin Cancer at DR Cipto Mangunkusumo Hospital in 2012-2015: Recurrence and Prognostic Factors

“…A cohort study of Margaret et al (2011) in the United States reporting the recurrence rate of 4.0%. 6 Study of Khan et al (2014) showed that age, tumor size, immune conditions, and modality of therapy were the affecting factors for the recurrence. Study of the National Comprehensive Cancer Network reporting tumor location and size, tumor boundary, previous cancer history, patient immunological status, perineural involvement, and tumor histopathology subtype were the predictors of recurrence.…”

“…Study of the National Comprehensive Cancer Network reporting tumor location and size, tumor boundary, previous cancer history, patient immunological status, perineural involvement, and tumor histopathology subtype were the predictors of recurrence. 6,9 Investigations on the affecting factors of the recurrence have been widely reported. In contrast, the recurrence rates and affecting factors in Indonesia have not been reported.…”