Recurrence Rates of Treated Basal Cell Carcinomas: Part 4: X‐Ray Therapy

Abstract

This is the fourth report in a series that reviews the experience in the Skin and Cancer Unit, from 1955 through 1982, with the treatment of basal cell carcinomas (BCCs). It concerns 862 primary (previously untreated) BCCs irradiated by a "standardized" x-ray therapy schedule. The overall 5-year recurrence rate for these lesions, as determined by the modified life-table method, was 7.4%. This rate was not significantly different from that experienced with 211 recurrent (previously treated) BCCs with a re-recurrence rate of 9.5% (P = .552). For the primary BCCs, multivariate analysis showed that increasing BCC diameter was the only independent risk factor for high recurrence rates (P = .003). The patient's age or sex, the duration of the BCC, the anatomic site of the BCC, or time-span treated (1955-1963, 1964-1972, 1973-1982) did not significantly affect the recurrence rate. Additional analysis showed that BCCs on the head less than 10 mm in diameter had a 5-year recurrence rate of 4.4% whereas those 10 mm or greater in diameter had a rate of 9.5%. Lastly, the proportion of recurrence-free treatment sites with a good or excellent long-term cosmetic outcome after x-ray therapy (63%) was lower than previous reports in this series with curettage-electrodesiccation (91%) and surgical excision (84%). Thus, if the long-term cosmetic outcome after treatment is not an overriding concern to the patient, x-ray therapy is an effective modality for many primary and recurrent BCCs.

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

“…The overall cure rate after X-ray therapy was consistent with published results, which range from 90% to 98% (Nevrkla and Newton, 1974;Orton, 1978, Reymann, 1980Dubin and Kopf, 1983;Fitzpatrick et al, 1984;Brady et al, 1987;Petrovich et al, 1987;Ashby et al, 1989;Mazeron et al, 1989;Rowe et al, 1989;Lovett et al, 1990;Wilder et al, 1991;Silverman et al, 1992b). More relapses occurred with brachytherapy in our study (8.8% failure rate at 4 years) than published in the literature, in which failure rates are less than 5% (Daly et al, 1984;Pierquin et al, 1987;Mazeron et al, 1989;Crook et al, 1990 (Chahbazian and Brown, 1980;Goldsmith and Sherwin, 1983;Brady et al, 1987;Pierquin et al, 1987;Mazeron et al, 1989;Morrison et al, 1993;Fleming et al, 1995).…”

“…The rate of good cosmetic results appears to be lower than those published, but comparison was difficult because of the wide range of published rates of good aesthetic results (60-93%) assessed by patients or physicians (Chahbazian and Brown, 1980;Goldsmith and Sherwin, 1983;Brady et al, 1987;Pierquin et al, 1987;Mazeron et al, 1989;Crook et al, 1990;Lovett et al, 1990;Silverman et al, 1992b). The deterioration of the cosmetic appearance with time with radiotherapy confirms the previous results of Silverman (1992b) and the small study of Cooper (1988). This is the first randomized trial of previously untreated BCC comparing surgery and radiotherapy.…”

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.…”

“…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.…”