- Email: [email protected]
Basal cell carcinoma of the face: Surgery or radiotherapy? Results of a randomized study (1)
Workshop W12. Radiotherapy for skin diseases
i WI2
4
Radiotherapy of benign and premalignant skin diseases
Renato G. Panizzon. CHUV-Luusanne, Switzerland In the first part the good results of radiotherapy, especially with Grenz rays in chronic eczemas, and psoriasis of the scalp and nails are shown. Excellent results are also achieved in keloids if radiotherapy starts immediately after surgery. In the second part the results in premalignant skin lesions, such as disseminated actinic keratoses, Bowen’s disease (97% cure rate) or lentigo maligna (99% cure rate) are shown. WI 2-5
Radiotherapy of extensive basal and squamous cell carcinomas of the skin
M. Caccialanza. Department of Photoradiotherapy. Institute of Dernlatological Sciences, University of Milan, Ospedale Maggiore IRCCS, Italy Radiotherapy often represents the only true therapeutic choice in extensive primitive malignant epithelial neoplasms of the skin, especially for patients who, because either of age (mean age in our series: 76.66 years) or of general conditions, can not undergo surgery. Objective of the study was to state the effectiveness and the safety of radiotherapy. We report the updated results of our experience obtained in 15 years and based on a retrospective study of a series of 163 patients treated by means of orthovoltage radiotherapy. The total dose of ionizing radiations administered ranged from 55 to 70 Gy. The mean follow-up was 29.72 months. The five-year cure-rate after the end of radiotherapy was 78.5%. The cosmetic results have been evaluated as good or acceptable in 88.7% of cases. Such results. obtained in a group of patients hard to treat with other techniques, support the choice of radiotherapy.
1W12-6
1 Basal cell carcinoma of the face: Surgery or radiotherapy? Results of a randomized study (1)
M.F. Avril’, A. AupCrin’, A. Margulis’, D. Chassagne’, M. Prade’, A. Gerbaulet’, R. Chalon’, J. Bouzy’, J.C. Guillaume2, H. Sancho-Gamie?, P. Duvillard’, J.Y. Petit4, E. Benhamou’. ‘Institut Gustave-Roussy, wllejlrif; 2Hopital Pasteur; Cohar; jEpidaure, Montpellier; France: 41nstitut Eump6en d’oncologie, Milan, Italie Methods: This randomized study was performed between 1982 and 1998. Inclusion criteria were: presence of a previously untreated basal cell carcinoma (BCC) of the face, confirmed by biopsy, with largest diameter ~4 mm, absence of contraindication to surgery or radiotherapy. Surgical treatment consisted in resection of the tumour with a 2 mm free margin. At surgeon’s request immediate pathological examination of frozen sections could be performed, and followed, in case of incomplete excision, by additional resections. Three radiation techniques could be used: interstitial brachytherapy, superficial contactherapy, conventional radiotherapy. Follow up visist were planned until the 41h year after treatment. Assessment criteria were persistance or recurrence of the tumor, and cosmetic results assessed by three different methods.
S‘ll
Results: 360 patients (pts) were enrolled in the trial. 13 pts were not treated (6 in surgical group, 7 in radiation group). 347 pts were analysed within allocated treatment group. Sex ratio was 1. Mean age was 66 years (s.d. = 12) Mean largest diameter was 11 mm.. 7% of BCC’s had a largest diameter ~-20 mm. In the surgical group, local anesthesia was used in 123 pts. Frozen section examinations were performed in 158 cases. Wound closure was obtained by direct surures (48%), or flaps (46%). Among pts in the radiotherapy group, 95 pts were treated with interstitial brachytherapy (doses 57-76 Gy), 57 pts with contactherapy (34-40 gy), 20 with conventionnal radiotherapy (60 gy). Mean follow up duration was 41 months. One pt had a recurrence in the surgical group, 11 pts had progression or recurrence in the radiation group. At 4 years, pts assessed cosmetic result as good for 87% in the surgical group, and in 69% after radiotherapy. Conclusion: surgery is recommanded as first line treatment of previously untreated BCC of the face. Radiotherapy is efficient with a 92.5% cure rate at 4 years, and should be proposed for pts in whom surgery is contraindicated. References [l] Br J Cancer 1997.76: 100-106. W12-7
Soft X-ray therapy of basal and squamous cell carcinomas of the skin
L. Suter, E.M. Hermsteiner, G. Bramkamp, C. Breitkopf, A. Lippold, V. Jasnoch, K.W. Schulte, H.J. Elsmann. Fachklinik Homheide Miinstec Germany In order to define the place of soft x-ray therapy in the spectrum of current treatments of skin tumors, exact follow-up studies of larger collectives of patients are necessary. 1988-90 we have treated 676 basal cell carcinomas and 147 squamous cell carcinomas of the skin with soft x-rays. A surface dose of 5 Gy (for larger fields: 3.5 Gy) was applied 3-6 times weekly. The total surface dose depended on the visible and palpable tumor involution under treatment: it was 50-70 Gy for most basal cell carcinomas and 60-70 Gy for most squamous cell carcinomas. Follow-up information was obtained after 5 years for 94% of the basal cell carcinomas and 96% of the squamous cell carcinomas. For 74% of the patients this information had to be collected by letters and phone calls because these patients did not attend the follow-up examinations in our clinic. Within 5 years 4.4% of the basal cell carcinomas and 5.4% of the squamous cell carcinomas recurred. The results were not worse for larger tumors (field size >4 cm). Radio ulcera were found in 6.7% of the roentgenoderms. Conclusions: Our treatment schedule which applies higher total doses than recommended by other authors achieve-s tumor control for a high percentage of basal and squamous cell carcinomas irrespective of their size. The collection of follow-up data for quality control requires a substantial amount of extra work.
i WI2
4
Radiotherapy of benign and premalignant skin diseases
Renato G. Panizzon. CHUV-Luusanne, Switzerland In the first part the good results of radiotherapy, especially with Grenz rays in chronic eczemas, and psoriasis of the scalp and nails are shown. Excellent results are also achieved in keloids if radiotherapy starts immediately after surgery. In the second part the results in premalignant skin lesions, such as disseminated actinic keratoses, Bowen’s disease (97% cure rate) or lentigo maligna (99% cure rate) are shown. WI 2-5
Radiotherapy of extensive basal and squamous cell carcinomas of the skin
M. Caccialanza. Department of Photoradiotherapy. Institute of Dernlatological Sciences, University of Milan, Ospedale Maggiore IRCCS, Italy Radiotherapy often represents the only true therapeutic choice in extensive primitive malignant epithelial neoplasms of the skin, especially for patients who, because either of age (mean age in our series: 76.66 years) or of general conditions, can not undergo surgery. Objective of the study was to state the effectiveness and the safety of radiotherapy. We report the updated results of our experience obtained in 15 years and based on a retrospective study of a series of 163 patients treated by means of orthovoltage radiotherapy. The total dose of ionizing radiations administered ranged from 55 to 70 Gy. The mean follow-up was 29.72 months. The five-year cure-rate after the end of radiotherapy was 78.5%. The cosmetic results have been evaluated as good or acceptable in 88.7% of cases. Such results. obtained in a group of patients hard to treat with other techniques, support the choice of radiotherapy.
1W12-6
1 Basal cell carcinoma of the face: Surgery or radiotherapy? Results of a randomized study (1)
M.F. Avril’, A. AupCrin’, A. Margulis’, D. Chassagne’, M. Prade’, A. Gerbaulet’, R. Chalon’, J. Bouzy’, J.C. Guillaume2, H. Sancho-Gamie?, P. Duvillard’, J.Y. Petit4, E. Benhamou’. ‘Institut Gustave-Roussy, wllejlrif; 2Hopital Pasteur; Cohar; jEpidaure, Montpellier; France: 41nstitut Eump6en d’oncologie, Milan, Italie Methods: This randomized study was performed between 1982 and 1998. Inclusion criteria were: presence of a previously untreated basal cell carcinoma (BCC) of the face, confirmed by biopsy, with largest diameter ~4 mm, absence of contraindication to surgery or radiotherapy. Surgical treatment consisted in resection of the tumour with a 2 mm free margin. At surgeon’s request immediate pathological examination of frozen sections could be performed, and followed, in case of incomplete excision, by additional resections. Three radiation techniques could be used: interstitial brachytherapy, superficial contactherapy, conventional radiotherapy. Follow up visist were planned until the 41h year after treatment. Assessment criteria were persistance or recurrence of the tumor, and cosmetic results assessed by three different methods.
S‘ll
Results: 360 patients (pts) were enrolled in the trial. 13 pts were not treated (6 in surgical group, 7 in radiation group). 347 pts were analysed within allocated treatment group. Sex ratio was 1. Mean age was 66 years (s.d. = 12) Mean largest diameter was 11 mm.. 7% of BCC’s had a largest diameter ~-20 mm. In the surgical group, local anesthesia was used in 123 pts. Frozen section examinations were performed in 158 cases. Wound closure was obtained by direct surures (48%), or flaps (46%). Among pts in the radiotherapy group, 95 pts were treated with interstitial brachytherapy (doses 57-76 Gy), 57 pts with contactherapy (34-40 gy), 20 with conventionnal radiotherapy (60 gy). Mean follow up duration was 41 months. One pt had a recurrence in the surgical group, 11 pts had progression or recurrence in the radiation group. At 4 years, pts assessed cosmetic result as good for 87% in the surgical group, and in 69% after radiotherapy. Conclusion: surgery is recommanded as first line treatment of previously untreated BCC of the face. Radiotherapy is efficient with a 92.5% cure rate at 4 years, and should be proposed for pts in whom surgery is contraindicated. References [l] Br J Cancer 1997.76: 100-106. W12-7
Soft X-ray therapy of basal and squamous cell carcinomas of the skin
L. Suter, E.M. Hermsteiner, G. Bramkamp, C. Breitkopf, A. Lippold, V. Jasnoch, K.W. Schulte, H.J. Elsmann. Fachklinik Homheide Miinstec Germany In order to define the place of soft x-ray therapy in the spectrum of current treatments of skin tumors, exact follow-up studies of larger collectives of patients are necessary. 1988-90 we have treated 676 basal cell carcinomas and 147 squamous cell carcinomas of the skin with soft x-rays. A surface dose of 5 Gy (for larger fields: 3.5 Gy) was applied 3-6 times weekly. The total surface dose depended on the visible and palpable tumor involution under treatment: it was 50-70 Gy for most basal cell carcinomas and 60-70 Gy for most squamous cell carcinomas. Follow-up information was obtained after 5 years for 94% of the basal cell carcinomas and 96% of the squamous cell carcinomas. For 74% of the patients this information had to be collected by letters and phone calls because these patients did not attend the follow-up examinations in our clinic. Within 5 years 4.4% of the basal cell carcinomas and 5.4% of the squamous cell carcinomas recurred. The results were not worse for larger tumors (field size >4 cm). Radio ulcera were found in 6.7% of the roentgenoderms. Conclusions: Our treatment schedule which applies higher total doses than recommended by other authors achieve-s tumor control for a high percentage of basal and squamous cell carcinomas irrespective of their size. The collection of follow-up data for quality control requires a substantial amount of extra work.