RADIOTHERAPY ALONE FOR SQUAMOUS-CELL CARCINOMA OF THE NASAL VESTIBULE- MANAGEMENT OF THE PRIMARY SITE AND REGIONAL LYMPHATICS

Purpose: To examine patterns of failures and complications in invasive squamous cell carcinoma of the nasal vestibule treated with radiother apy alone. Methods and Materials: Thirty-nine patients are reported wi th two-year minimum follow-up. Twenty-nine patients had tumors that we re previously untreated; 10 were recurrent after prior surgical resect ion. Twelve patients received external beam alone, 18 had external bea m followed by a radium implant, and nine had radium implant alone. Res ults: Local control in patients eligible for analysis was as follows: Tl, 11 of 13; T2, 6 of 6; and T4, 12 of 17 (1988 AJCC skin cancer stag ing classification). Previously untreated tumors and tumors recurrent after surgical excision alone had similar local control, stage for sta ge. Among T4 tumors, local control with radiotherapy was achieved in 1 1 of 13 lesions measuring <4 cm in diameter versus 1 of 4 of those mea suring greater-than-or-equal-to 4 cm. Of 37 patients with clinically n egative regional nodes at presentation, 32 were managed with observati on alone; of those eligible for 1-year minimum follow-up, 4 (15%) of 2 7 developed disease in the regional lymphatics. All regional node fail ures have been salvaged. In general, cosmesis was very good and compli cations were minimal. Conclusion: Radiotherapy in this series proved t o be an effective and cosmetically favorable alternative to surgery fo r nasal vestibule carcinoma. Elective treatment of the regional lympha tics is not warranted in early stage, previously untreated patients, b ut should be considered for selected advanced and recurrent lesions.