External beam radiotherapy for basal cell carcinoma. Local control and cosmetic outcome

Background: The basal cell, carcinoma which is often occurring in the elder ly can be well treated by surgery. For Large and recurrent Lesions and in c osmetically difficult Locations external beam radiotherapy provides an equa lly effective treatment alternative. Patients and Methods: From 1986 to 1999, 60 females and 39 males received p rimary radiotherapy for a total of 127 histologically verified basal cell c arcinoma Lesions. Tumors were mostly Localized in the face at the temple, n ose and forehead. Radiotherapy was applied with orthovoltage equipment and energies of up to 100 kV, Single doses ranged from 2 to 5 Gy related to the 80%-isodose depth. Weekly doses ranged from 8 to 25 Gy and total doses fro m 25 to 60 Gy. The mean follow-up period was 36 +/- 21 months. The acute se quelae were scored according to CTC criteria. Radiogenic Late effects as si ngle events were related to the radiation portal. Results: 3 months after treatment all besides one patient (99%) experienced complete tumor remission (CR). In all cases, acute radiation reaction occu rred within the radiation portal: CTC Grade 1 in 100%, CTC Grade 2 in 54% a nd CTC Grade 3 in 30% of the cases. ALL side effects regressed under simple Local measures without further complications. Late sequelae were observed in three cases. Overall cosmetic outcome was good to excellent in almost al l patients (98%). In two cases (2%) a Local recurrence was observed 6 and 2 0 months after radiotherapy. Conclusion: External beam (orthovoltage) radiotherapy is very effective and yields high tumor control rates and good cosmetic results in long-term fol low-up. Former dermatological treatment concepts should be replaced by an I CRU-based radiophysical dose prescription and should respect the newer radi obiological fractionation principles.