Radiotherapy alone for clinical T4 skin carcinoma of the head and neck with surgery reserved for salvage

Purpose: To evaluate the outcomes of definitive radiotherapy in the treatme nt of clinical stage T4 cutaneous carcinomas of the head and neck. Patients and Methods. Between October 1964 and September 1997, 85 patients with 88 biopsy-proven clinical AJCC stage T4 carcinomas of the skin of the head and neck received radiotherapy with curative intent. A total of 43 les ions were previously untreated, and 45 were recurrent after other treatment modalities. Histologic types of carcinoma included squamous cell (37 lesio ns), basal cell (41 lesions), and metatypical basal (basosquamous) cell (10 lesions). Minimum follow-up was 2 years. The product-limit method was used to determine the rates of disease control, severe late complications, and survival. Multivariate analyses included histology, previous treatment, inv olvement of bone or nerve, number of structures invaded, node stage, extern al beam dose, and overall treatment time. Results: At 5 years, the rates of local control after radiotherapy and ulti mate local control after salvage surgery were 53% and 90%, respectively. Lo cal control rates were better for patients having previously untreated lesi ons (P = .05). Regional and ultimate regional control rates were 93% and 10 0%, respectively, and were better for previously untreated lesions (P < .01 ), basal cell histology or its metatypical variant (P = .04), and absence o f bone invasion (P = .08). At 5 years, the risk of severe late complication s was 17%, the risk of distant metastasis was 5%, and the overall absolute and cause-specific survival probabilities were 56% and 76%, respectively. Conclusion: Radiotherapy alone results in a relatively high probability of cure for selected patients with T4 skin cancers. Copyright (C) 2001 by W.B. Saunders Company.