title: Radical radiotherapy for T4 carcinoma of the skin of the head and neck: a multivariate analysis.
abstract: Sixty-seven patients with 68 stage T4 carcinomas of the skin of the head and neck were treated with radical radiotherapy at the University of Florida between October 1964 and November 1989. Thirty-three lesions were previously untreated and 35 were recurrent. Twenty-nine lesions were squamous cell carcinomas, 37 were basal cell carcinomas, and 2 were basosquamous carcinomas. Minimum follow-up was 2 years. The 5-year local control, local control including surgical salvage, and cause-specific survival probabilities were 53%, 74%, and 75%, respectively. Local control rates with radiotherapy alone were poorer in patients with recurrent lesions (41% vs. 67%, p = .07) or bone involvement (40% vs. 62%, p = .08). Results were analyzed by multivariate methods using local control, local control with surgical salvage, and cause-specific survival as endpoints. The parameters analyzed were histology; size of primary lesion; previous treatment (previously untreated vs. recurrent); involvement of bone, nerve, or cartilage; and skeletal muscle invasion. Three important prognostic factors were identified, each predictive of poorer ultimate local control and cause-specific survival rates: (a) bone involvement (p < .01); (b) recurrent lesions (p < .01); and (c) nerve involvement (p < .02). Radiotherapy alone can control advanced carcinomas of the skin of the head and neck, although lesions that have recurred after prior treatment and those with involvement of bone or nerve are associated with a lower likelihood of cure.
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, Gainesville.
authors.forename: W R
authors.initials: WR
authors.lastname: Lee
authors.forename: W M
authors.initials: WM
authors.lastname: Mendenhall
authors.forename: J T
authors.initials: JT
authors.lastname: Parsons
authors.forename: R R
authors.initials: RR
authors.lastname: Million
mesh_terms: D001918:Brachytherapy / Q000009:adverse effects; D002277:Carcinoma / Q000473:pathology* / Q000532:radiotherapy* / Q000556:secondary; D002280:Basal Cell Carcinoma / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy / Q000556:secondary; D003037:Cobalt Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D006801:Humans; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D009367:Neoplasm Staging; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D011882:Radiotherapy, High-Energy / Q000009:adverse effects; D011883:Radium / Q000009:adverse effects / Q000627:therapeutic use; D016879:Salvage Therapy; D012878:Skin Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D003037:Cobalt Radioisotopes; D011883:Radium