title: Results of radiotherapy for epithelial skin cancer of the pinna: the Princess Margaret Hospital experience, 1982-1993.
abstract: OBJECTIVE
  To assess the treatment outcome, late toxicity, and prognostic factors for radiotherapy (RT) of carcinoma of the pinna.
  
  
  METHODS
  The charts of 313 patients treated between 01/82 and 12/93 were retrospectively reviewed. There were 334 lesions treated: 201 basal cell carcinoma (BCC), 122 squamous cell carcinoma (SCC), and 11 basosquamous carcinoma. RT was most commonly given by orthovoltage X-rays (278 lesions) or electrons (39 lesions). The most frequently used dose prescriptions were 35 Gy in 5 fractions (123 treatments with median field size = 4.9 cm(2)), 42. 5-45 Gy in 10 fractions (67 treatments with median field size = 10.5 cm(2)), and 50-65 Gy in 20-30 fractions (42 treatments with median field size = 81 cm(2)).2 cm. RESUL TS: The actuarial 2- and 5-year local control rates were 86.6% and 79.2 %. Multivariate analysis revealed two factors to be statistically signi ficant for increased local failure: tumor size > 2 cm (hazard ratio [HR] = 2.66, 95% confidence interval [CI] = 1.16-6.08), and a low biological effective dose (BED) (for each decrease of 5 BED units, HR = 1.76, 95% CI = 1.07-2.88). The 5-year actuarial rate of significant Grade 4 late toxicity was 7.3%. Factors statistically significant for this endpoint on univariate analysis were tumor size (p = 0.035), T-stage (p = 0.02), field size (p = 0.05), fraction size (p = 0.003), and BED (p = 0.05).
  
  
  CONCLUSIONS
  RT is an eff ctive treatment option for epithelial skin cancer of the pinna. Large t umor size and low BED were independently statistically significantly ass ociated with increased local failure. Dose-fractionation schedules usin g fraction sizes < 4 Gy may reduce the risk of necrosis and ulceration, particularly for field sizes > 5 cm2.
authors.affiliation: Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. silvaj@mskcc.org
authors.forename: J J
authors.initials: JJ
authors.lastname: Silva
authors.forename: R W
authors.initials: RW
authors.lastname: Tsang
authors.forename: T
authors.initials: T
authors.lastname: Panzarella
authors.forename: W
authors.initials: W
authors.lastname: Levin
authors.forename: W
authors.initials: W
authors.lastname: Wells
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002280:Basal Cell Carcinoma / Q000532:radiotherapy*; D002281:Carcinoma, Basosquamous / Q000532:radiotherapy*; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D004428:Ear Neoplasms / Q000532:radiotherapy*; D004431:Ear, External; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000628:therapy; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016879:Salvage Therapy; D012878:Skin Neoplasms / Q000532:radiotherapy*