title: Radiotherapy alone for clinical T4 skin carcinoma of the head and neck with surgery reserved for salvage.
abstract: OBJECTIVE
  To evaluate the outcomes of definitive radiotherapy in the treatment of clinical stage T4 cutaneous carcinomas of the head and neck.
  
  
  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 lesions were previously untreated, and 45 were recurrent after other treatment modalities. Histologic types of carcinoma included squamous cell (37 lesions), 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, involvement of bone or nerve, number of structures invaded, node stage, external beam dose, and overall treatment time.
  
  
  RESULTS
  At 5 years, the rates of local control after radiotherapy and ultimate local control after salvage surgery were 53% and 90%, respectively. Local control rates were better for patients having previously untreated lesions (P =.05). Regional and ultimate regional control rates were 93% and 100%, respectively, and were better for previously untreated lesions (P <.01), basal cell histology or its metatypical variant (P =.04), and absence of bone invasion (P =.08). At 5 years, the risk of severe late complications was 17%, the risk of distant metastasis was 5%, and the overall absolute and cause-specific survival probabilities were 56% and 76%, respectively.
  
  
  CONCLUSIONS
  Radiotherapy alone results in a relatively high probability of cure for selected patients with T4 skin cancers.
authors.affiliation: Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA.
authors.forename: M O
authors.initials: MO
authors.lastname: Al-Othman
authors.forename: W M
authors.initials: WM
authors.lastname: Mendenhall
authors.forename: R J
authors.initials: RJ
authors.lastname: Amdur
mesh_terms: D000328:Adult; D000368:Aged; D002280:Basal Cell Carcinoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D016879:Salvage Therapy; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy* / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome