title: Surgery and adjuvant radiotherapy in patients with cutaneous head and neck squamous cell carcinoma metastatic to lymph nodes: combined treatment should be considered best practice.
abstract: OBJECTIVE
  Patients with cutaneous squamous cell carcinoma (SCC) may develop metastatic SCC to nodes in the head and neck. Recent data support best outcome with the addition of adjuvant radiotherapy. This study aims to present further supportive evidence.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Patients were identified with metastatic cutaneous SCC to nodes of the head and neck treated with surgery or surgery and adjuvant radiotherapy. Relapse and outcome were analyzed using Cox regression analysis. Disease-free survival and overall survival rates were calculated using Kaplan-Meier survival curves.
  
  
  RESULTS
  Between 1980 to 2000, 167 patients were treated with curative intent at Westmead Hospital, Sydney. Median age was 67 years (range, 34-95) in 143 men and 24 women with a minimum follow-up of 24 months. Patients underwent surgery (21/167; 13%), or surgery and adjuvant radiotherapy (146/167; 87%). The majority (98/167; 59%) of metastatic nodes were located in the parotid and/or cervical nodes. The remaining 69 (41%) had metastatic cervical nodes (levels I-V). Forty-seven patients (28%) had recurrences, with the majority (35/47; 74%) as locoregional failures. On multivariate analysis, spread to multiple nodes and single-modality treatment significantly predicted worse survival. Patients undergoing combined treatment had a lower rate of locoregional recurrence (20% vs. 43%) and a significantly better 5-year disease-free survival rate (73% vs. 54%; P = .004) compared to surgery alone.
  
  
  CONCLUSIONS
  In patients with metastatic cutaneous head and neck SCC, surgery and adjuvant radiotherapy provide the best chance of achieving locoregional control and should be considered best practice.
authors.affiliation: Head and Neck Cancer Service, Westmead Hospital, University of Sydney, Sydney, Australia. michael.radonc.wsahs.nsw.gov.au
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Veness
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Morgan
authors.forename: Carsten E
authors.initials: CE
authors.lastname: Palme
authors.forename: Val
authors.initials: V
authors.lastname: Gebski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006257:Head; D006801:Humans; D015182:Lymphatic Irradiation / Q000379:methods; D008207:Lymphatic Metastasis / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009333:Neck; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant / Q000379:methods*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D015996:Survival Rate