title: The role of radiotherapy for T4 non-melanoma skin carcinoma.
abstract: BACKGROUND
  To review outcomes of patients treated with radiotherapy (RT) for T4 non-melanoma skin cancer (NMSC).
  
  
  METHODS
  A retrospective chart review was performed of 21 patients who received RT for T4 NMSC from 2004 to 2010. Outcomes of treatment efficacy, RT technique and patient morbidity were analysed. Twelve patients (57.1%) were treated definitively without prior treatment, five (23.8%) were recurrent lesions and four (19.1%) were treated postoperatively. Ten patients (47.6%) had evidence of bony erosion at presentation, and four (19.1%) had nodal disease. Intensity-modulated radiotherapy (IMRT), three-dimensional conformal RT and electron treatment were included RT techniques.
  
  
  RESULTS
  Median follow-up was 12 months (range, 5-48 months). Twelve patients (57.1%) following RT required no further treatment and had no disease recurrence. Three patients (14.3%) required salvage treatment and are disease-free following all treatment. Tumours treated initially or postoperatively had improved control rates following RT compared with recurrent lesions (58.3% and 100% vs. 20%). Sixty percent of patients treated with IMRT achieved local control following RT, and 80% were disease-free following surgical salvage treatment. Squamous cell carcinoma (SCC) histology, presence of bony erosion and/or nodal disease was associated with a higher incidence of disease recurrence.
  
  
  CONCLUSIONS
  Patients presenting with untreated lesions, smaller tumour volumes (<70 cm(3)) postoperatively, basal cell histology and absence of bone erosion or nodal disease have improved local control and outcomes. Basal cell carcinoma and SCC should be staged and treated as two separate disease entities. The use of IMRT for advanced skin cancer warrants further investigation.
authors.affiliation: Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA. chance-matthiesen@ouhsc.edu
authors.forename: Chance
authors.initials: C
authors.lastname: Matthiesen
authors.forename: J Spencer
authors.initials: JS
authors.lastname: Thompson
authors.forename: Christina
authors.initials: C
authors.lastname: Forest
authors.forename: Salahuddin
authors.initials: S
authors.lastname: Ahmad
authors.forename: Terence
authors.initials: T
authors.lastname: Herman
authors.forename: Carl
authors.initials: C
authors.lastname: Bogardus
mesh_terms: D002280:Basal Cell Carcinoma / Q000473:pathology / Q000532:radiotherapy*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011379:Prognosis; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D016896:Treatment Outcome