title: Multimodality management of high-risk head and neck basal cell carcinoma requiring free-flap reconstruction.
abstract: OBJECTIVE
  (1) Investigate overall survival (OS) and disease-free survival (DFS) for high-risk head and neck basal cell carcinoma (HNBCC) requiring large extirpation with free-flap reconstruction. (2) Determine impact of prognostic features-tumor size, subsite, number of high-risk features, perineural invasion, and bony invasion-on high-risk HNBCC survival. (3) Determine survival benefit of adjuvant radiation for high-risk HNBCC.
  
  
  METHODS
  Case series with chart review (2002-2013).
  
  
  METHODS
  Academic tertiary care center.
  
  
  METHODS
  Consecutive head and neck patients (N = 431) required free-flap reconstruction following tumor extirpation, 38 for aggressive HNBCC. All cases were high risk. DFS and OS were examined using Kaplan-Meier analysis. Prognostic variables and adjuvant radiation were analyzed utilizing Student's t test for continuous variables and Fisher's exact testing for categorical dependent variables. Complications were reported.
  
  
  RESULTS
  Mean tumor diameter was 5.17 cm (range, 1.2-15.0 cm). Mean follow-up was 19.9 months. Overall 2-year survival was 80%, falling to 66% at 5 years. Two-year disease-free survival was 72%. Six patients recurred (n = 5 local, 1 distant). Adjuvant radiotherapy improved DFS (P < .01) but not OS (P = .66). Tumors >2.5 cm did not affect OS (P = .61), regardless of subsite. Bone involvement (44.7% cases) did not affect DFS (P = .39) or OS (P = .18).
  
  
  CONCLUSIONS
  Larger HNBCC warranting free tissue transfer do not confer worse outcomes, independent of subsite. Adjuvant radiotherapy does not improve OS but significantly affected DFS, allowing for 13.7 additional months of DFS. Bone involvement does not influence DFS or OS and should not preclude surgery, even in advanced cases requiring free-flap reconstruction.
authors: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alabama at Birmingham, Alabama, USA mbburch@uab.edu.
authors: M Benjamin
authors: MB
authors: Burch
authors: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alabama at Birmingham, Alabama, USA.
authors: Thomas K
authors: TK
authors: Chung
authors: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alabama at Birmingham, Alabama, USA.
authors: Eben L
authors: EL
authors: Rosenthal
authors: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alabama at Birmingham, Alabama, USA.
authors: Cecelia E
authors: CE
authors: Schmalbach
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*
keywords: basal cell carcinoma; free flap reconstruction; head and neck