title: Efficacy of elective nodal irradiation in skin squamous cell carcinoma of the face, ears, and scalp.
abstract: BACKGROUND
  In patients at high risk for regional node metastasis from squamous cell carcinoma (SCC) of the skin of the face, ear, or scalp, radiotherapy to the regional nodes is an alternative to parotid or neck surgery. Data on the efficacy of elective nodal radiotherapy in this setting are scarce such that there is no publication specifically addressing the subject. The purpose of our study is to fill this void in the skin cancer literature.
  
  
  METHODS
  This is a single-institution study of outcomes following elective nodal radiotherapy in 71 consecutively treated adults with SCC of the face, ears, or scalp. Primary site stage distribution per the American Joint Committee on Cancer, 7(th) Edition, was as follows: T1, 15 %; T2, 34 %; T3, 1 %; and T4, 50 %. Other disease characteristics included the following: clinical perineural invasion, 13 %; pathological perineural invasion, 78 %; recurrent disease, 32 %; and positive or close margin, 67 %. The median radiation dose to the first- and second-echelon nodal area was 50 Gy. Acute and late toxicity were graded per the Common Terminology Criteria for Adverse Events, version 4.0. Regional control was assessed using the Kaplan-Meier product limit method.
  
  
  RESULTS
  Median followup was 4.5 years for all patients. The actuarial regional control rate at 5 years was 96 %. There were no (0 %) grade 3 or higher complications from elective nodal irradiation.
  
  
  CONCLUSIONS
  Elective nodal irradiation in patients with high-risk SCC of the face, ears and scalp is safe and effective.
authors.affiliation: Department of Radiation Oncology, University of Florida, 2000 SW Archer Road, PO Box 100385, Gainesville, FL, USA. WRAYJU@shands.ufl.edu.
authors.forename: Justin
authors.initials: J
authors.lastname: Wray
authors.affiliation: Department of Radiation Oncology, University of Florida, 2000 SW Archer Road, PO Box 100385, Gainesville, FL, USA. amdurr@shands.ufl.edu.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Amdur
authors.affiliation: Department of Radiation Oncology, University of Florida, 2000 SW Archer Road, PO Box 100385, Gainesville, FL, USA. morrcm@shands.ufl.edu.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Morris
authors.affiliation: Department of Otolaryngology, University of Florida, Gainesville, FL, USA. John.Werning@ent.ufl.edu.
authors.forename: John
authors.initials: J
authors.lastname: Werning
authors.affiliation: Department of Radiation Oncology, University of Florida, 2000 SW Archer Road, PO Box 100385, Gainesville, FL, USA. mendwm@shands.ufl.edu.
authors.forename: William M
authors.initials: WM
authors.lastname: Mendenhall
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy*; D004428:Ear Neoplasms / Q000473:pathology / Q000532:radiotherapy; D005145:Face / Q000473:pathology; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008198:Lymph Nodes; D008207:Lymphatic Metastasis / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012535:Scalp / Q000473:pathology; D012878:Skin Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D000077195:Squamous Cell Carcinoma of Head and Neck