title: Head and Neck Non-Melanoma Skin Cancer Treated By Superficial X-Ray Therapy: An Analysis of 1021 Cases.
abstract: BACKGROUND
  To report a single-institutional experience with the use of Superficial X-Ray Therapy (SXRT) for head and neck non-melanoma skin cancer (N-MSC) and to compare outcomes by prescribed fractionation schedules.
  
  
  METHODS
  The medical records of 597 patients with 1021 lesions (720 BCC, 242 SCC, 59 SCC in situ) treated with kilovoltage radiation from 1979-2013 were retrospectively reviewed. The majority of patients were treated according to 1 of 3 institutional protocols based on the discretion of the radiation oncologist: 1) 22 x 2.5 Gy; 2) 20 x 2.5 Gy; 3) 30 x 2.0 Gy. "T" stage at first presentation was as follows: Tis (59); T1 (765); T2 (175); T3 (6), T4 (9); Tx, (7). All patients were clinical N0 and M0 at presentation. Chi-square test was used to evaluate any potential association between variables. The Kaplan-Meier method was used to analyze survival with the Log Rank test used for comparison. A Cox Regression analysis was performed for multivariate analysis.
  
  
  RESULTS
  The median follow up was 44 months. No significant difference was observed among the 3 prescribed fractionation schemes (p = 0.78) in terms of RTOG toxicity. There were no failures among SCC in situ, 37 local failures (23 BCC, 14 SCC), 5 regional failures (all SCC) and 2 distant failures (both SCC). For BCC, the 5-year LC was 96% and the 10-year LC was 94%. For SCC the corresponding rates of local control were 92% and 87%, respectively (p = 0.03). The use of >2.0 Gy daily was significantly associated with improved LC on multivariate analysis (HR: 0.17; CI 95%: 0.05-0.59).
  
  
  CONCLUSIONS
  SXRT for N-MSC of the head and neck is well tolerated, achieves excellent local control, and should continue to be recommended in the management of this disease. Fractionation schedules using >2.0 Gy daily appear to be associated with improved LC.
authors.affiliation: Barretos Cancer Hospital, Department of Radiation Oncology, Barretos, Brazil.
authors.forename: Daniel
authors.initials: D
authors.lastname: Grossi Marconi
authors.affiliation: Barretos Cancer Hospital, Department of Radiation Oncology, Barretos, Brazil.
authors.forename: Bruno
authors.initials: B
authors.lastname: da Costa Resende
authors.affiliation: Barretos Cancer Hospital, Department of Radiation Oncology, Barretos, Brazil.
authors.forename: Erick
authors.initials: E
authors.lastname: Rauber
authors.affiliation: Barretos Cancer Hospital, Department of Radiation Oncology, Barretos, Brazil.
authors.forename: Paula
authors.initials: P
authors.lastname: de Cassia Soares
authors.affiliation: Barretos Cancer Hospital, Department of Radiation Oncology, Barretos, Brazil.
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Fernandes
authors.affiliation: South Florida Radiation Oncology, Miami, Florida, United States of America.
authors.forename: Niraj
authors.initials: N
authors.lastname: Mehta
authors.affiliation: Barretos Cancer Hospital, Head and Neck Division, Barretos, Brazil.
authors.forename: Andre
authors.initials: A
authors.lastname: Lopes Carvalho
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California, United States of America.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Kupelian
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California, United States of America.
authors.forename: Allen
authors.initials: A
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D019583:Dose Fractionation, Radiation; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000532:radiotherapy*; D017211:Treatment Failure; D014964:X-Ray Therapy