Results of Radiotherapy of Skin Cancer, with Special Emphasis on Treatment Failure

Abstract

It is well known that of all carcinomas treated by radiation, skin cancer is the most easily controlled, and the cure rate in general is excellent. Because both the tumor and the surrounding normal tissues are easily observed, a number of papers dealing with optimal time-dose relationships have appeared (1–3, 8), and other reports have dealt with particular problems in radiotherapy (4–7). Some of these papers have referred to special difficulties at sites with underlying cartilage which are not easily related to time-dose relationship studies so far published. The experience of The Roswell Park Memorial Institute has been reported by Traenk1e and Mu1ay (9, 10) and Murphy (4). Traenk1e's reports compare the late radiation damage observed after massive-dose short-period treatment with that following more fractionated schedules, while Murphy covers the problems encountered in the radiotherapy of skin cancer in its entirety. For the past fifteen years, patients with skin cancer submitted for radiotherapy have been treated by one of three rather fixed schedules based upon a previous study and experience at this Institute. With this in mind, this study was designed to determine which, if any, of the schedules produced a better result, as well as to present the treatment results in general. Special attention has been devoted to the analysis of those cases in which treatment resulted in failure or in unusual radiation damage to normal skin. Material A number of excellent methods are available for management of carcinoma of the skin. Because all of these produce excellent results in good hands, the treatment of choice for the individua11esion should be based upon technical simplicity and cosmetic result as well as curability. Needless to say, this does not imply that the first two criteria should be given so much weight as to reduce cure rates. At Roswell Park Memorial Institute early basal-cell carcinomas have been managed e1ectrosurgically because of the simplicity and speed of the procedure. It has been amply demonstrated that this type of management should be limited to lesions measuring less than 1 cm2 and that ill-defined lesions or those situated on the nose, nasolabial fold, or postauricular area generally should not be treated in this manner. Wide, local surgical excision has also been used in this Institute, especially for lesions involving the extremities, the scalp, forehead, neck, and external ear. The chemosurgical technic of Mohs (3a) has been used quite extensively in recent years for cases uncontrolled by other methods, or initially in tumors with exceptionally ill-defined borders. Because of the above policies, the clinical material managed by radiation has tended to be limited to the face. This report is based on 1,059 histologically proved carcinomas of the skin treated with radiation at Roswell Park Memorial Institute between Jan. 1, 19,51, and Dec. 31, 1960.