Department of Radiation Oncology, Princess Margaret Cancer Centre / University of Toronto, Toronto, Ontario, Canada.
Department of Otolaryngology-Head and Neck Surgery and Surgical Oncology, Princess Margaret Cancer Centre / University of Toronto, Toronto, Ontario, Canada.
Oral Oncol. 2017 Sep;72:157-164. doi: 10.1016/j.oraloncology.2017.07.018. Epub 2017 Jul 27.
The literature demonstrates that 'aggressive' head-and-neck basal cell carcinomas (HN-BCC) have a higher than expected relapse rate with unfavorable outcomes. We report outcomes following definitive (dRT) or post-operative radiotherapy (PORT) for these tumors.
We reviewed all HN-BCC patients with 'aggressive' features (primary lesions diameter >10mm, >2 recurrences, or extra-cutaneous extension), treated with megavoltage dRT or PORT between 1998 and 2013. Loco-regional control (LRC) and relapse-free survival (RFS) were estimated using the competing risk method, and overall survival (OS) by Kaplan-Meier method. Univariable analysis explored factors associated with relapse.
A total of 108 histologically confirmed 'aggressive' HN-BCC patients were identified, including 38 (35%) presenting de novo and 70 (65%) treated for recurrence (rBCC). dRT was offered to 72 (66.7%) patients and PORT to 36 (33.3%). Median follow-up was 3.5years. Actuarial 3-year LRC, RFS, and OS were 87% (95% confidence interval: 77-92), 82% (72-89), and 87% (80-94), respectively. LRC rates for dRT and PORT were similar [hazard ratio (HR) 0.61 (0.17-2.23), p=0.46]. Factors associated with higher risk of relapse were: rBCC [HR 7.96 (1.03-61.71), p=0.047], 'H-zone' (mid face, eyes, and ears) location [HR 3.13 (1.07-9.19), p=0.04], tumor size [HR 1.32 (1.08-1.6), p=0.006], nodal involvement [HR 3.68 (1.11-12.2), p=0.03] and stage [HR 3.13 (1.19-8.26), p=0.02].
RT is an effective treatment for 'aggressive' HN-BCC when used as a definitive modality or as PORT. Non-surgical management with definitive radiotherapy provides an alternative effective option if surgery is not used.
文献表明，具有“侵袭性”的头颈部基底细胞癌（HN-BCC）的复发率高于预期，且预后不良。我们报告了这些肿瘤采用根治性（dRT）或术后放疗（PORT）后的治疗结果。
我们回顾了 1998 年至 2013 年间，采用兆伏 dRT 或 PORT 治疗的直径>10mm、>2 次复发或皮肤外扩展等具有“侵袭性”特征的所有 HN-BCC 患者。采用竞争风险法估计局部区域控制（LRC）和无复发生存（RFS），采用 Kaplan-Meier 法估计总生存（OS）。单变量分析探讨了与复发相关的因素。
共确定了 108 例组织学证实的“侵袭性”HN-BCC 患者，其中 38 例（35%）为初发，70 例（65%）为复发（rBCC）。72 例（66.7%）患者接受了 dRT，36 例（33.3%）接受了 PORT。中位随访时间为 3.5 年。dRT 和 PORT 的 3 年 LRC、RFS 和 OS 分别为 87%（95%置信区间：77-92）、82%（72-89）和 87%（80-94）。dRT 和 PORT 的 LRC 率相似[风险比（HR）0.61（0.17-2.23），p=0.46]。与复发风险较高相关的因素为：rBCC[HR 7.96（1.03-61.71），p=0.047]、“H 区”（中面部、眼睛和耳朵）位置[HR 3.13（1.07-9.19），p=0.04]、肿瘤大小[HR 1.32（1.08-1.6），p=0.006]、淋巴结受累[HR 3.68（1.11-12.2），p=0.03]和分期[HR 3.13（1.19-8.26），p=0.02]。
当作为根治性治疗或作为 PORT 时，放疗是治疗“侵袭性”HN-BCC 的有效方法。如果不进行手术，根治性放疗的非手术治疗是一种有效的替代方法。
