Beydoun Nadine, Graham Peter H, Browne Lois
Department of Radiation Oncology, St George Hospital, Kogarah, New South Wales, Australia.
University of New South Wales, Sydney, New South Wales, Australia.
World J Oncol. 2012 Oct;3(5):217-226. doi: 10.4021/wjon503w. Epub 2012 Oct 28.
Nodal metastasis from cutaneous SCC carries a high morbidity and mortality. Limited direct evidence is available as to the impact of radiotherapy on the outcome of patients with metastatic axillary SCC. The purpose of this study was to report on the outcomes of patients with metastatic cutaneous SCC to the axilla treated with radiotherapy.
A retrospective review of patients treated with radiotherapy between 1993 and 2010 for metastatic cutaneous SCC to the axilla was undertaken at St George Hospital, Sydney.
Radiotherapy was administered to 36 patients, 30 with curative intent (4 definitive, 26 adjuvant) and 6 with palliative intent, 27/36 (75%) were male, 22/36 (61%) had a previous diagnosis of cutaneous SCC, and 1/36 (3%) was immunosuppressed. Mean age was 74.6 years. Mean radiotherapy dose (BEDGy10) was 61Gy (range 39-85 Gy), 20/36 (56%) patients experienced recurrence, including 16 local failures and 4 isolated distant failures. Median survival for the curative and palliative groups was 3 years and 1 month, respectively. Relapse free survival (n = 36) at 2 and 5 years was 46% and 35%, respectively (curative 52% and 39%). Only 1 failure achieved complete salvage.
Despite current best practice (surgery and radiotherapy), the predominant pattern of failure in these patients with metastatic axillary cSCC was locoregional. The difficulty in successfully salvaging patients after locoregional nodal relapse suggests a need for treatment intensification.
皮肤鳞状细胞癌的淋巴结转移具有较高的发病率和死亡率。关于放疗对转移性腋窝皮肤鳞状细胞癌患者预后的影响，目前可获得的直接证据有限。本研究的目的是报告接受放疗的转移性腋窝皮肤鳞状细胞癌患者的预后情况。
对1993年至2010年间在悉尼圣乔治医院接受放疗的转移性腋窝皮肤鳞状细胞癌患者进行回顾性研究。
36例患者接受了放疗，其中30例有治愈意图（4例根治性，26例辅助性），6例有姑息意图，27/36（75%）为男性，22/36（61%）曾被诊断为皮肤鳞状细胞癌，1/36（3%）为免疫抑制患者。平均年龄为74.6岁。平均放疗剂量（BEDGy10）为61Gy（范围39 - 85Gy），20/36（56%）的患者出现复发，包括16例局部复发和4例孤立性远处复发。根治性和姑息性治疗组的中位生存期分别为3年和1个月。2年和5年的无复发生存率（n = 36）分别为46%和35%（根治性治疗组为52%和39%）。只有1例复发患者实现了完全挽救。
尽管目前采用了最佳治疗方法（手术和放疗），这些转移性腋窝皮肤鳞状细胞癌患者的主要失败模式仍是局部区域复发。局部区域淋巴结复发后成功挽救患者存在困难，这表明需要强化治疗。
