Head and Neck Cancer

PV QA 2 - Poster Viewing Q&A 2

MO_29_2689 - Use of Radiation in High Risk Population with Non Melanoma Skin Cancer at a rural Cancer Center

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Use of Radiation in High Risk Population with Non Melanoma Skin Cancer at a rural Cancer Center
S. Prakash, S. Emandi, and S. Prakash; Texas Oncology, Paris, TX

Purpose/Objective(s): Radiotherapy in Non melanoma skin cancer (NMSC) can be employed adjuvantly, primarily, or for recurrence. We investigated tumor and host characteristics affecting treatment outcome, and patterns of failure according to treatment modality of patients with NMSC in a rural setting.

Materials/Methods: We retrospectively studied 274 cases of NMSC referred to a rural Cancer Center between 2010 and 2017. The effect of patient characteristics (age, sex, immunosuppression), tumor characteristics (histology, size, location), and radiation modality (Brachytherapy, Electrons, Photons) on prognosis were evaluated.

Results: The median age was 75 with a male to female ratio of 2.5:1. 56% of patients had basal cell carcinoma (BCC), and 44% had squamous cell (SCC). 83% received radiation as primary treatment, 6% adjuvantly, and 11% for recurrence. 88% of cancers were located in the head/neck area. 38% were stage T2 or greater. HDR Ir 192 brachytherapy was used to treat 56% of the cancers, Electron Beam 34%, and Photons 10%. Median radiation dose was 4600 cGy, and median number of fractions was 10. Majority of patients experienced grade 1 radiodermatitis. 21% of patients had an underlying immunosuppressed state at diagnosis. Median follow up duration was 2 years. The overall local recurrence rate was 9.5%, with median time to recurrence of 22 months. The recurrence rate was 11.7% in SCC vs 7.8% in BCC (p=0.348). The recurrence rate was higher in scalp lesions (21%) as compared to other sites (p>0.05). Recurrence rate among immunosuppressed was 16%, and recurrence among T2/T3/T4 lesions was 15% (p>0.05). Recurrence rate was 11% in Electron treated cancers vs 7% in those treated with HDR (p>0.05).

Conclusion: This is the largest series of Radiation (Brachytherapy and Electron Beam) to treat NMSC in a rural center (population <25000). Radiation provided excellent local control and cosmesis in a relatively high risk population (large tumor, elderly, immunocompromised, recurrent). SCC histology and scalp location correlated with higher rates of treatment failure but not statistically significant. Similarly, tumor size and radiation modality, did not correlate with recurrence. Immunosuppression was a risk factor for development of skin cancer, but not local recurrence. Radiation can be offered as an effective treatment to patients with NMSC in rural areas, to provide quality care close to home.

Author Disclosure: S. Prakash: None. S. Emandi: None.

Shikha Prakash

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