Abstract
Objectives:
(1) Determine the impact of adjuvant radiotherapy on high-risk head and neck basal cell carcinoma (H&N BCC). (2) Analyze risk factors associated with recurrence and survival.
Methods:
Case series with planned chart review (2002-2013) in an academic tertiary care center. A total of 431 consecutive patients presented with H&N defects requiring free flap reconstruction, 38 specifically for aggressive BCC. Cases were classified as high risk based on National Comprehensive Cancer Network (NCCN) criteria. Overall and disease-free survival were examined using Kaplan-Meier analysis. Independent variables included: site, recurrent tumor, radiation, bony involvement, and perineural invasion. Complications were reported.
Results:
Nineteen (50%) lesions were recurrent. Mean tumor diameter was 5.17 cm (1.2-15.0cm). Mean follow-up was 19.9 months. Overall 2-year survival was 80%, falling to 66% at 5 years. Two-year disease-free survival was 72%. Six patients recurred (5 local; 1 distant). Adjuvant radiotherapy was utilized in 17 (44.7%) and did not significantly impact recurrence (P = .15) or survival (P = .48). Tumors >2.5 cm did not impact survival (P = .09), regardless of subsite. Bony involvement was identified in 17 (44.7%) cases, but did not correlate with survival (P = .18). Complication rates: 4 exposed bone, 4 hematoma/seroma, 3 infection, 2 osteoradionecrosis, 2 donor site evisceration, 2 ear canal stenosis, 1 severe trismus, 1 flap arterial insufficiency, 1 nasal obstruction.
Conclusions:
Larger H&N BCC do not confer worse outcomes, independent of subsite. Adjuvant radiotherapy does not improve survival or recurrence. Bony involvement does not correlate with survival and should not preclude surgical intervention, even in advanced cases.
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