Efficacy of a hypofractionated schedule in electron beam radiotherapy for epithelial skin cancer: Analysis of 434 cases

Background and purpose: Efficacy of radiotherapy for epithelial skin cancer was evaluated and treatment outcomes of two electron beam fractionation schedules were compared.

Materials and methods: Outcome data of 434 epithelial skin cancers in 333 patients were analysed; 332 were basal cell carcinomas (BCCs) and 102 squamous cell carcinomas (SCCs). Patients were treated with electron beam, and received either 54 Gy in 18 fractions (n = 159) or 44 Gy in 10 fractions (n = 275). Local recurrence free (LRF) rates were analysed as well as metastases free rates, cancer specific survival (CSS) and cosmetic result.

Results: Median follow-up was 42.8 months. For BCC, actuarial 3-year LRF rates were 97.6% for tumours treated with 54 Gy and 96.9% for 44 Gy. In SCC 3-year LRF rates were 97.0% for 54 Gy and 93.6% for 44 Gy (n.s.). T stage was found to be the only significant factor for recurrence (p = 0.036). Three-year CSS was 98% for SCC and 100% for BCC.

Conclusions: Electron beam irradiation is a safe and effective treatment modality for epithelial skin cancer. In view of a similar efficacy and patient convenience of the hypofractionated schedule, 44 Gy in 10 fractions can be regarded the radiation schedule of choice.