Chemoradiotherapy Shows Promise in Nonmelanoma Skin Cancer of the Head and Neck

D. Neil Hayes, MD

Chemotherapy given at the same time as radiotherapy may be a feasible treatment for high-risk nonmelanoma skin cancer (NMSC) of the head and neck, according to preliminary data from a small study.

D. Neil Hayes, MD, with the University of North Carolina Hospitals in Chapel Hill, and colleagues reviewed the records of 15 patients treated for NMSC of the head and neck with either concomitant radiotherapy and chemotherapy between 2001 and 2007. The study excluded patients with histologies other than squamous or basal cell carcinoma and NMSC of the lip.

NMSC is the most common malignancy globally, with an incidence of over 1.3 million in the United States. These cancers occur in anatomic areas with frequent sun exposure, most often the head and neck.

If diagnosed early, most patients can be cured with local treatments, such as surgical excision, Mohs chemosurgery, electrocautery, and radiotherapy. However, NMSC cancers of the head and neck are sometimes biologically and clinically aggressive, which confers a greater likelihood of local, regional nodal, and, less often, metastatic spread. The optimal management of these high-risk tumors is not known because of insufficient data.

Locoregional failures are common despite aggressive treatment with surgery and/or radiotherapy and are associated with high morbidity and mortality. Accordingly, optimizing locoregional control may significantly improve outcomes. A combination of surgery, radiotherapy, and chemotherapy has been suggested as a possible method of achieving this goal.

High-risk tumor features in the 15 patients included T4 disease in 93% of patients, unresectability in 60%, regional nodal involvement in 40%, and/or recurrence in 47%. Ten patients were treated in the definitive setting and 5 in the postoperative setting.

Ten of 15 patients (67%) completed all planned treatments. Thirteen patients (87%) completed at least 80% of planned chemotherapy, and 14 (93%) completed the planned radiation treatments.

At a median survival of 31 months, the estimated 2-year locoregional control and relapse-free survival rates were 79% and 49%, respectively. Radiation dermatitis occurred in all patients and was usually mild.

Hayes and associates said that the main drawbacks of their study are its retrospective design and the small sample size. They emphasized, however, that except for isolated case reports, their study is the first to examine chemoradiation for NMSC of the head and neck. “Our experience provides initial data to support additional exploration of this treatment approach for high-risk head and neck NMSCs,” they wrote. Future research should more closely examine toxicity and also identify patient subgroups that might benefit from treatment, they added.

For now, the authors recommended that concomitant radiotherapy and chemotherapy “should at least be considered as an alternative aggressive treatment approach for locally advanced disease or tumors with nodal metastasis.”

Apisarnthanarax S, Dhruva N, Ardeshirpour F, et al. Concomitant radiotherapy for high-risk nonmelanoma skin carcinomas of the head and neck. Int J Surg Onc. DOI:10.1155/2011/464829.