Hu, Marcus, Liu, Howard, Bernard, Anne, Efendy, Michael, and Porceddu, Sandro V. (2025) Hypofractionated adjuvant radiotherapy in cutaneous squamous cell and basal cell carcinoma of the head and neck: 50(Gy) in 20 study. Oral Oncology Reports, 13. 100732.

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Abstract

Purpose: To assess clinical outcomes and tolerability of patients with cutaneous squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) of the head and neck region, treated with adjuvant radiotherapy prescribed to a moderately hypofractionated regimen of 50Gy in 20 fractions. Methods and materials: Eligibility for this retrospective study included patients with cutaneous SCC and BCC of the head and neck who received adjuvant radiotherapy to a dose of 50Gy in 20 fractions (2.5Gy per fraction) between 1/1/2007 and 31/12/2019 at a tertiary Queensland hospital. Primary endpoint was freedom from local failure (FFLF). Secondary outcomes were loco-regional recurrence-free survival (LRRFS), overall survival (OS) and toxicity rates. Acute toxicities were retrospectively collected and reported according to Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Results: A total of 126 patients were evaluated in this study with a median follow up period of 19.7 months (interquartile range 1.63–121.03). The median age was 68.3 years old. Twenty-six patients were immunosuppressed. Predominant histopathology was SCC (63.5 %). The majority were staged pT1-2 (74.6 %), and clinically or pathologically N0 (96.8 %). 122 patients received adjuvant radiotherapy to the primary tumour bed, and four patients received treatment both the primary and nodal region. FFLF was 95.8 % and 92.2 % at 2 and 5 years, respectively. No statistically significant clinico-pathological factors were prognostic of FFLF. LRRFS was 90.5 % at 2 years and 83.1 % at 5 years. OS was 88.7 % at 2 years and 69.9 % at 5 years. Five of the 21 deaths were related to the index cutaneous carcinoma. Grade 3 radiation dermatitis and mucositis occurred in 13.5 % and 4.0 % of patients, respectively. There were no grade 4/5 toxicities. Four patients required treatment breaks, of which two were planned breaks. No patient required enteral feeding during their RT course. Conclusion: This is the largest series to date evaluating a single moderately hypofractionated adjuvant radiotherapy regimen for cutaneous SCC and BCC of the head and neck. This regimen was associated with high locoregional control and was well tolerated. A moderately hypofractionated course of adjuvant radiotherapy in cutaneous SCC and BCC can be a suitable option to reduce treatment duration.

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