Table 6.
Studies using adjuvant radiotherapy with surgery to treat previously untreated SCCs that were non-metastatic at presentation
| Study and No of SCCs | Reasons for adjuvant radiotherapy | Surgical treatment | Site of adjuvant radiotherapy (local/regional) | Dose of adjuvant radiotherapy | Follow-up |
|---|---|---|---|---|---|
| Barrett 1993 (n=3) | Head and neck perineural invasion (asymptomatic) | Surgical excision or Mohs micrographic surgery | Not specified | Mean 51.7 Gy, 18-22 fractions | Mean 28.3 months (range 18-37) |
| Cottel 1982 (n=2) | Head and neck perineural invasion, both symptomatic (infraorbital and supraorbital nerves); patients with the “most difficult cases” selected for adjuvant radiotherapy | Mohs micrographic surgery | Primary site and course of involved cranial nerve | 4600-5000 rads (200 rads/day over 4.5-6 weeks) | Mean 30 months (range 24-36) for adjuvant radiotherapy |
| DeAmbrosis 2010 (n=6) | Head and neck perineural invasion, nerve diameter 0.15-0.4 mm (all asymptomatic) but indications for radiotherapy inconsistent | Excision | Not specified | Not specified | Mean 104.8 months (range 44-218) |
| Geist 2008 (n=7) | Head and neck perineural invasion (all incidental) | Mohs micrographic surgery | Tumour bed and first echelon lymphatics and course of involved nerve | Mean dose 57.9 Gy (range 52-66), 20-33 fractions | Mean 10.4 months (range 4-20) |
| Khan 1999 (n=26) | No specific reasons. Prospective cohort with SCC diameter >2 cm | Excision | Elective irradiation of draining lymph nodes | Total dose 45 Gy, 20 fractions | Up to 12 months |
| Lifeso 1990 (n=11) | Unclear | Amputation or wide local excision | Regional lymph nodes | 4500 rads, 20 fractions, 4 weeks | Mean 37 months (range 24-86) |
| Osguthorpe 1997 (n=4) | Head and neck perineural invasion; supraorbital, infraorbital, and buccal nerves; regional lymphatic or perivascular spread; neural spread on multiple nerves from primary tumour site; extension through bony foramen, needing extended resection | Mohs micrographic surgery with or without intracranial clearance | Not specified | Mean 56.2 Gy (range 50-65) | 49.5 months (range 6-99) |
| Shiffman 1975 (n=4) | Not specified | Surgery | Not specified | Not specified | <1 year to >3 years |
| Veness 1999 (n=6) | Patients undergoing cardiothoracic transplantation who developed “aggressive cutaneous malignancies,” but not specified how patients were selected to have adjuvant radiotherapy | Wide local excision | Not specified | Mean dose 52 Gy | Mean 25.8 months (range 8-54) |