Kilovoltage RT for carcinomas overlying nasal cartilage (671 lesions)
ForBCC and SCC of skin overlying nasal cartilage
TL;DR5-yr cure rate 88.09% and 10-yr 86.51% in 671 BCC and SCC over nasal cartilage; cosmesis good or acceptable in 96.84%.
Failure was mostly marginal (25 of 38 recurrences) with 0.5-1 cm field margins, which argues for generous margins over nasal skin; morpheaform lesions got 1.5 cm. With 5 Gy twice weekly (median 55 Gy), the authors report no cartilage sequelae. That supports kV RT as the nonsurgical option where excision would need complex reconstruction.
In a pt with BCC or SCC of skin over the nasal cartilage whose excision would need complex reconstruction, this supports superficial kV RT as a durable nonsurgical option; with no surgical arm, it does not settle RT vs excision for a surgically straightforward lesion.
Failure was mostly marginal (25 of 38 recurrences) with 0.5-1 cm margins, which argues for wider fields over nasal skin. With 5 Gy twice weekly (median 55 Gy), the authors report no cartilage sequelae, supporting kV RT where excision would need complex reconstruction.
11 details
Retrospective single-institution series of 671 lesions treated 1972-2007. Mean follow-up 38.016 mo (range 1-351). Actuarial cure rate by life-table method; chi-squared for dose and size associations.
Basal and squamous cell carcinomas of the skin overlying the nasal cartilages. Histology split of the full cohort not given in the source excerpt. Relapses included 10 lesions already recurrent after prior non-radiological treatment.
CRT in 668 lesions: 55-60 kV, HVD 2-12 mm, 5 Gy/fx twice weekly, total 30-75 Gy (median 55 Gy). Margin 0.5-1 cm, 1.5 cm for morpheaform BCC. Septal cartilage shielded with 1 mm Pb nostril inserts at the alae.
CR 98.80% at 1 mo; 5-yr cure 88.09%, 10-yr 86.51%. Recurrence 38 lesions (13 central, 25 marginal), onset 3-96 mo. No relationship between relapse and dose or size.
| Endpoint | Lesions | % |
|---|---|---|
| CR at 1 mo | 663 | 98.80% |
| PR (all BCC) | 3 | 0.44% |
| Recurrence (13 central, 25 marginal) | 38 | 5.66% |
| 5-yr cure rate | n/a | 88.09% |
| 10-yr cure rate | n/a | 86.51% |
| Rating | Lesions | % |
|---|---|---|
| Good | 496 | 74.47% |
| Acceptable | 149 | 22.37% |
| Not acceptable | 16 | 2.40% |
Cosmesis good or acceptable in 96.84%; 16 lesions not acceptable. Authors report no complications or sequelae, and flag the 7 newly not-acceptable cases for continued follow-up.
No contemporaneous comparator. The authors cite randomised facial BCC data comparing RT with surgery: cosmesis was similar on nasal skin but control favoured surgery, in tumors under 4 cm treated with mixed RT techniques. Mohs surgery, the usual comparator for nasal BCC today, is not addressed.
Toxicity is clinician-rated cosmesis without a named scale, and a mean follow-up near 3 years is short for late cartilage effects. The null dose-relapse finding is likely confounded by dose being chosen by lesion size.
The data support kV RT as an effective, cartilage-sparing option for nasal skin carcinoma, where tight adherence of skin to cartilage complicates excision. They do not establish superiority over surgery, and the marginal-failure pattern raises the question of whether margins were adequate.
Single-institution retrospective series, 1972-2007, no surgical comparator; the authors' claim of superiority over other modalities rests on cross-literature comparison this design cannot support.
- Local control vs Mohs surgery for nasal skin carcinoma
- Adequate field margin given mostly marginal recurrences
- Late cartilage toxicity of 5 Gy fractions beyond 10 years
📚 Sources · 📄 1 paper
The longer read
The headline that matters is the actuarial one. A crude recurrence rate of 5.66% sits beside a 5-year cure rate of 88.09%, and the gap is the follow-up: a mean of about 38 months, with some lesions seen for as little as one month, while recurrences surfaced anywhere from 3 to 96 months after treatment. Read the crude figure and kV RT looks near-perfect. Read the life-table figure, plus a 10-year rate of 86.51%, and it looks like good, durable control with most failures arriving in the first several years. The actuarial number is the one to quote to a colleague or a tumor board.
The pattern of failure is more useful to a radiation oncologist than the cure rate. Twenty-five of 38 recurrences were marginal, not central. That is a geometry problem rather than a dose problem, which matches the authors' finding of no association between relapse and dose. Margins of 0.5-1 cm over the nose are tight by many current superficial-RT conventions, and the authors already widened to 1.5 cm for morpheaform BCC because its edge is hard to define clinically. A reasonable reading is that the infiltrative-edge problem was not limited to the lesions labelled morpheaform. The null dose-response should not be over-read. Dose was almost certainly chosen by lesion size and depth, so the analysis cannot separate the two, and with 38 events the comparison has little power.
The toxicity claim needs the most caution. The paper reports no complications or sequelae over a span that includes 5 Gy fractions delivered over nasal cartilage, which is exactly the setting where large fractions raise concern for chondritis and necrosis. That is reassuring, but the ascertainment is a clinician's cosmetic grade without a named scale, follow-up is short relative to late cartilage effects, and the authors themselves flag 7 not-acceptable cosmetic results that need ongoing review. Absence of reported necrosis in a retrospective chart series is weaker evidence than absence in a prospectively graded cohort.
The authors' conclusion, that dermatologic RT is superior to any other modality for these lesions, does not follow from a single-arm series compared against literature values with different selection, staging and follow-up. Their own cited randomised data on facial BCC favoured surgery for control while showing similar cosmesis on nasal skin, and that trial predates the routine use of Mohs surgery, which is what most nasal BCC now receives. The series also spans 35 years and mixes BCC with SCC without reporting histology-specific control in the excerpt, so the SCC result is effectively unknown.
Where this lands: it is a large, long-horizon dataset supporting superficial kV RT as a legitimate curative option over the nasal cartilages, particularly for elderly pts or lesions whose excision would need complex reconstruction. It does not move the default for a surgically straightforward lesion in a fit pt, and its main practical lesson for the RT reader is to treat the margin generously.