Hypofractionated radiotherapy for invasive squamous cell carcinoma of the scalp in the elderly: Efficacy and tolerance, preliminary results

• Published in: Cancer radiothérapie 2023-06, Vol.27 (4), p.290-295
• Main Authors: Jacques, J., Renard, S., Demogeot, N., Faivre, J.C., Peiffert, D.
• Format: Article
• Language: English
• Subjects: Carcinomes épidermoïdes; Elderly; Human health and pathology; Hypofractionated; Hépatology and Gastroenterology; Life Sciences; Radiotherapy; Radiothérapie hypofractionnées; Scalp; SCC; Sujets âgés; Vertex
• ISSN: 1278-3218; 1769-6658
• DOI: 10.1016/j.canrad.2023.01.003

Skin squamous cells carcinomas (SCC) are frequently tumor, especially in the elderly population. Surgical excision is the standard treatment. But for patients suffering large tumor or/with comorbidity, a conservative approach with irradiation can be proposed. The hypofractionated schedule is used to shorten the overall treatment time with same results and without compromising therapeutic outcomes. The aim of this study is to assess the efficacy and tolerance of hypofractionated radiotherapy for invasive SCC of the scalp in elderly. We included patients suffering from SCC of the scalp and treated by hypofractionated radiotherapy at the Institut de cancérologie de Lorraine or centre Émile-Durkeim d’Épinal, from January 2019 to December 2021. Characteristics of patients, size of the lesion and side effects were collected retrospectively. Tumor size at 6 months corresponded to the primary endpoint. Toxicity was collected for the secondary endpoint. Twelve patients with a median age of 85 years old were included. The mean size was 4,5cm with a bone invasion in 2/3 of cases. Radiotherapy was delivered after surgical excision for half of the patient. The dose delivered was 54Gy in 18 daily fractions size. Six months after irradiation: 6/11 patients had no residual lesion, 2/11 had a partial response with a residual lesion of about 1cm. 3 patients presented local recurrence. One patient died within 6 months of radiotherapy because of another comorbidity. In total, 25% had presented a grade 3 acute radiation dermatitis, no grade 4 toxicity. Short term of moderately hypofractionated schedule radiotherapy was a success with complete or partial response for more than 70% of the patients in squamous cell carcinomas. There is no major side effect. Les carcinomes épidermoïdes font partie des tumeurs cutanées les plus fréquentes et sont essentiellement liés à l’exposition solaire. Ils touchent majoritairement les sujets âgés de plus de 65ans, avec comme localisation préférentielle la tête et le cou. Ils sont connus pour leur radiosensibilité. L’exérèse chirurgicale reste la référence quand elle est possible. Toutefois, chez les patients fragiles ou pour lesquels la chirurgie serait trop délabrante, un traitement conservateur par irradiation est une alternative. Le schéma hypofractionné permet une réduction du nombre de déplacements avec une efficacité tumorale similaire. L’objectif de cette étude était d’évaluer l’efficacité et la tolérance de la radiothérapie hypofractio