Surgery and Hypofractionated Radiotherapy Improve Local Control in High-Risk Head and Neck Non-Melanoma Skin Cancer

Non-melanoma skin cancers (NMSCs) are the most common malignancies worldwide. This study aimed to evaluate the clinical outcomes of radiotherapy (RT) alone versus surgery followed by RT in patients with high-risk head and neck (HN) NMSCs. Patients diagnosed with HN-NMSCs and treated with RT at three institutions between June 2010 and September 2022 were retrospectively analyzed. The primary endpoint was local recurrence-free survival (LRFS). A total of 73 patients were included. The median follow-up was 50 months (range: 18-164). Fifty patients (68.5%) underwent surgery prior to RT, while 23 patients (31.5%) received definitive RT. Nine patients (12.3%) experienced in-field recurrence. The 2-year LRFS was 90.2%, and the 5-year LRFS was 86.3%. LRFS was significantly better in patients who received surgery plus RT compared to those treated with definitive RT alone (p= 0.014; HR: 0.20; 95% CI: 0.05-0.83). Hypofractionated RT regimens were associated with improved LRFS compared to conventional RT (p= 0.040; HR: 4.4; 95% CI: 0.91-21.3). In high-risk HN-NMSC patients, the combination of surgery and RT, as well as hypofractionated RT regimens, provided superior local control compared to definitive RT alone and conventional fractionation schedules. Keywords: Basal cell carcinoma, Non-melanoma skin cancer, Radiotherapy, Head and neck cancer, Local control