Impact of Radiotherapy Waiting Time on Recurrence of Basal Cell Carcinoma: A Study at Dr. Soetomo General Hospital, Surabaya

Abstract

Basal cell carcinoma (BCC) is the most common skin cancer, often indolent but with a significant risk of local recurrence. Surgery remains the mainstay of treatment, while adjuvant radiotherapy is indicated for high-risk cases. Delayed initiation of radiotherapy may increase recurrence, yet evidence from Indonesia remains limited. This retrospective case–control investigation involved 62 patients with histopathologically verified basal cell carcinoma (BCC) treated at Dr. Soetomo General Hospital, Surabaya, from January 2017 to December 2023. All participants underwent wide local excision followed by adjuvant radiotherapeutic management. Relevant clinical parameters, including demographic characteristics, tumor features, radiotherapy latency, and recurrence status, were obtained from institutional medical records. Associations with recurrence were examined using the Chi-square test for categorical variables, the independent t-test for parametric data, and the Mann–Whitney U test for non-parametric distributions. Statistical significance was determined at p < 0.05. The majority of patients were female (54.8%) and aged 61–70 years (35.5%). The nasal region (H-zone) was the most common tumor site (38.7%), with mean tumor size of 4.0 ± 1.9 cm. Recurrence occurred in 31 patients (50%). Those with recurrence had significantly longer radiotherapy waiting times (mean 17.6 ± 12.2 months) compared with non-recurrence cases (p < 0.001). Larger tumor size was also associated with recurrence (p = 0.034). Tumor location within the H-zone showed a significant trend (p = 0.021), and high-risk histopathological subtypes were strongly predictive of recurrence (p < 0.001). No significant associations were found for sex (p = 0.61) or age (p = 0.76). Radiotherapy waiting time is a key modifiable factor influencing BCC recurrence. The need of early initiation of adjuvant radiotherapy, combined with optimal surgical margins and structured follow-up, is critical to reducing recurrence. These findings underscore the importance of timely treatment scheduling and warrant further research in Indonesian populations.