Aims To report the local control and complication rates of orthovoltage radiotherapy in the management of medial canthal basal cell carcinoma (BCC).

Methods The medical records of all patients treated with medial canthal BCC between 1998 and 2010, with orthovoltage radiotherapy as primary treatment, adjuvant treatment after incomplete surgical excision, or for tumour recurrence following surgical excision, were retrospectively studied. The actuarial rates of tumour control and complications were calculated using Kaplan–Meier estimates. Main outcome measures were rates of tumour control and radiation complications.

Results 90 patients were included with a median follow-up of 80 months. Tumour control rate at 10 years for the entire cohort was 94% (95% CI 84% to 98%). Tumour control rates showed no statistically significant differences among different treatment intents or treatment radiation energies. Radiation-related complication rates included loss of eyelashes in 59% (95% CI 48% to 66%), epiphora 51% (95% CI 39% to 62%), dry eye 14% (95% CI 3% to 35%) and conjunctival scarring 11% (95% CI 1% to 33%). No patient developed long-term corneal complications.

Conclusions Orthovoltage radiotherapy can be a reliable therapeutic alternative for selected medial canthal BCCs, which can be contained within the prescribed radiation field, with anticipated radiation-related toxicities.