Purpose Non-melanoma skin cancers of the face are at high-risk for local recurrence and metastatic spread. While surgical interventions such as Mohs microsurgery are considered the standard of care, this modality has the potential for high rates of toxicity in sensitive areas of the face. Catheter flap high-dose-rate (HDR) brachytherapy has shown promising results, with high rates of local control and acceptable cosmetic outcomes. Material and methods Patients with non-melanoma skin cancers (NMSC) located on the face were treated with 40 Gy in 8 fractions, given twice weekly via catheter flap HDR brachytherapy. Clinical target volume (CTV) included the visible tumor plus a margin of 5 mm in all directions, with no additional planning target volume (PTV) margin. Results Fifty patients with 53 lesions on the face were included, with a median follow-up of 15 months. All were considered high-risk based on NCCN guidelines. Median tumor size and thickness were 18 mm and 5 mm, respectively. Median PTV volume and D 90 were 1.7 cc and 92%, respectively. Estimated rate of local control at twelve months was 92%. Three patients (5%) experienced acute grade 2 toxicity. Two patients (4%) continued to suffer from chronic grade 1 skin toxicity at 12 months post-radiotherapy (RT), with an additional two patients (4%) experiencing chronic grade 2 skin toxicity. Forty-nine lesions (92%) were found to have a good or excellent cosmetic outcome with complete tumor remission. Conclusions CT-based flap applicator brachytherapy is a valid treatment option for patients with NMSC of the face. This modality offers high rates of local control with acceptable cosmetic outcomes and low rates of toxicity.
Purpose/Objective(s): Incomplete surgery (gross total resection, near total resection, and subtotal resection) of head and neck adenoid cystic carcinoma (HNACC) is controversially considered as an unfavorable prognostic factor as to curative intent surgery (CIS). However, in Intensity-Modulated Radiotherapy (RT) era, after planed incomplete surgery (PIS), intensified RT or RT with concurrent chemotherapy (CCT) may contribute to tumor control and survival. Thus, we investigated the contribution of IMRT after PIS on local control and survival in HNACC. Materials/Methods: Retrospective review was performed for 170 consecutive patients with HNACC treated with curative postoperative IMRT with or without concurrent chemotherapy, between 2015 and 2018, after PIS (n Z 102) or CIS (n Z 68). All plan target volumes were designed to including the primary tumor and related cranial nerve pathway. Patients with other malignant tumors or distant metastasis were excluded. Results: Among the 170 patients (98 women and 72 men; median age, 53 years), the median follow-up time was 27.8 (range, 9.6-59.1) months. The estimated 3-year local-regional recurrence-free survival (LRRFS) rate, progression-free survival (PFS) rate, overall survival (OS) rate, and distant metastasis-free survival (DMFS) rate were 92.4% (95%CI: 87.3-95.9), 74.7% (95%CI: 67.5-81.0), 98.5% (95%CI: 94.9-99.6), and 76.0% (95% CI: 68.7-82.1), respectively. Patients with high grade, Ki-6710%, Stage III-IV, extra-nodal extension (ENE), perineural invasion (PNI) and positive margin was associated with worse PFS (p<0.0001, p Z 0.002, p Z 0.003, and p Z 0.0004, p Z 0.042, and p Z 0.021, respectively). The baseline and treatment characteristics were equally distributed between PIS and CIS group, except that there were more patients with positive margin and received RT dose66 Gy in PIS group (p Z 0.000 and p Z 0.000). There was no difference in LRRFS, DFS, OS, and DMFS between two groups, both in stage I-II and Stage III-IV (p Z 0.280, p Z 0.371, p Z 0.752, and p Z 0.549, respectively). Among patients with high grade, Ki-6710%, ENE or PNI, there was also no difference in PFS between two groups. Among patients received radiation dose<66Gy, PIS group patients had significant worse PFS (p Z 0.029), while among patients without any CCT, PIS group patients had marginal significant worse PFS (p Z 0.067). Conclusion: In IMRT era, PIS does not compromise oncologic treatment, even in patients with worse prognostic factors; however, Doses of 66 Gy or CCT might be essential. This strategy warrants further evaluation in prospective randomized trials with longer follow-up.
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