A Sudden and Concerning Increase in the Use of Electronic Brachytherapy for Skin Cancer

Linos, Eleni; VanBeek, Marta; Resneck, Jack S.

doi:10.1001/jamadermatol.2015.0385

Cited by 25 publications

(27 citation statements)

References 6 publications

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“…In addition, there is patient selection that benefits BT. Given the higher reimbursement for BT, there may be a financial conflict of interest for studies mentioning name brands of the devices used. Furthermore, it is expected that larger tumors would be preferentially treated with EBRT instead of BT.…”

Section: Discussionmentioning

confidence: 99%

Surgical excision, Mohs micrographic surgery, external‐beam radiotherapy, or brachytherapy for indolent skin cancer: An international meta‐analysis of 58 studies with 21,000 patients

Lee

Lehrer

Aphale

et al. 2019

Cancer

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BACKGROUND:The objective of this study was to compare the cosmesis and recurrence rates of conventional excision (CE), Mohs micrographic surgery (MMS), external-beam radiation therapy (EBRT), or brachytherapy (BT), for basal cell carcinoma and squamous cell carcinoma of the skin. METHODS: Population, Intervention, Control, Outcome, Study Design (PICOS), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and Meta-Analyses of Observational Studies in Epidemiology (MOOSE) methods were used to identify studies on PubMed (from 1985 to 2018), including patients with American Joint Committee on Cancer (AJCC) T1-T2N0 basal cell carcinomas and squamous cell carcinomas and ≥10 months follow-up who received CE, MMS, EBRT, or BT. The primary endpoint was cosmesis, classified as "good," "fair," or "poor." The secondary endpoint was 1-year recurrence. Fixed-effects and random-effects meta-analyses were performed to evaluate primary and secondary outcomes with respect to treatment modality. RESULTS: In total, 18,095 studies met initial search criteria. There were 24 CE, 13 MMS, 19 EBRT, and 7 BT studies included with a total of 21,371 patients. The summary effect size for "good" cosmesis was 81% (95% CI, 70.6%-89.6%), 74.6% (95% CI, 63%-84.6%), and 97.6% (95% CI, 91.3%-100%) for CE, EBRT, and BT, respectively. Good cosmesis was 96.0% in the only MMS study that reported cosmesis. BT had improved "good" cosmesis over EBRT (P = .0025) and was similar to CE and MMS. No significant differences were seen for "fair" or "poor" cosmesis. One-year recurrence rates were low throughout at 0.8% (95% CI, 0.3%-1.6%), 0.2% (95% CI, 0%-0.6%), 2% (95% CI, 1.3%-2.7%), and 0% (95% CI, 0%-0.5%) for CE, MMS, EBRT, and BT, respectively. CONCLUSIONS: For T1-T2N0 skin cancers, BT and MMS have improved cosmesis over EBRT and CE. It is unclear whether this is because of treatment superiority or selection and reporting bias. Local control is similar among all modalities at 1 year. Cancer 2019;125:3582-3594.

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Section: Discussionmentioning

confidence: 99%

Surgical excision, Mohs micrographic surgery, external‐beam radiotherapy, or brachytherapy for indolent skin cancer: An international meta‐analysis of 58 studies with 21,000 patients

Lee

Lehrer

Aphale

et al. 2019

Cancer

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“…However, aforementioned studies are often retrospective and not peer reviewed before publishing. Higher level prospective research is needed on EBT for positioning this new technique [8] and confirming improved clinical outcome when compared to existing technologies. No studies to date have reported on optimizing fractionation schedules [9].…”

Section: Purposementioning

confidence: 99%

Electronic brachytherapy for superficial and nodular basal cell carcinoma: a report of two prospective pilot trials using different doses

Ballester‐Sánchez¹,

Pons-Llanas

Candela-Juan

et al. 2016

jcb

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Purpose: Basal cell carcinoma (BCC) is a very common cancer in the Caucasian population. Treatment aims to eradicate the tumor with the lowest possible functional and aesthetic impact. Electronic brachytherapy (EBT) is a treatment technique currently emerging. This study aims to show the outcomes of two consecutive prospective pilot clinical trials using different radiation doses of EBT with Esteya ® EB system for the treatment of superficial and nodular basal cell carcinoma.Material and methods: Two prospective, single-center, non-randomized, pilot studies were conducted. Twenty patients were treated in each study with different doses. The first group (1) was treated with 36.6 Gy in 6 fractions of 6.1 Gy, and the second group (2) with 42 Gy in 6 fractions of 7 Gy. Cure rate, acute toxicity, and late toxicity related to cosmesis were analyzed in the two treatment groups.Results: In group 1, a complete response in 90% of cases was observed at the first year of follow-up, whereas in group 2, the complete response was 95%. The differences with reference to acute toxicity and the cosmetic results between the two treatment groups were not statistically significant.Conclusions: Our initial experience with Esteya ® EB system to treat superficial and nodular BCC shows that a dose of 36.6 Gy and 42 Gy delivered in 6 fraction of 7 Gy achieves a 90% and 95% clinical cure rate at 1 year, respectively. Both groups had a tolerable toxicity and a very good cosmesis. The role of EBT in the treatment of BCC is still to be defined. It will probably become an established option for selected patients in the near future.

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“…Reports of older published series mainly done in European facilities with wide experience in BT showing efficacy in treating skin cancer have led to recent interest and growth in new techniques [7,8,9]. Several innovative applicators have been introduced to the BT community, and the use of skin BT has significantly increased [10].…”

Section: Purposementioning

confidence: 99%

A dosimetric study of electron beam therapy vs. high-dose-rate mould brachytherapy in adjuvant treatment of non-melanoma skin carcinomas of the head and neck region

Sen¹,

Bandyopadhyay²,

Pal³

et al. 2019

jcb

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Purpose: Radiation for superficial tumours of the head and neck region can be given either by brachytherapy or electrons. Brachytherapy (BT), due to rapid dose fall-off and minor setup errors, should be superior to external beam radiotherapy (EBRT) for treatment of lesions in difficult locations such as the nose and earlobe. The present study is a dosimetric comparison of computed tomography (CT)-based mould brachytherapy treatment plans with 3D conformal electron beam therapy in the treatment of non-melanoma skin cancers (NMSC). Material and methods: From December 2017 to November 2018 10 patients with NMSC of the head and neck region (forehead, nose, cheek) who underwent adjuvant radiation with HDR brachytherapy (BT) with a surface mould individual applicator were enrolled for analysis. We evaluated dose coverage by minimal dose to 90% of planning target volume (PTV, D 90), volumes of PTV receiving 90-150% of prescribed dose (PD) (VPTV 90-150), conformal index for 90% and 100% of PD (COIN 90 , COIN 100), dose homogeneity index (DHI), dose nonuniformity ratio (DNR), and exposure of organs at risk (OARs) (eyes, lens, underlying bone and skin). Prospectively, we created CT-based treatment plans for electron beam therapy. We compared conformity (COIN 90 , COIN 100), dose coverage of PTV (D 90 , VPTV 90 , VPTV 100), volumes of body receiving 10-90% of PD (V 10-V 90), doses to OARs (D 0.1cc and D 2cc) of BT and electron plans. Results: We obtained mean BT-DHI 0.81, BT-DNR 0.608, Electron-DHI 1.25. We observed no significant differences in VPTV 90,100 and D 90 between BT and electron beam. Mean BT-VPTV 125,150 were significantly higher than Electron-VPTV 100,125. COIN 90 was superior for BT plans. Conclusions: CT-based surface mould brachytherapy results in better conformity of superficial lesions on small, irregular surfaces such as the nose and inner canthus than electrons with a slightly higher skin dose.

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A Sudden and Concerning Increase in the Use of Electronic Brachytherapy for Skin Cancer

Cited by 25 publications

References 6 publications

Surgical excision, Mohs micrographic surgery, external‐beam radiotherapy, or brachytherapy for indolent skin cancer: An international meta‐analysis of 58 studies with 21,000 patients

Surgical excision, Mohs micrographic surgery, external‐beam radiotherapy, or brachytherapy for indolent skin cancer: An international meta‐analysis of 58 studies with 21,000 patients

Electronic brachytherapy for superficial and nodular basal cell carcinoma: a report of two prospective pilot trials using different doses

A dosimetric study of electron beam therapy vs. high-dose-rate mould brachytherapy in adjuvant treatment of non-melanoma skin carcinomas of the head and neck region

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