Computed tomography-based flap brachytherapy for non-melanoma skin cancers of the face

Abstract

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.

High dose rate brachytherapy in nonmelanoma skin cancer—Systematic review

“…Even in the same institution various dose fractionation schedules were used. Despite that local control rate remains high in both short‐ and long‐term observations 19–32 and varies between 71% and 99%.…”

“…Among presented data in total 2403 patients with BCC and SCC were treated with average local control of 91.2% (between71% and 99%) 19–32 . It is worth mentioning that presented studies were heterogenic.…”

“…Most of them reported only very good tolerance. Detailed description of clinical presentation of adverse effects was presented by Guix, 20 Olek, 26 Casey, 28 Gogineni, 31 and Conejo 32 . Dominant acute radiodermatitis was presented as erythema grade 1 or grade 2 (According to RTOG/EORTC).…”

“…Dominant acute radiodermatitis was presented as erythema grade 1 or grade 2 (According to RTOG/EORTC). Due to high precision in dose delivery all adverse effects were limited to about 1 cm radius around tumors 19–32 . Exception was G1–2 conjunctivitis accompanying treatment of tumors of the periorbital area 28 .…”

ORIFICE (Interventional Radiotherapy for Face Aesthetic Preservation) Study: Results of Interdisciplinary Assessment of Interstitial Interventional Radiotherapy (Brachytherapy) for Periorificial Face Cancer

“…Several authors have proposed to subdivide the regions of the face into three main zones, low-risk, intermediate-risk and high-risk, which reflect the risk of recurrence after radical treatment [ 8 ]. Moreover, five different major criteria have been identified to consider the tumor “high-risk”, and these criteria include: tumor location (the so-called “H zone”), tumor size, clinical appearance, tumor recurrence or persistence and tumor histology [ 9 ].…”