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

Abstract

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.

Non-melanoma skin cancer treated with high-dose-rate brachytherapy: a review of literature

“…[20] described a standardized surface mold technique prospectively utilizing HDR brachytherapy in 236 NMSC lesions, and achieved 5-year local control of 98% with excellent treatment tolerance and no severe early or late complications. Similar results were reported by other authors [19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30] in their retrospective studies. Despite the potential interest in BT for the treatment of non-melanoma skin cancer, there are not a lot of randomized controlled trials, systematic reviews, and/or metanalyses in literature.…”

“…Different hypofractionated regimens with very good local control has been reported in literature [19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 37, 41, 42]. Most commonly hypofractionated course described consist in a total dose of 30-40 Gy, delivered in 5-10 fractions once/twice per week (Köhler-Brock et al .…”

“…[25], and Ballester-Sánchez et al . [28] with the use of hypofractionated course and Valencia applicators or HDR electronic BT with surface applicators, which resulted in excellent local control, cosmetic results, and very low-grade toxicities. More recently, we reported our data [26] of 57 lesions in elderly patients receiving hypofractionated regimes at the dose of 40-50 Gy in 8-10 fractions (using Valencia applicator) with excellent local control, cosmetic results with no G3 or higher acute or late toxicity.…”

GEC-ESTRO ACROP recommendations in skin brachytherapy

“…The dose rate allows for shorter treatment times, lasting approximately one third of the Valencia applicator times. The design of Esteya TM has significantly improved radiation leakage [41][42][43][44][45][46][47] (see separate file for table).…”

Skin surface brachytherapy: A survey of contemporary practice patterns

“…These recent studies tended to have more strict patient selection criteria compared to older data on external beam radiotherapy. Coupled with a rather short follow up, it is not surprising that they report control rates at or beyond 95% in tandem with good to excellent cosmesis(11–14, 16, 17). Only prospective phase III trials comparing different radiation modalities or comparing variations (ie.…”