HDR brachytherapy with individual epithetic molds for facial skin cancer: techniques and first clinical experience

Abstract

Background Facial skin cancer lesions in close proximity to critical organs require further development of radiotherapeutic techniques for highly conformal treatment, especially when treating elderly frail patients. We report on our treatment technique and first clinical experience for patients with perinasal/periorbital skin cancer treated with individualized epithetic mold high‐dose‐rate brachytherapy (BRT). Methods From January 2019, patients with complex shaped or unfavorably located skin cancer not eligible for surgery or external beam radiotherapy (RT) were screened for mold‐based BRT. Six patients were identified. Toxicity and clinical response were documented during therapy and posttreatment follow‐up. Results Median patient age was 80 years (74–92 years). Median prescription dose was 42 Gy (range, 33–44 Gy) delivered in once‐daily fractions of 3 or 4 Gy. Two patients had treatment interruptions caused by acute conjunctivitis grade 2 and a nontreatment‐related cardiac event, respectively. At a median follow‐up of 335 days (96–628 days), no ≥ grade 2 late toxicity was documented with all patients showing complete clinical response. Conclusions High‐dose‐rate BRT with individualized epithetic molds for perinasal/periorbital skin cancer is a well‐tolerated and safe treatment option for patients not eligible for primary surgery or definitive external beam RT because of comorbidities or tumor location.

3D‐gedruckte Moulagen für die individualisierte HDR‐Brachytherapie kutaner Malignome im Gesichtsbereich: Erste klinische Erfahrungen

“…15,16 Für Patienten mit Hauttumoren im Gesichtsbereich, die nicht für einen operativen Eingriff in Frage kommen und auch keine optimalen Kandidaten für eine definitive EBRT sind, wurde im Jahr 2019 in unserer Klinik eine neue HDR-BT-Technik unter Verwendung von individuell gefertigten epithetischen Moulagen implementiert. 17,18 Als Weiterentwicklung dieser manuell hergestellten Oberflächenapplikatoren mit dem Ziel einer weiteren Verbesserung der Hautadaptation sowie Optimierung der dreidimensionalen (3D) Tumorabdeckung mit assoziierter OAR-Schonung haben wir die oben genannte Technik im Januar 2020 durch 3D-gedruckte Moulagen ersetzt. In diesem Bericht stellen wir unsere Erfahrungen in Bezug auf die ersten onkologischen Ergebnisse unter Berücksichtigung des Toxizitätsprofils und der Patienten-Compliance vor.…”

Customized 3D‐printed molds for high dose‐rate brachytherapy in facial skin cancer: First clinical experience

“…15,16 For patients with perinasal/periorbital skin tumors not eligible for surgery who are also not optimal candidates for EBRT, a new BT technique implementing individualized epithetic molds manufactured by dental technicians was introduced in 2019 in our department. 17,18 As a further improvement of the treatment in terms of conformity and efficacy, we replaced the aforementioned technique with in-house manufactured three-dimensional (3D)-printed molds in January 2020. In this report, we present our experience with these individualized 3D printed molds in terms of patient compliance and clinical outcome.…”