High-dose-rate brachytherapy in treatment of non-melanoma skin cancer of head and neck region: preliminary results of a prospective single institution study

Abstract

PurposeSkin cancers are the most common human malignancy with increasing incidence. Currently, surgery is standard of care treatment for non-melanoma skin cancers. However, brachytherapy is a growing modality in the management of skin cancers. Therefore, we aimed to assess the outcome of patients with non-melanoma skin cancers treated by high-dose-rate (HDR) brachytherapy with surface mold technique.Material and methodsIn this prospective study, we recruited patients with basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin who were candidates for definitive or adjuvant brachytherapy during 2013-2014. Alginate was used for making the individualized surface molds for each patient. Patients were treated with afterloading radionuclide HDR brachytherapy machine, with a total dose of 30-52 Gy in 10-13 fractions. Participants were followed for 2 years for radiation toxicity, cosmetic results, and local failures.ResultsA total of 60 patients (66.7% male; median age, 71 years) were included, of which 42 (70.0%) underwent definitive radiotherapy. Seventy-five percent of lesions were BCC. The mean total dose was 39.6 ± 5.4 Gy. Of patients in definitive group, 40/42 (95.2%) experienced complete clinical response after 3 months. The recurrence rate was 2/18 (11.11%) and 1/42 (2.38%) in adjuvant and definitive groups, respectively. The percentage of grade 3-4 acute (3-month post-treatment) and late toxicities (2 years post-treatment) was 6.7% and 0%, respectively. The cosmetic results were good/excellent in 96.2% of patients after 2 years of follow-up.ConclusionsWith appropriate patient selection and choosing as lowest dose per fraction as possible, HDR brachytherapy with customized surface molds yields good oncological and cosmetic results for the treatment of localized skin BCC and SCC.

Surface Mould Brachytherapy for Skin Cancers: The British Columbia Cancer Experience

“…The median age of our patients was 82, which certainly played a role in why surface brachytherapy was the chosen modality in these elderly patients. Our control rates compare favorably with other brachytherapy literature, which have noted LC rates anywhere from 83.3% to 100%, though some studies involve a small pool of patients [3,4,6,8,10,12,[16][17][18][19]. This also compares favorably with EBRT LC rates of 87-100% [26][27][28], and 95-99% for Mohs [5,7,8], particularly when you consider that many patients were not suitable for surgery due to location, or patient performance status or comorbidities.…”

“…The LC rates compared favorably with EBRT. Several other retrospective studies and case studies showed excellent results with adequate follow-up -LC rates varied from 83.3% to as much as 100% [8,17,[20][21][22][23].…”

“…Guix [3,6,23]. A recent paper published by Kalaghchi et al of 60 patients treated radically or adjuvantly noted 6.7% rate of grade 3-4 acute toxicities at three months post-brachytherapy, and one patient with late grade 3-4 toxicity which resolved at two years after treatment completion [8]. Even in more difficult to treat regions, such as eyelids, hands or pinna, good LC and cosmetic and functional outcomes were noted by multiple authors [4,13,24].…”

“…Surgery is most frequently used, given the low overall treatment time and excellent local control (LC) rates -generally 95%. The highest overall cure rates are seen with Mohs microsurgery, at 95-99% LC [5,[7][8][9][10][11]. However, there remain scenarios where surgery is not feasible, either because of tumor concerns (size, residual disease, perineural invasion), concerns regarding cosmetic outcome or functional status postsurgery (Ex.…”

“…However, there remain scenarios where surgery is not feasible, either because of tumor concerns (size, residual disease, perineural invasion), concerns regarding cosmetic outcome or functional status postsurgery (Ex. Tumors on the ears, nose, eyelids) or patient factors (elderly patients, or those with comorbidities which preclude them from surgical resection) [2,5,8,10]. In recent years, technological advances have improved the ability to deliver safe and effective radiotherapy, resulting in renewed interest in this modality [2,5,12,13].…”