Clinical and Cosmetic Outcomes in Patients Treated With High Dose Rate Electronic Brachytherapy for Nonmelanoma Skin Cancer

Abstract

To analyze clinical and cosmetic outcomes of patients treated for nonmelanoma skin cancer (NMSC) with high dose rate (HDR) electronic brachytherapy (EBT) using surface applicators. We identified 142 patients who had 169 NMSC lesions, 164 of which were basal cell carcinoma, treated with HDR EBT at our institution between July 2012 and March 2014. Lesions were treated to 40 Gy in eight fractions. Local control, acute toxicity, late toxicity, and cosmetic outcomes were analyzed retrospectively. Acute and late toxicities were graded using the Common Terminology Criteria for Adverse Events v4.0 (CTCAE v4.0). Cosmetic outcomes were graded using a standard scale based on the RTOG/EORTC Late Radiation Morbidity Scoring Schema. Mean follow-up time was 11.8 months. The overall recurrence rate was 1.2% (n=2). Grade 0-1 acute radiation dermatitis was observed in 53.2% of treated lesions (n=90), grade 2 in 35.5% (n=60), and grade 3 in 12.4% (n=21). No acute toxicity greater than grade 3 was observed and all acute toxic events resolved after treatment. Grade 0-1 late toxicity was observed in 94.7% of cases (n=160), and grade 2 in 5.3% (n=9). No late toxicity greater than grade 2 was observed. Across the 167 controlled lesions, cosmetic results were excellent in 95.2% of treated lesions (n=159), good in 3.6% (n=6), fair in 0.6% (n=1), and poor in 0.6% (n=1). HDR EBT confers excellent local control, minimal toxicity, and excellent cosmesis in our institutional experience. It should be considered ideal for NMSC of the head and neck, particularly for basal cell carcinoma involving central facial locations where surgical cosmesis may be inferior.