Radiation Therapy for Cutaneous Squamous and Basal Cell Carcinomas of the Face Treated with HDR Brachytherapy Using Custom Thermoplastic Applicators

Abstract

<h3>Purpose/Objective(s)</h3> Non-melanoma skin cancer (NMSC) of the face is prevalent and increasing in incidence with cosmetic outcome and functionality of utmost importance. We report on an underutilized modality of radiation treatment with HDR brachytherapy custom thermoplastic applicators. <h3>Materials/Methods</h3> A total of 301 cutaneous carcinomas of the face with a mean tumor size of 1.4cm (0.2cm-8cm) were treated with HDR brachytherapy Ir-192 custom thermoplastic applicators (CTA). Most commonly, hypofractionated radiation regimens included 40Gy in 8 fractions delivered twice weekly or 48Gy in 16 fractions delivered four times weekly. <h3>Results</h3> Mean follow up was 28.2 months (range, 1-149 months). Of the 301 facial lesions treated, local control was 95.7% with most recurrences being salvaged by either re-irradiation in 30.7%, wide local excision (WLE) 23.1%, or Moh's micrographic surgery 23.1%. 65% were basal cell carcinomas and the most common sites of disease were the nose (33.9%), cheek (20.9%), forehead (18.6%), and ear (17.3%). At first follow up, Grade 0-1 acute radiation dermatitis was observed in 66.1% of lesions, grade 2 in 27.4%, grade 3 in 6.2% (n=18) and grade 4 toxicity was seen in one patient (0.34%). Chronic toxicity included erythema (8.2%), fibrosis (7.4%), telangiectasia (4.1%), and hypo/hyperpigmentation (1.7%). No patients exhibited chronic ulcers. The median number of catheters used was 4 (range, 1-17), and the largest diameter treated was a median of 2.5cm (0.2-14.2cm). <h3>Conclusion</h3> Non-melanoma skin cancer of the face can be successfully treated with HDR brachytherapy custom thermoplastic applicators with low toxicity and excellent outcomes.