Abstract
PurposeTo report on skin tumor treatment with surface mould brachytherapy at our institution.MethodsThis was a retrospective review for all patients with skin tumors treated using Ir-192 high dose rate (HDR) surface mould brachytherapy from January 1, 2010 to December 31, 2017 in British Columbia. We identified 65 lesions (59 patients). Median age at diagnosis was 83 (range = 45-97). The majority were basal cell (54%, n = 35) or squamous cell carcinomas (31%, n = 20). Most lesions were located in the head and neck region. The most commonly used RT dose was 40 Gy/10 fractions; all patients had individualized CT-based planning.ResultsThe two-year overall survival (OS) was 77.6% and two-year progression-free survival (PFS) was 71.5%. Most deaths were from unrelated causes. Response was assessed in clinic 2-4 months post-treatment. Our complete response (CR) rate was 96.8%, with partial response in two patients; two patients could not be assessed for response. We report a two-year local control (LC) rate of 84.9%, and local recurrence in five patients. The procedure was well tolerated, with no grade 3-5 acute or late toxicities. There was one case of grade 2 radionecrosis (Common Terminology Criteria for Adverse Events (CTCAE) v. 4.03). The 100% isodose line median depth was 0.5 cm, and median surface dose = 126.5%. The median V90 = 92.3%.ConclusionSurface mould brachytherapy for skin tumors is a safe and effective modality, with excellent response rates. It is well-tolerated and a non-invasive option for elderly patients with comorbidities.
Highlights
The incidence of skin malignancies is on the rise, with a recent estimate of over 3 million people in the US [1,2,3,4]
Our complete response (CR) rate was 96.8%, with partial response in two patients; two patients could not be assessed for response
We report a two-year local control (LC) rate of 84.9%, and local recurrence in five patients
Summary
The incidence of skin malignancies is on the rise, with a recent estimate of over 3 million people in the US [1,2,3,4] Of these increasingly common cancers, basal cell carcinomas (BCC) followed by squamous cell carcinomas (SCC) constitute the majority [5]. These tumors have low metastatic potential, but can be locally destructive, resulting in significant morbidity and disfigurement [6]. A plethora of options are available for treating skin malignancies, including: topical therapy (such as Imiquimod), cryotherapy, curettage, surgical resection and radiotherapy (both external beam techniques as well as brachytherapy).
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