The initial experience of electronic brachytherapy for the treatment of non-melanoma skin cancer

Ajay Bhatnagar,Alphonse Loper

doi:10.1186/1748-717x-5-87

Abstract

BackgroundMillions of people are diagnosed with non-melanoma skin cancers (NMSC) worldwide each year. While surgical approaches are the standard treatment, some patients are appropriate candidates for radiation therapy for NMSC. High dose rate (HDR) brachytherapy using surface applicators has shown efficacy in the treatment of NMSC and shortens the radiation treatment schedule by using a condensed hypofractionated approach. An electronic brachytherapy (EBT) system permits treatment of NMSC without the use of a radioactive isotope.MethodsData were collected retrospectively from patients treated from July 2009 through March 2010. Pre-treatment biopsy was performed to confirm a malignant cutaneous diagnosis. A CT scan was performed to assess lesion depth for treatment planning, and an appropriate size of surface applicator was selected to provide an acceptable margin. An HDR EBT system delivered a dose of 40.0 Gy in eight fractions twice weekly with 48 hours between fractions, prescribed to a depth of 3-7 mm. Treatment feasibility, acute safety, efficacy outcomes, and cosmetic results were assessed.ResultsThirty-seven patients (mean age 72.5 years) with 44 cutaneous malignancies were treated. Of 44 lesions treated, 39 (89%) were T1, 1 (2%) Tis, 1 (2%) T2, and 3 (7%) lesions were recurrent. Lesion locations included the nose for 16 lesions (36.4%), ear 5 (11%), scalp 5 (11%), face 14 (32%), and an extremity for 4 (9%). Median follow-up was 4.1 months. No severe toxicities occurred. Cosmesis ratings were good to excellent for 100% of the lesions at follow-up.ConclusionsThe early outcomes of EBT for the treatment of NMSC appear to show acceptable acute safety and favorable cosmetic outcomes. Using a hypofractionated approach, EBT provides a convenient treatment schedule.

Highlights

Millions of people are diagnosed with non-melanoma skin cancers (NMSC) worldwide each year
According to the American Academy of Dermatology, 80% of NMSC lesions in the U.S are basal cell carcinomas (BCC), and 16% are categorized as squamous cell carcinoma (SCC) [4]
Dose fractionation schemes for external beam radiation therapy are based on the size and location of the lesion and can take up to seven weeks of daily treatments for a 70 Gy prescription dose to be delivered in 35 fractions [9,10,11,12,13]

Summary

Introduction

Millions of people are diagnosed with non-melanoma skin cancers (NMSC) worldwide each year. An electronic brachytherapy (EBT) system permits treatment of NMSC without the use of a radioactive isotope The incidence of both non-melanoma and melanoma skin cancers has been increasing over the past decade. A variety of modalities for the treatment of BCC and SCC are available, including surgery, radiation therapy and topical agents. Kohler-Brock, et al, reported their 10-year experience with 520 patients with skin lesions mainly comprising SCC and BCC treated with standardized surface applicators and a remote afterloading HDR system. Et al, published their series of 136 patients with BCC or SCC of the face treated with surface molds and HDR brachytherapy using a radioisotope source (Ir-192) and showed a 5-year local control rate of 98% with no severe early or late complications detected [16]

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