Treatment of Non-Melanoma Skin Cancer with Different Radiation Techniques

Abstract

ABSTRACT Aim: To compare local control and toxicity in non melanoma skin cancer treated with electrons and Leipzig applicators. Methods: We evaluated 60 patients (pts) with non melanoma skin cancer treated using electrons and Leipzig applicators (microselectron-HDR afterloader). The lesions were: 30 basal cell cancer, 17 squamous cell cancer, 10 basosquamous cell cancer, 1 dermatofibrosarcoma, 1 keloid, 1 histiocytoma fibrosus. Median age was 54 (25-84). The lesions were localized on head and neck, except 1 in the sternum and 1 in posterior part of knee. 49 pts underwent surgery before radiation treatment with negative margin in 38 pts and positive margins in 11. 30 pts were treated with electrons to a total dose 40 to 50 Gy (2Gy/fr). Electrons beam energy was selected based on delivering the treatment to the 90% isodose line, using bolus when required to superficialize the depth of the dose. 30 pts, considering the size and the depth of the lesions (0.5-3cm) were treated with Leipzig applicators using a dose of 40 Gy in 8 fractions twice a week for 4 weeks. Results: Median follow up was 12 months in each group. Electrons group report 30 complete remissions of tumor lesion. Leipzig group reports 26 complete remissions and 4 partial remissions including keloid. Recurrences appeared in 5 pts with lesion size larger than 2 cm or depth> 3mm. Tolerance to the treatment was good in each group with no difficulties in compliance but longer treatment is not well tolerate by elderly pts for positioning. Acute toxicity was similar in both groups, with a low or mild skin toxicity according RTOG toxicity scale. Conclusions: Our experience suggests both Leipzig and Electrons treatment are feasible and well tolerate with a good or excellent cosmetic results. Yet Leipzig technique with surface applicators of different diameters, although the radiation is hightly direct on lesion covering it completly, radiation may leak through the backside of the applicators having uncertainties of dosimetric distributions. So we consider Leipzig a good treatment in few selected pts with a very small and superficial skin lesions ( Disclosure: All authors have declared no conflicts of interest.