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

Ajay Bhatnagar, Alphonse Loper, Ajay Bhatnagar, Alphonse Loper

Abstract

Background: Millions 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.

Methods: Data 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.

Results: Thirty-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.

Conclusions: The 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.

Figures

Figure 1
Figure 1
EBT Surface Applicators for Use with the Axxent® System.
Figure 2
Figure 2
Depth Dose Comparison of HDR EBT with HDR 192Iridium.
Figure 3
Figure 3
EBT Source Beam Profile.
Figure 4
Figure 4
EBT Treatment of Basal Cell Carcinoma. Photo at pretreatment (top left), prior to fraction 7 of 8 (top right), at one-month follow up (bottom left), and at six months of follow up (bottom right).
Figure 5
Figure 5
EBT Treatment of Cutaneous T-cell Lymphoma. Photo at pretreatment (left) and at two months of follow up (right).

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Source: PubMed

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