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ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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5/2021
vol. 13
 
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abstract:
Original paper

Electronic brachytherapy for treatment of non-melanoma skin cancers: clinical results and toxicities

Uma Goyal
1
,
Michael K. Cheung
2
,
Justin Suszko
3
,
Brady Laughlin
4
,
Yongbok Kim
5
,
Jeanette Askam
5
,
Hina Arif-Tiwari
6
,
Benjamin Slane
7
,
John Gordon
8
,
Baldassare Stea
5

  1. Banner MD Anderson Cancer Center and University of Arizona, Phoenix, USA
  2. Veterans Affair West Los Angeles Healthcare System, Radiation Oncology, Los Angeles, USA
  3. RadiantCare, Lacey, USA
  4. Department of Radiation Oncology, Mayo Clinic, Phoenix, USA
  5. Department of Radiation Oncology, Banner University Medical Center Tucson, USA
  6. Department of Medical Imaging, Banner University Medical Center, Tucson, USA
  7. Lawrence Cancer Center, Radiation Oncology, Lawrence, USA
  8. Intermountain Healthcare, Salt Lake City, USA
J Contemp Brachytherapy 2021; 13, 5: 497–503
DOI: https://doi.org/10.5114/jcb.2021.109753
Online publish date: 2021/10/06
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Introduction
Although surgical approaches are standard for most non-melanomatous skin cancers, some patients are not candidates due to medical co-morbidities or functional or cosmetic or lesion location. High-dose-rate electronic brachytherapy (HDR-EBT) may be an alternative treatment modality.

Material and methods
A retrospective chart review was conducted from April 2011 to April 2013. All lesions were pathologically confirmed as malignant basal cell or squamous cell carcinoma. A HDR-EBT system delivered a median biological equivalent dose of 50 Gy total to a depth of 0.1-0.5 cm using various sizes of applicators. Treatment feasibility, acute and late toxicity, cosmetic outcomes, and local recurrence were assessed.

Results
Thirty-three patients with a mean age of 76 years with 50 cutaneous lesions were treated. Locations included 17 extremity lesions and 33 head and neck lesions. After treatments, acute grade 3 moist desquamation developed in 9 of the lesions (18%). Acute grade 4 ulceration developed in 3 lesions in the lower extremity (6%) and 1 upper lip lesion (2%). These toxicities were improved after a median of 20 days. Amongst the 4 lesions with grade 4 toxicities, a greater proportion were in lower extremity lesions compared to head and neck lesions (75% vs. 25%). There was no difference in the rate of grade 3 and 4 toxicities between patients aged ≤ 75 years and aged > 75 years (p = 0.082). With a mean long-term follow-up of 45.6 months, there was 1 local recurrence treated with surgery and no reported late toxicities.

Conclusions
Our experience with HDR-EBT for non-melanomatous skin cancers is encouraging in terms of efficacy and convenience for patients. Our long-term follow-up shows a good response in all treated sites. Caution should be used for extremity sites, and more fractionated regimens should be considered to avoid severe acute toxicities.

keywords:

electronic brachytherapy, toxicities, clinical

  
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