eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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5/2020
vol. 12
 
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abstract:
Original paper

High-dose-rate brachytherapy using Leipzig applicators for non-melanoma localized skin cancer

Antonio Cassio Assis Pellizzon
1
,
Ricardo Fogaroli
1
,
Michael Jenwei Chen
1
,
Polyana Maia
1
,
Guilherme Gondim
1
,
Douglas de Castro Guedes
1
,
Henderson Ramos
1
,
Maria Leticia Gobo Silva
1

  1. Department of Radiation Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
J Contemp Brachytherapy 2020; 12, 5: 435–440
Online publish date: 2020/10/30
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Introduction
Technological advances with commercial production of surface applicators allowed high-dose-rate (HDR) afterloading brachytherapy to overpass challenges associated with the delivery of superficial radiation when treating non-melanoma skin cancer (NMSC). We reviewed our single institutional experience using HDR to treat basal (BCC) and squamous cell (SCC) carcinomas.

Material and methods
A retrospective review of all patients treated with HDR and Leipzig-style applicators for NMSC at the Radiation Oncology Department, AC Camargo Cancer Center, from March 2013 to December 2018 was performed.

Results
Seventy-one patients with 101 lesions (BCCs, 69.3% or n = 70) and median age 80 (range, 51-102) years old were evaluated. The median follow-up was 42.8 (range, 12-82) months. The 3-year and 5-year actuarial local control (LC) rates were 97.9% and 87.2%, respectively. On univariate analysis, treatments with EQD2 less than 50 Gy (p < 0.001) and dose per fraction smaller than 3 Gy (p < 0.001) were found to be statistically significant predictive factors of a worse outcome. On multivariate analysis, SCC had a worse prognosis over BCC (p = 0.007, HR = 2.3, CI: 1.2-6.6). All patients developed some degree of acute side effects graded 1 to 2. Grade 3 acute side effects were observed in 9 (8.9%) patients. Moreover, severe late side effects (grade 3), hypopigmentation, and telangiectasia were observed in 4 (3.9%) patients. No grade 4 acute or late side effects were seen in this cohort.

Conclusions
HDR offers a convenient treatment schedule for patients and is associated with excellent LC. The most effective regimen, in terms of dose and fractionation, to treat superficial NMSC with HDR remains uncertain, but a moderate minimum EQD2 dose of 50 Gy should be used.

keywords:

non-melanoma skin cancer, brachytherapy, high-dose-rate, mould

 
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