29 Skin Cancer

Skin Cancer

14

THE GEC ESTROHANDBOOKOF BRACHYTHERAPY | Part II Clinical Practice Version 1 - 30/04/2017

Table 31.3: Local control after HDR skin brachytherapy in in basal cell and squamous cell skin carcinoma: various patient cohorts with heterogeneous treatment schedules (retrospective evalua- tion)

Author [reference]

Local control

Year

Number

System Fractions Prescription Total dose Frequency

Single/ weekly/ twice a day/ Daily Twice a day

4-22 Gy 9 Gy x 3 at surface

Silicone moulds

Svoboda [42]

1995

130

1-15

12-50 Gy

100%

Allan [43]

1998

13

moulds

8

5.5 Gy x 8

44Gy

100%

Kohler-Brock [44]

1999

520

Leipzig app

5-10 Gy

30 Gy

1-2/week

92%

33-36 + Boost 42-44

1.8 Gy at 5mm

60-65 Gy 75-80 Gy

99% radical 87% adjuvant

Guix [49]

2000

136

moulds

Daily

4 Gy at 5

Montero [50]

2009

11

moulds

11-12

100%

mm 44-48 Gy

Wax/ bolus molds

3-4 Gy at 3 mm 48-57 Gy 3 times per week

Maroñas [51]

2011

51

12-18

89% at 5y.

6,5 Gy at 5-10mm 39Gy 3 G-4y at 3-4mm 36 Gy

90% 50%

Azad [53]

2011

20 eyelid Interstitial

6

6 days

Gauden [45]

2013

236

Leipzig app

12

Daily

98%

Electronic BT

Twice a week Twice a week

100% at 10m.

Bathnagar [54]

2013

171

8

5 Gy

40 Gy

Tormo [47]

6-7 Gy at 3-4mm 42 Gy 5 Gy at 3-4mm 40-50Gy

2014

45

Valencia app

6-7

97.7% at 4y.

2-3 times per week

96% at 1 year

Delishaj [48]

2015

57

Valencia app

8-10

Leipzig app 101 Molds 33

95% 88% at 5 y.

Arenas [46]

2015

134

15-18

3Gy at 5mm 45-54Gy 3 times per week

Kohler-Brock et al. [44] treated 520 skin lesions with Leipzig applicators™, reaching a total dose of 30-40 Gy, 5-10 Gy/fraction, 1 or 2 fractions/wk with complete response in 91% of the cases, partial in 6%, and a relapse rate of 8%, without late complications. Another study with Leipzig applicators™ used lower doses per fraction, 3 Gy daily x 12 fractions to deliver 36 Gy prescribed to 3-4mm, in 236 lesions with median follow-up of 66 months and achieved 98% of local control with cosmesis good or excellent in 88% [45]. In 101 cases with 3Gy three times per week x 15-18 fractions, achieved local control in 95% at 5 years [46] (Fig. 13.17). With Valencia™ applicators, the first results treating 45 cases of BCC, 6-7 Gy twice a week to achieve 42Gy at 3-4mmobtain a local control of 97.7% with a mean follow-up of 47 months [47] (Fig. 13.18). With 5Gy 2-3 times per week to 40-50 Gy 96% showed a complete response after 12 months [48]. Guix et al. [49] treated 136 cutaneous carcinomas with contact HDR-BT reaching a total dose of 60-65 Gy, 1.8 Gy/session, and for lesions greater than 4cm, a boost of 18 Gy was added.The actuarial local control rate at 5 years was 98%; 99% for the treatments with radical intention (n=73), and 87% for the adjuvant treatments (n=63). Montero et al. [50] used custom-made moulds in 11 cases of non- melanoma skin carcinoma, with 11-12 fractions of 4 Gy over 4

weeks to achieve 44-48 Gy, with no relapses at 15 months Maroñas et al. [51] treated 51 facial skin carcinomas, with a size between 0.5 and 4 cm and a maximum thickness of 3 mm, making customized moulds, with a dose per fraction of 3-4 Gy three times a week. The relapse rate was 9.8% with median follow-up of 45 months. No failure was recorded on flat surfaces. To treat nose carcinomas, a wax mould with plastic tubes was made, only one of 20 cases (5%) on the nasal bridge or alae had recurrences, but 4 out of 15 cases (27%) on the nasal tip, because the applicator did not fully cover the margins to be radiated (Fig. 13.19). Unusual locations as eyelid carcinomas, have been treated with HDRwith successful results, achieving local control in 17 cases at a mean follow-up of 24 months, with 10 fractions of 4 Gy prescribed at 3mmwith no visual complication reported [52]. Azad et al. [53] treated 20 carcinomas of the eyelid with six fractions of 6.5 Gy in six days with HDR brachytherapy, and with a median follow up of 40 months, the 5-year disease free survival rate was 90%, 57% and 50 % for squamous, sebaceous cell and basal cell carcinoma respectively. Initial experience with electronic brachytherapy appears to show acceptable acute safety and favourable cosmetic outcomes. Treatment of 171 skin carcinomas delivering eight fractions of 5 Gy twice weekly showed no recurrence with a median follow-up of 10 months [19]. In 40 patients treated with six fractions of 7 Gy or