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

Bhatnagar A, Loper A - Radiat Oncol (2010)

Bottom Line: Pre-treatment biopsy was performed to confirm a malignant cutaneous diagnosis.No severe toxicities occurred.Using a hypofractionated approach, EBT provides a convenient treatment schedule.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA USA. abhatnagar@cancertreatmentservices.com

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.

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Related in: MedlinePlus

EBT Source Beam Profile.
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Figure 3: EBT Source Beam Profile.

Mentions: Electronic brachytherapy (EBT) is the administration of HDR brachytherapy without the use of a radioactive isotope and with minimal shielding requirements due to the low energies utilized with this system. EBT treatments are delivered using the Axxent® System controller, source and surface applicators (Xoft Inc., Sunnyvale, CA), which have been cleared by the United States Food and Drug Administration to deliver HDR X-ray radiation for brachytherapy. The EBT skin surface applicator weighs less than 2 pounds and appears similar to the Leipzig applicator used with HDR Iridium-192 (Ir-192) brachytherapy (Figure 1). Dosimetric analyses have been performed revealing similar depth dose profiles for these two surface applicators (Figure 2)[17-19]. However, data output for the beam profile measurements show superior beam flatness with reduced penumbra for the EBT surface applicator (Figure 3)[17-20].


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

Bhatnagar A, Loper A - Radiat Oncol (2010)

EBT Source Beam Profile.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2957390&req=5

Figure 3: EBT Source Beam Profile.
Mentions: Electronic brachytherapy (EBT) is the administration of HDR brachytherapy without the use of a radioactive isotope and with minimal shielding requirements due to the low energies utilized with this system. EBT treatments are delivered using the Axxent® System controller, source and surface applicators (Xoft Inc., Sunnyvale, CA), which have been cleared by the United States Food and Drug Administration to deliver HDR X-ray radiation for brachytherapy. The EBT skin surface applicator weighs less than 2 pounds and appears similar to the Leipzig applicator used with HDR Iridium-192 (Ir-192) brachytherapy (Figure 1). Dosimetric analyses have been performed revealing similar depth dose profiles for these two surface applicators (Figure 2)[17-19]. However, data output for the beam profile measurements show superior beam flatness with reduced penumbra for the EBT surface applicator (Figure 3)[17-20].

Bottom Line: Pre-treatment biopsy was performed to confirm a malignant cutaneous diagnosis.No severe toxicities occurred.Using a hypofractionated approach, EBT provides a convenient treatment schedule.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA USA. abhatnagar@cancertreatmentservices.com

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.

Show MeSH
Related in: MedlinePlus