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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 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).
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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).

Mentions: Patients were followed for a median of 4.1 months (range 1-9 months). There have been no recurrences to date. Cosmetic outcomes were assessed as excellent, good, fair or poor according to Cox, et al., at each follow-up visit[24]. All patients had an excellent or good cosmetic outcome at each follow-up visit. At 1-month of follow up, 90% of patients had excellent cosmesis, and 10% had good cosmesis. At 3-months of follow up, 95% of the 19 evaluable patients had excellent cosmesis, and 5% had good cosmesis. An example of BCC treatment resulting in an excellent cosmetic outcome at 6 months post-radiation therapy is shown in Figure 4.


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

Bhatnagar A, Loper A - Radiat Oncol (2010)

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).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

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).
Mentions: Patients were followed for a median of 4.1 months (range 1-9 months). There have been no recurrences to date. Cosmetic outcomes were assessed as excellent, good, fair or poor according to Cox, et al., at each follow-up visit[24]. All patients had an excellent or good cosmetic outcome at each follow-up visit. At 1-month of follow up, 90% of patients had excellent cosmesis, and 10% had good cosmesis. At 3-months of follow up, 95% of the 19 evaluable patients had excellent cosmesis, and 5% had good cosmesis. An example of BCC treatment resulting in an excellent cosmetic outcome at 6 months post-radiation therapy is shown in Figure 4.

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