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Postoperative interstitial brachytherapy in eyelid cancer: long term results and assessment of Cosmesis After Interstitial Brachytherapy scale.

Laskar SG, Basu T, Chaudhary S, Chaukar D, Nadkarni M, Gn M - J Contemp Brachytherapy (2014)

Bottom Line: All patients had Radiation Therapy Oncology Group (RTOG) grade 1 acute toxicity and 2 had grade 1 Common Terminology Criteria for Adverse Events (CTCAE) version.3 late toxicities.The cosmesis score for the whole group ranged between 0-1 indicating excellent to very good cosmesis.Future prospective studies with the validation of CAIB scale would give us more insight to this effective yet often ignored modality of IBRT.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Tata Memorial Hospital.

ABSTRACT

Purpose: To analyse feasibility and safety of postoperative interstitial brachytherapy (IBRT) in patients of eyelid cancer treated primarily by surgical excision.

Material and methods: In this series, 8 patients with eyelid cancer were treated using postoperative interstitial brachytherapy. Patients were followed up for local control, cosmetic outcome, and acute and late toxicities. Cosmetic outcome was measured using a 6 point indigenous Cosmesis After Interstitial Brachytherapy (CAIB) scale.

Results: The patients were between 23-82 years (median: 71 years). There were 3 females and 5 males, and 3 patients had lesions in upper eyelid. Postoperative high-dose-rate brachytherapy was used in all with 2 catheters implanted in most of them (6 out of 8). Local control was calculated from end of treatment to last follow-up. At last follow-up, all patients remained locally controlled. Two patients had nodal recurrence 6 months after interstitial brachytherapy and were salvaged effectively by external beam radiotherapy. At last follow-up, 7 patients were loco-regionally controlled and one was lost to follow up. All patients had Radiation Therapy Oncology Group (RTOG) grade 1 acute toxicity and 2 had grade 1 Common Terminology Criteria for Adverse Events (CTCAE) version.3 late toxicities. The cosmesis score for the whole group ranged between 0-1 indicating excellent to very good cosmesis.

Conclusions: Postoperative high-dose-rate brachytherapy resulted in excellent disease control and cosmesis without significant acute or late toxicities. It is an effective modality for treatment of eyelid cancers in selected patients. Future prospective studies with the validation of CAIB scale would give us more insight to this effective yet often ignored modality of IBRT.

No MeSH data available.


Related in: MedlinePlus

Postoperative IBRT in eyelid cancer-planning and dosimetry
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Figure 0001: Postoperative IBRT in eyelid cancer-planning and dosimetry

Mentions: Between August 2007 and July 2012, 8 patients of eyelid cancer receiving post-operative HDR IBRT were analysed. There were 5 male and 3 female patients with age between 23-82 years. All of them underwent primary surgery in the form of wide excision followed by appropriate reconstruction. The initial tumour region was assessed clinically. Appropriate regional nodal dissection was carried out where necessary (parotid and/or neck). The disease was staged by American Joint Committee on Cancer (AJCC) 6th edition of TNM staging. The patient characteristics (demographics) are described in Table 1. Patients were planned for post-operative HDR IBRT after complete wound healing. The implant procedure was carried out under general anaesthesia. The tumour volume (post-operative target volume for brachytherapy) was based on the initial extent of disease and post-operative scar. The irradiated volume included the primary disease extent with a margin of 3-5 mm with modifications if required. Plastic tube technique was used for interstitial implant. In all patients, a single plane interstitial implant was carried out. Sixteen gauge stainless steel needles were used with appropriate spacing between them. Plastic tubes were then threaded through these needles and left in place after removal of the stainless steel needles. Plastic tubes were then secured, opposing the skin by means of plastic buttons and plastic beads (Fig. 1). During treatment, a custom made conformer was fashioned out of dental prosthesis material to prevent additional dose spillage to normal eyes. Image acquisition for brachytherapy treatment planning was done using a dedicated CT simulator. Images were acquired using the GE system light speed CT simulator (GE Health Care, Milwaukee, WI, USA) with patients in supine position with slice thickness of 1-1.5 mm. The brachytherapy planning was done using Nucletron Plato Sunrise V 14.3.1 computerized treatment planning system (Nucletron, an Elekta company, Elekta AB, Stockholm, Sweden). Optimization was done along dose points specified at a distance of 2-3 mm from the catheters depending on thickness of tumour bed. In the case of single wire implant, dose prescription point of 2 mm was selected as per the American Association of physicist in Medicine (AAPM) Task Group (TG) report no. 60 [12]. With two parallel implant wires, the dose prescription was followed as per Paris system recommendation [13]. The 85 or 100% isodose lines were used as reference isodose based on the adequacy of tumour bed coverage and the dose to normal structures like skin and cornea (Fig. 1).


Postoperative interstitial brachytherapy in eyelid cancer: long term results and assessment of Cosmesis After Interstitial Brachytherapy scale.

Laskar SG, Basu T, Chaudhary S, Chaukar D, Nadkarni M, Gn M - J Contemp Brachytherapy (2014)

Postoperative IBRT in eyelid cancer-planning and dosimetry
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4300356&req=5

Figure 0001: Postoperative IBRT in eyelid cancer-planning and dosimetry
Mentions: Between August 2007 and July 2012, 8 patients of eyelid cancer receiving post-operative HDR IBRT were analysed. There were 5 male and 3 female patients with age between 23-82 years. All of them underwent primary surgery in the form of wide excision followed by appropriate reconstruction. The initial tumour region was assessed clinically. Appropriate regional nodal dissection was carried out where necessary (parotid and/or neck). The disease was staged by American Joint Committee on Cancer (AJCC) 6th edition of TNM staging. The patient characteristics (demographics) are described in Table 1. Patients were planned for post-operative HDR IBRT after complete wound healing. The implant procedure was carried out under general anaesthesia. The tumour volume (post-operative target volume for brachytherapy) was based on the initial extent of disease and post-operative scar. The irradiated volume included the primary disease extent with a margin of 3-5 mm with modifications if required. Plastic tube technique was used for interstitial implant. In all patients, a single plane interstitial implant was carried out. Sixteen gauge stainless steel needles were used with appropriate spacing between them. Plastic tubes were then threaded through these needles and left in place after removal of the stainless steel needles. Plastic tubes were then secured, opposing the skin by means of plastic buttons and plastic beads (Fig. 1). During treatment, a custom made conformer was fashioned out of dental prosthesis material to prevent additional dose spillage to normal eyes. Image acquisition for brachytherapy treatment planning was done using a dedicated CT simulator. Images were acquired using the GE system light speed CT simulator (GE Health Care, Milwaukee, WI, USA) with patients in supine position with slice thickness of 1-1.5 mm. The brachytherapy planning was done using Nucletron Plato Sunrise V 14.3.1 computerized treatment planning system (Nucletron, an Elekta company, Elekta AB, Stockholm, Sweden). Optimization was done along dose points specified at a distance of 2-3 mm from the catheters depending on thickness of tumour bed. In the case of single wire implant, dose prescription point of 2 mm was selected as per the American Association of physicist in Medicine (AAPM) Task Group (TG) report no. 60 [12]. With two parallel implant wires, the dose prescription was followed as per Paris system recommendation [13]. The 85 or 100% isodose lines were used as reference isodose based on the adequacy of tumour bed coverage and the dose to normal structures like skin and cornea (Fig. 1).

Bottom Line: All patients had Radiation Therapy Oncology Group (RTOG) grade 1 acute toxicity and 2 had grade 1 Common Terminology Criteria for Adverse Events (CTCAE) version.3 late toxicities.The cosmesis score for the whole group ranged between 0-1 indicating excellent to very good cosmesis.Future prospective studies with the validation of CAIB scale would give us more insight to this effective yet often ignored modality of IBRT.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Tata Memorial Hospital.

ABSTRACT

Purpose: To analyse feasibility and safety of postoperative interstitial brachytherapy (IBRT) in patients of eyelid cancer treated primarily by surgical excision.

Material and methods: In this series, 8 patients with eyelid cancer were treated using postoperative interstitial brachytherapy. Patients were followed up for local control, cosmetic outcome, and acute and late toxicities. Cosmetic outcome was measured using a 6 point indigenous Cosmesis After Interstitial Brachytherapy (CAIB) scale.

Results: The patients were between 23-82 years (median: 71 years). There were 3 females and 5 males, and 3 patients had lesions in upper eyelid. Postoperative high-dose-rate brachytherapy was used in all with 2 catheters implanted in most of them (6 out of 8). Local control was calculated from end of treatment to last follow-up. At last follow-up, all patients remained locally controlled. Two patients had nodal recurrence 6 months after interstitial brachytherapy and were salvaged effectively by external beam radiotherapy. At last follow-up, 7 patients were loco-regionally controlled and one was lost to follow up. All patients had Radiation Therapy Oncology Group (RTOG) grade 1 acute toxicity and 2 had grade 1 Common Terminology Criteria for Adverse Events (CTCAE) version.3 late toxicities. The cosmesis score for the whole group ranged between 0-1 indicating excellent to very good cosmesis.

Conclusions: Postoperative high-dose-rate brachytherapy resulted in excellent disease control and cosmesis without significant acute or late toxicities. It is an effective modality for treatment of eyelid cancers in selected patients. Future prospective studies with the validation of CAIB scale would give us more insight to this effective yet often ignored modality of IBRT.

No MeSH data available.


Related in: MedlinePlus