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A pilot study of ultrasound-guided electronic brachytherapy for skin cancer.

Goyal U, Kim Y, Tiwari HA, Witte R, Stea B - J Contemp Brachytherapy (2015)

Bottom Line: All patients had a complete response and no failures have occurred with a median follow-up of 12 months (range of 6-22 months).Also, no prolonged skin toxicities have occurred.A routinely available radiological US unit can objectively determine depth and lateral extension of NMSC lesions for more accurate eBT treatment planning, and should be considered in future eBT treatment guidelines.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology.

ABSTRACT

Purpose: Electronic brachytherapy (eBT) has gained acceptance over the past 5 years for the treatment of non-melanomatous skin cancer (NMSC). Although the prescription depth and radial margins can be chosen using clinical judgment based on visual and biopsy-derived information, we sought a more objective modality of measurement for eBT planning by using ultrasound (US) to measure superficial (< 5 mm depth) lesions.

Material and methods: From December 2013 to April 2015, 19 patients with 23 pathologically proven NMSCs underwent a clinical examination and US evaluation of the lesions prior to initiating a course of eBT. Twenty lesions were basal cell carcinoma and 3 lesions were squamous cell carcinoma. The most common location was the nose (10 lesions). A 14 or 18 MHz US unit was used by an experienced radiologist to determine depth and lateral extension of lesions. The US-measured depth was then used to define prescription depth for eBT planning without an added margin. A margin of 7 mm was added radially to the US lateral extent measurements, and an appropriate cone applicator size was chosen to cover the target volume.

Results: The mean depth of the lesions was 2.1 mm with a range of 1-3.4 mm, and the mean largest diameter of the lesions was 8 mm with a range of 2.6-20 mm. Dose ranged from 32-50 Gy in 8-20 fractions with a median dose of 40 Gy in 10 fractions. All patients had a complete response and no failures have occurred with a median follow-up of 12 months (range of 6-22 months). Also, no prolonged skin toxicities have occurred.

Conclusions: A routinely available radiological US unit can objectively determine depth and lateral extension of NMSC lesions for more accurate eBT treatment planning, and should be considered in future eBT treatment guidelines.

No MeSH data available.


Related in: MedlinePlus

Clinical setup and ultrasound image. A right forehead basal cell carcinoma (A) delineated with a pen (dotted line) and (B) on ultrasound found to have a hypoechoic lesion that measures 7.5 mm in the transverse dimension, 3 mm in depth and 5 mm in the sagittal dimension (not shown). A 20 mm applicator was chosen to treat to a depth of 3 mm. A hyperechoic epidermis (thin arrow), a hypoechoic dermal layer with a more echoic signal from subcutaneous fat beneath (arrowhead), and the strongly echoic layer below subcutaneous fat is bone that creates shadowing so nothing deeper is anatomically distinguishable (thick arrows)
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Figure 0002: Clinical setup and ultrasound image. A right forehead basal cell carcinoma (A) delineated with a pen (dotted line) and (B) on ultrasound found to have a hypoechoic lesion that measures 7.5 mm in the transverse dimension, 3 mm in depth and 5 mm in the sagittal dimension (not shown). A 20 mm applicator was chosen to treat to a depth of 3 mm. A hyperechoic epidermis (thin arrow), a hypoechoic dermal layer with a more echoic signal from subcutaneous fat beneath (arrowhead), and the strongly echoic layer below subcutaneous fat is bone that creates shadowing so nothing deeper is anatomically distinguishable (thick arrows)

Mentions: Normal anatomy: The layers of skin: epidermis (thickness 0.06-0.6 mm), dermis (thickness 1-4 mm), and hypodermis (subcutaneous tissues; thickness 5-20 mm) can be visualized on US. The epidermis appears as the most superficial, well-defined, hyperechoic, linear band producing the “entry echo” between the US gel and skin (epidermal entry echo [EEE]). The dermis below the epidermis is also hyperechoic, usually less echogenic than epidermis, and with hypoechoic hair follicles, vessels, and sebaceous glands. The hypodermis is hypoechoic with intervening hyperechoic connective tissue septa separating fat lobules. Underneath the skin, superficial fascia covering muscle may be identified as a linear hyperechoic structure [29, 30]. Figure 2B illustrates each layer described on US.


A pilot study of ultrasound-guided electronic brachytherapy for skin cancer.

Goyal U, Kim Y, Tiwari HA, Witte R, Stea B - J Contemp Brachytherapy (2015)

Clinical setup and ultrasound image. A right forehead basal cell carcinoma (A) delineated with a pen (dotted line) and (B) on ultrasound found to have a hypoechoic lesion that measures 7.5 mm in the transverse dimension, 3 mm in depth and 5 mm in the sagittal dimension (not shown). A 20 mm applicator was chosen to treat to a depth of 3 mm. A hyperechoic epidermis (thin arrow), a hypoechoic dermal layer with a more echoic signal from subcutaneous fat beneath (arrowhead), and the strongly echoic layer below subcutaneous fat is bone that creates shadowing so nothing deeper is anatomically distinguishable (thick arrows)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663218&req=5

Figure 0002: Clinical setup and ultrasound image. A right forehead basal cell carcinoma (A) delineated with a pen (dotted line) and (B) on ultrasound found to have a hypoechoic lesion that measures 7.5 mm in the transverse dimension, 3 mm in depth and 5 mm in the sagittal dimension (not shown). A 20 mm applicator was chosen to treat to a depth of 3 mm. A hyperechoic epidermis (thin arrow), a hypoechoic dermal layer with a more echoic signal from subcutaneous fat beneath (arrowhead), and the strongly echoic layer below subcutaneous fat is bone that creates shadowing so nothing deeper is anatomically distinguishable (thick arrows)
Mentions: Normal anatomy: The layers of skin: epidermis (thickness 0.06-0.6 mm), dermis (thickness 1-4 mm), and hypodermis (subcutaneous tissues; thickness 5-20 mm) can be visualized on US. The epidermis appears as the most superficial, well-defined, hyperechoic, linear band producing the “entry echo” between the US gel and skin (epidermal entry echo [EEE]). The dermis below the epidermis is also hyperechoic, usually less echogenic than epidermis, and with hypoechoic hair follicles, vessels, and sebaceous glands. The hypodermis is hypoechoic with intervening hyperechoic connective tissue septa separating fat lobules. Underneath the skin, superficial fascia covering muscle may be identified as a linear hyperechoic structure [29, 30]. Figure 2B illustrates each layer described on US.

Bottom Line: All patients had a complete response and no failures have occurred with a median follow-up of 12 months (range of 6-22 months).Also, no prolonged skin toxicities have occurred.A routinely available radiological US unit can objectively determine depth and lateral extension of NMSC lesions for more accurate eBT treatment planning, and should be considered in future eBT treatment guidelines.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology.

ABSTRACT

Purpose: Electronic brachytherapy (eBT) has gained acceptance over the past 5 years for the treatment of non-melanomatous skin cancer (NMSC). Although the prescription depth and radial margins can be chosen using clinical judgment based on visual and biopsy-derived information, we sought a more objective modality of measurement for eBT planning by using ultrasound (US) to measure superficial (< 5 mm depth) lesions.

Material and methods: From December 2013 to April 2015, 19 patients with 23 pathologically proven NMSCs underwent a clinical examination and US evaluation of the lesions prior to initiating a course of eBT. Twenty lesions were basal cell carcinoma and 3 lesions were squamous cell carcinoma. The most common location was the nose (10 lesions). A 14 or 18 MHz US unit was used by an experienced radiologist to determine depth and lateral extension of lesions. The US-measured depth was then used to define prescription depth for eBT planning without an added margin. A margin of 7 mm was added radially to the US lateral extent measurements, and an appropriate cone applicator size was chosen to cover the target volume.

Results: The mean depth of the lesions was 2.1 mm with a range of 1-3.4 mm, and the mean largest diameter of the lesions was 8 mm with a range of 2.6-20 mm. Dose ranged from 32-50 Gy in 8-20 fractions with a median dose of 40 Gy in 10 fractions. All patients had a complete response and no failures have occurred with a median follow-up of 12 months (range of 6-22 months). Also, no prolonged skin toxicities have occurred.

Conclusions: A routinely available radiological US unit can objectively determine depth and lateral extension of NMSC lesions for more accurate eBT treatment planning, and should be considered in future eBT treatment guidelines.

No MeSH data available.


Related in: MedlinePlus