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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

Ultrasound (US) measurements of lateral extensions and depth. The largest lateral extent (mm) and second largest lateral extent (mm) of each non-melanomatous skin cancer measured with US and used for electronic brachytherapy planning are shown (A). The largest lateral extension (mm) and depth (mm) of each non-melanomatous skin cancer measured with US and used for electronic brachytherapy planning are shown (B)
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Figure 0003: Ultrasound (US) measurements of lateral extensions and depth. The largest lateral extent (mm) and second largest lateral extent (mm) of each non-melanomatous skin cancer measured with US and used for electronic brachytherapy planning are shown (A). The largest lateral extension (mm) and depth (mm) of each non-melanomatous skin cancer measured with US and used for electronic brachytherapy planning are shown (B)

Mentions: The mean largest diameter of all lesions was 8 mm (range 2.6-20 mm). The mean depth of all lesions was 2.1 mm (range 1-3.4 mm). For BCC, the largest lateral extent ranged from 2.6-12 mm and depth ranged from 1-3.4 mm. For SCC, the largest lateral extent ranged from 8-20 mm and depth ranged from 2.5-3.1 mm. The only upper extremity lesion had the largest lateral extent (20 mm). With US depth measurements, prescription depth could be rounded or prescribed to the fractional depth (e.g. 1.5 mm rather than every millimeter). Figure 3A and B shows the largest lateral extent and the second largest lateral extent, and also depicts the largest diameter and depth for each lesion using US-determined measurements for eBT. No correlation between location, lateral size, and depth was seen in our study.


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)

Ultrasound (US) measurements of lateral extensions and depth. The largest lateral extent (mm) and second largest lateral extent (mm) of each non-melanomatous skin cancer measured with US and used for electronic brachytherapy planning are shown (A). The largest lateral extension (mm) and depth (mm) of each non-melanomatous skin cancer measured with US and used for electronic brachytherapy planning are shown (B)
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0003: Ultrasound (US) measurements of lateral extensions and depth. The largest lateral extent (mm) and second largest lateral extent (mm) of each non-melanomatous skin cancer measured with US and used for electronic brachytherapy planning are shown (A). The largest lateral extension (mm) and depth (mm) of each non-melanomatous skin cancer measured with US and used for electronic brachytherapy planning are shown (B)
Mentions: The mean largest diameter of all lesions was 8 mm (range 2.6-20 mm). The mean depth of all lesions was 2.1 mm (range 1-3.4 mm). For BCC, the largest lateral extent ranged from 2.6-12 mm and depth ranged from 1-3.4 mm. For SCC, the largest lateral extent ranged from 8-20 mm and depth ranged from 2.5-3.1 mm. The only upper extremity lesion had the largest lateral extent (20 mm). With US depth measurements, prescription depth could be rounded or prescribed to the fractional depth (e.g. 1.5 mm rather than every millimeter). Figure 3A and B shows the largest lateral extent and the second largest lateral extent, and also depicts the largest diameter and depth for each lesion using US-determined measurements for eBT. No correlation between location, lateral size, and depth was seen in our study.

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