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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

Non-melanomatous skin cancer treated with electronic brachytherapy. A scalp lesion measured to be 6.3 mm × 4 mm × 2 mm with ultrasound was treated with a 35 mm applicator to a 2 mm depth. The dose regimen was 40 Gy in 10 fractions every other day and the lesion is shown: (A) prior to initial treatment, (B) after 5 fractions, (C) after completion of 10 fractions, and (D) after 1 month follow-up. There was progressively worsening erythema over the course of electronic brachytherapy that resolved after 1 month
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Figure 0004: Non-melanomatous skin cancer treated with electronic brachytherapy. A scalp lesion measured to be 6.3 mm × 4 mm × 2 mm with ultrasound was treated with a 35 mm applicator to a 2 mm depth. The dose regimen was 40 Gy in 10 fractions every other day and the lesion is shown: (A) prior to initial treatment, (B) after 5 fractions, (C) after completion of 10 fractions, and (D) after 1 month follow-up. There was progressively worsening erythema over the course of electronic brachytherapy that resolved after 1 month

Mentions: All patients have had a complete response, and with a median follow-up of 12 months (range 6-22 months), there have been no failures. More importantly, there have been no cases of grade 4 skin necrosis or delayed healing. Figure 4 shows progressively worsening radiation-induced erythema during eBT for a patient with BCC. This grade 2 erythema usually resolves by the 1 month follow-up.


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)

Non-melanomatous skin cancer treated with electronic brachytherapy. A scalp lesion measured to be 6.3 mm × 4 mm × 2 mm with ultrasound was treated with a 35 mm applicator to a 2 mm depth. The dose regimen was 40 Gy in 10 fractions every other day and the lesion is shown: (A) prior to initial treatment, (B) after 5 fractions, (C) after completion of 10 fractions, and (D) after 1 month follow-up. There was progressively worsening erythema over the course of electronic brachytherapy that resolved after 1 month
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0004: Non-melanomatous skin cancer treated with electronic brachytherapy. A scalp lesion measured to be 6.3 mm × 4 mm × 2 mm with ultrasound was treated with a 35 mm applicator to a 2 mm depth. The dose regimen was 40 Gy in 10 fractions every other day and the lesion is shown: (A) prior to initial treatment, (B) after 5 fractions, (C) after completion of 10 fractions, and (D) after 1 month follow-up. There was progressively worsening erythema over the course of electronic brachytherapy that resolved after 1 month
Mentions: All patients have had a complete response, and with a median follow-up of 12 months (range 6-22 months), there have been no failures. More importantly, there have been no cases of grade 4 skin necrosis or delayed healing. Figure 4 shows progressively worsening radiation-induced erythema during eBT for a patient with BCC. This grade 2 erythema usually resolves by the 1 month follow-up.

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