ESTRO 2022

Session Item

Brachytherapy: Head and neck, skin, eye

Session Code: 7018

Session Type: Poster (digital)

Track: Brachytherapy

Therapeutic possibilities in the radiation treatment of NMSC: brachytherapy vs. electrons therapy

Carlos Camacho Fuentes, Spain

Presentation Number: PO-1812

Abstract

Abstract Title:

Therapeutic possibilities in the radiation treatment of NMSC: brachytherapy vs. electrons therapy

Authors:

Carlos Camacho Fuentes¹, Carla Sánchez Cortés¹, María Calderó Torra¹, María Luisa Ferrández Millán¹, Marina Gascón Ferrer¹, Luis Sopeña Sanz¹

¹Lozano Blesa Clinical Universitary Hospital, Radiation Oncology, Zaragoza, Spain

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Purpose or Objective

The incidence of skin cancer has been increasing in recent decades, with an estimated 2-3 million non-melanoma skin cancer (NMSC) occurring annually globally. There are different treatment modalities for this pathology, with brachytherapy (BT) playing a fundamental role. The main objective of this work is to compare the toxicity profile, aesthetic results and local control of patients with non-melanoma skin cancer treated with skin brachytherapy with Leipzig applicator versus those treated with electron therapy (ET) at the Lozano Blesa Clinical Universitary Hospital.

Material and Methods

A retrospective-comparative study where demographic, tumor, treatment and toxicity characteristics of 22 patients treated with BT at 42Gy/7fx and 24 treated with ET at 45-55Gy/9-11fx from June/2020 to June/2021 were collected and analyzed.

Table 1. ASTRO indications for radiation therapy in NMSC.
Type of treatment	Histology	Indications
Radical	BCC and SCC	Patients who cannot undergo or decline surgical resection. Patients with tumors in anatomic locations where surgery can compromise function or cosmesis.
Adjuvant	BCC and SCC	For groos perineural spread that is clinically or radiologically apparent. Close or positive margins that cannot be corrected with further surgery (secondary to morbidity or adverse cosmetic outcome). In the setting of recurrence after a prior margin-negative resection.
	BCC	Locally advanced or neglected tumors involving bone or infiltrating into muscle.
	SCC	T3 and T4 tumors. For desmoplastic or infiltrative tumors in the setting of chronic immunosuppression.

Results

Median follow-up was 8 months (range 3-11). 21 patients received treatment with radical intention and 24 as adjuvant. Median age was 77.5 years (57.8% were male). In terms of histology, 53.3% were squamous cell carcinomas and 46.7% basal cell carcinomas. The most frequently treated site was frontoparietal (35.6%). The most frequent collimator diameters used in BT were 45 and 30mm. Of those treated with BT, 66.7% presented acute toxicity (42.9% G-I and 28.6 G-II) and 46.6% chronic toxicity, compared to 100% (62.5% G-I and 33.3% G-II) (p=0.011) and 50% of those treated with ET, respectively. A total of 86.7% obtained excellent aesthetic results with BT and 75% with ET. 100% obtained a complete response at 90 days. There were no recurrences and only one death occurred due to non-tumor causes.

Conclusion

With equal effectiveness in the treatment of NMSC, BT with Leipzig applicators appears to have better acute toxicity profiles than ET.