High-dose-rate brachytherapy using Leipzig applicators for non-melanoma localized skin cancer

• Published in: Journal of contemporary brachytherapy 2020-10, Vol.12 (5), p.435-440
• Main Authors: Pellizzon, Antonio Cassio Assis, Fogaroli, Ricardo, Chen, Michael Jenwey, Maia, Polyana, Gondim, Guilherme, Guedes, Douglas de Castro, Ramos, Henderson, Silva, Maria Leticia Gobo
• Format: Article
• Language: English
• Subjects: brachytherapy; high-dose-rate; mould; non-melanoma skin cancer; Original Paper
• ISSN: 1689-832X; 2081-2841
• DOI: 10.5114/jcb.2020.100376

Technological advances with commercial production of surface applicators allowed high-dose-rate (HDR) afterloading brachytherapy to overpass challenges associated with the delivery of superficial radiation when treating non-melanoma skin cancer (NMSC). We reviewed our single institutional experience using HDR to treat basal (BCC) and squamous cell (SCC) carcinomas. A retrospective review of all patients treated with HDR and Leipzig-style applicators for NMSC at the Radiation Oncology Department, AC Camargo Cancer Center, from March 2013 to December 2018 was performed. Seventy-one patients with 101 lesions (BCCs, 69.3% or = 70) and median age 80 (range, 51-102) years old were evaluated. The median follow-up was 42.8 (range, 12-82) months. The 3-year and 5-year actuarial local control (LC) rates were 97.9% and 87.2%, respectively. On univariate analysis, treatments with EQD less than 50 Gy ( < 0.001) and dose per fraction smaller than 3 Gy ( < 0.001) were found to be statistically significant predictive factors of a worse outcome. On multivariate analysis, SCC had a worse prognosis over BCC ( = 0.007, HR = 2.3, CI: 1.2-6.6). All patients developed some degree of acute side effects graded 1 to 2. Grade 3 acute side effects were observed in 9 (8.9%) patients. Moreover, severe late side effects (grade 3), hypopigmentation, and telangiectasia were observed in 4 (3.9%) patients. No grade 4 acute or late side effects were seen in this cohort. HDR offers a convenient treatment schedule for patients and is associated with excellent LC. The most effective regimen, in terms of dose and fractionation, to treat superficial NMSC with HDR remains uncertain, but a moderate minimum EQD dose of 50 Gy should be used.