Despite greater toxicity, the use of MMC in a definitive CR regimen for anal cancer is justified, particularly in patients with large primary tumors. Salvage CR should be attempted in patients with residual disease following definitive CR before resorting to radical surgery.

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PurposeHigh-dose-rate electronic brachytherapy (EBT) provides a non-surgical treatment option for non-melanoma skin cancer (NMSC). This matched-pair cohort study compared the outcomes of treatment with EBT to those of Mohs micrographic surgery (MMS) in patients with NMSC.Material and methodsAt four treatment centers, patients treated with EBT were case matched to patients treated with MMS based on retrospectively-collected patient age, lesion size, location and type, and year of treatment. Follow-up data were prospectively collected and included local recurrence, toxicities, cosmesis, and patient-reported outcomes.ResultsThe 369 patients (188 in the EBT treatment group and 181 in the MMS treatment group) had 416 lesions (208 in the EBT group and 208 in the MMS group), including 226 basal cell carcinomas (BCC) and 190 squamous cell carcinomas (SCC). Most patients were Caucasian (98.9% and 99.5%) and male (65.4% and 66.3%) of median age 80.7 (range: 61-98) (EBT) and 76.8 (range: 51-98) years (MMS). Most lesions were size > 1 cm and ≤ 2 cm, and located on the head. At mean 3.4 years post-treatment, 99.5% of EBT, and 100.0% of MMS-treated lesions were free of recurrence (p = ns). One recurrence was noted in the EBT group. Physicians rated cosmesis as “excellent” or “good” in 97.6% of EBT-treated lesions, and 95.7% of MMS-treated lesions.ConclusionsThis matched-pair cohort study supports the use of EBT as an effective non-surgical treatment option for NMSC with equivalent recurrence rates and cosmetic outcomes to MMS in appropriately-selected patients with early stage NMSC at extended follow-up.

High dose rate electronic brachytherapy (EBX) provides a non-surgical treatment option for nonmelanoma skin cancer (NMSC). This matched-pair cohort study compared the outcomes of treatment with EBX to those of Mohs micrographic surgery (MMS) in patients with NMSC. METHODSAll patients who had already received EBX for NMSC at 4 clinical sites and met the eligibility criteria were invited to participate. EBX was previously administered using the Xoft® Axxent® Electronic Brachytherapy System® (Xoft, Inc., A Subsidiary of iCAD, Inc. San Jose, CA). Standard surface applicators (Xoft, Inc.) included sizes 10, 20, 35, and 50 mm in diameter and EBX was administered in 8-10 fractions twice per week, with a dose per fraction of 4, 4.5 or 5 Gy, to an average depth of 3mm. MMS was previously performed by clinicians who had completed Mohs fellowship training, and surgeries were conducted according to guidelines of the ACMS. The EBX participants were individually matched with MMS patients based on patient age, lesion size (≤1cm, >1cm ≤2cm, >2cm ≤3 cm) type, and location (head, nose, torso, upper extremity, lower extremity), and treatment dates. Eligibility criteria included: Completion of EBX or MMS for NMSC ≥3 years prior to enrollment; age >40 years; pathological diagnosis confirmed (SCC, BCC) prior to treatment; cancer stage 0-2. Exclusion criteria included: Target area adjacent to a burn scar; surgical resection of the cancer prior to EBX; known metastatic disease. Data were collected prospectively at an office visit, during which patients were clinically evaluated by the physician who had conducted the EBX or MMS, and each participant completed a questionnaire. RESULTSThe 369 patients (188 in the EBX treatment group and 181 in the MMS treatment group) had 416 lesions (208 in the EBX group and 208 in the MMS group), including 226 basal cell carcinomas (BCC) and 190 squamous cell carcinomas (SCC). Most patients were Caucasian (98.9% and 99.5%) and male (65.4% and 66.3%) of median age 80.7 (EBX) and 76.8 years (MMS). Most lesions were size >1 cm and ≤2 cm, and located on the head (Ear/Eyelid/Face/Neck/Lip/Scalp), 59.2% in each group. At follow up, 66.7% of EBX and 68.8% showed a relatively invisible scar (p=ns). 99.5% of EBX and 100.0% of MMS-treated lesions were recurrence-free (p=ns). Physicians rated cosmesis as "Excellent" or "Good" in 97.6% and 95.7% of EBXtreated and MMS-treated lesions respectively (p=ns). CONCLUSIONRecurrence rates and patient reported outcomes with EBX and MMS were similar at a mean of 3.4 years following treatment of NMSC. Poor 5 (2.4%) 0 (0.0%) (χ2 p-value = 0.277). Cosmesis ratings by patients were "excellent" or "good" in 90% of EBT-treated sites and 95% of MMS-treated sites 1. Adapted from Cox et al. Comparison of Electronic Brachytherapy and Mohs Micrographic Surgery for the Treatment of Early-Stage Non-Melanoma Skin