A small case series about safety and effectiveness of a hypofractionated electron beam radiotherapy schedule in five fractions for facial non melanoma skin cancer among frail and elderly patients

Abstract

background:The aim of the study was to evaluate local control and toxicities of strongly hypofractionated electron beam radiotherapy (rT) in elderly and fragile patients with facial nonmelanoma skin cancer (NMsc). Materials and methods:We enrolled patients aged ≥ 65 years with facial NMsc, Karnofsky performance status (Kps) ≥ 40 and life expectancy ≥ 6 months, amenable neither to daily rT nor surgery. radiotherapy consisted of 35 Gy, delivered with 6 MeV electron beam, in 5 fractions of 7 Gy/day twice a week (tw). prescription isodoses were 100% for cT1-cT2 and 90% for cT3-cT4. Objective response was assessed clinically 4 and 8 weeks after the end of rT and then monitored every 6 months. side effects were assessed according to the cTcae scale.results: 12 patients of median age 89.5 years with a total of 23 NMsc cN0 achieved a median follow-up time of 6 months (range 1-10), with total treatment compliance. 10/12 patients had a 40 ≤ Kps < 70 and 2/12 a 70 ≤ Kps < 90. 5/12 patients had synchronous lesions. 22/23 lesions were classified as T1-T2 and had complete response (cr), 1/23 as T4 with partial response (pr). Within 4 weeks after the end of treatment, G1 toxicity was reported for 12/23 lesions , G2 for 8/23, G3 for 3/23, G4 for 0/23, all disappeared 8 weeks later, with or without topical therapy. after last follow-up (1 June 2020) 1/12 patients died with pr from senile marasmus, 11/12 are alive with cr and widely tolerated toxicities. conclusions: extreme hypofractionation of radiotherapy dose for facial NMsc is effective, safe and suitable for elderly patients.

Whole Brain Irradiation or Stereotactic RadioSurgery for five or more brain metastases (WHOBI-STER): A prospective comparative study of neurocognitive outcomes, level of autonomy in daily activities and quality of life

“…After all, achieving an optimal locoregional control while limiting the onset of treatment-related adverse events, especially among frail patients ineligible for other treatments, is usually the main goal of current radiotherapy practice [19] , [20] .…”

Radiotherapy in Current Neuro-Oncology: There Is Still Much to Reveal

“…Classically, both primary and secondary malignant CNS tumors had a poor prognosis, and radiotherapy was mainly devoted to preserving the quality of life while avoiding iatrogenic injury. Indeed, nervous tissues have limited regenerative capability in response to radiation damage compared to other tissues (i.e., mucous membranes and skin) [5,6]; this is of particular concern among radiation oncologists, who must ponder every day the need for an escalated dose, such as that used in stereotactic ablative treatments, with the risk of serious adverse events (i.e., radionecrosis) [7]. In recent decades, this preliminary assessment has become particularly pervasive among insiders, since the recent advances in systemic therapy have prolonged the survival of cancer patients, making the scenario of controlled or controllable intracranial disease more common in radiotherapy departments [8].…”

Volumetric Modulated Arc Therapy Capabilities for Treating Lower-Extremity Skin Affected by Several Merkel Cell Carcinoma Nodules: When Technological Advances Effectively Achieve the Palliative Therapeutic Goal while Minimising the Risk of Potential Toxicities

“…These techniques have already been effectively tested in other clinical scenarios demanding a significant sparing of some OARs, e.g., spinal cord or urethra, similarly located within a surrounding radiotherapy target [23][24][25], or for reirradiation [26]. We know that other radiotherapy techniques are equally effective in the treatment of cutaneous targets [27][28][29][30], but their use is less suitable for highly complex clinical situations such as the present one. Our work presents a similar arrangement to the that used by Servy et al [31], but with a more challenging circumferential target around a very close organ-at-risk that needs to be spared.…”