Comparison of electronic brachytherapy and Mohs micrographic surgery for the treatment of early-stage non-melanoma skin cancer: a matched pair cohort study

Abstract

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.

GEC-ESTRO ACROP recommendations in skin brachytherapy

“…For radionuclide-based BT and electronic BT applicators, an extra margin of approximately 1-2 mm (PTV) should be added to account for any misalignment. Excellent results are obtained comparing electronic BT and Mohs surgery [81]. A very useful method for applicators setup is the use of templates, as the template La Fe/ ITIC TM for the superficial shielded applicators [32].…”

The Treatment of Non-Melanoma Skin Cancer with Image-Guided Superficial Radiation Therapy: An Analysis of 2917 Invasive and In Situ Keratinocytic Carcinoma Lesions

“…Therapy with superficial radiation therapy (SRT) is another long-established and effective treatment for NMSC. Patient outcomes with radiation therapy, whether using superficial orthovoltage X-rays or EBX, are comparable to MMS, with patients experiencing low rates of complication and favorable cosmetic results [ 9 ]. Advantages of SRT include the lack of pain and scarring associated with surgery.…”

Management of keratinocyte carcinoma - Special considerations in the elderly

“…RT can be a beneficial option for nonsurgical candidates who have skin cancers located in areas near or involving tendons or bones or on areas with a complex topography, such as the face and hands (Fig. 5; Aldelaijan et al., 2017, Patel et al., 2017). RT can also be used as an adjunct to surgery for very bulky or high risk of recurrence tumors as well as those with positive margins, bony or perineural invasion, or in instances of recurrence (Hulyalkar et al., 2011).…”