High-Dose-Rate Brachytherapy for the Treatment of Basal and Squamous Cell Carcinomas on Sensitive Areas of the Face: A Report of Clinical Outcomes and Acute and Subacute Toxicities

Abstract

Basal cell and cutaneous squamous cell carcinoma are common malignancies (keratinocyte carcinomas [KCs]). Surgical resection is the standard of care. Radiation using high-dose rate brachytherapy (HDR-BT) may serve as a superior alternative where surgical scars may be of cosmetic concern or in elderly patients with significant comorbidity. We aim to describe the clinical and cosmetic outcomes as well as posttreatment radiation toxicities associated with HDR-BT in patients who were treated for KCs of the face. Methods and Materials: Patients with KCs treated with HDR-BT from 2015 to 2018 were included in the study. Patient medical records and clinical photos were reviewed at multiple time points: start of treatment, end of treatment, short-term (2 week) follow-up, 3-month follow-up, and if needed at 6 months. Radiation toxicity was graded using the Radiation Therapy Oncology Grading (RTOG) acute toxicity scale. Median (range) toxicity grades at follow-up intervals were calculated. Clinical outcomes including local recurrence were evaluated for all patients. Results: The study included 19 patients and 20 KCs. The median radiation dose was 42 Gy (39-42 Gy) over 6 fractions. The median toxicity at completion of treatment was RTOG grade 2 (85% of patients). At short-term follow-up, 50% of patients (n Z 10) improved to RTOG grade 1 (0-2). At 3 months, 70% of patients (n Z 14) had RTOG grade 0, and by 6 months, 100% of patients (n Z 18) had RTOG grade 0. No RTOG grade 3 or higher skin toxicity was observed. With a median follow-up of 7.2 months (range, 1.3-54.4 months), the local recurrence-free survival was 95%. Conclusions: We demonstrate that HDR-BT can be used as definitive treatment of KCs of the face with excellent cosmetic outcomes and local control. Acute and subacute skin toxicities were most commonly RTOG grade 2 or less with resolution of patient's skin toxicity by 3 months.

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“…Also, cosmetic results of the patients included are very promising, with more than 96% of the cases showing good/ excellent results detected at follow-up. Taylor et al [26] observed grade 2 toxicity at completion of treatment in 85% of patients and no grade 3 or higher skin toxicity. Moreover, Gauden et al in a cohort of 200 patients reported G1 acute skin toxicity in 168 treated lesions (71%), G2 in 81 (34%), and good or excellent cosmesis in 208 cases (88%).…”

“…Taylor et al . [ 26 ] observed grade 2 toxicity at completion of treatment in 85% of patients and no grade 3 or higher skin toxicity. Moreover, Gauden et al .…”

“…Several studies, in which HDR-BT was compared with surgery showed that RT provided lower local control [ 26 , 28 , 29 ]. Indeed, some surgery studies showed recurrence rates at 5 years < 5%, but also certain research on RT demonstrated LC rates between 95% to 100%.…”

“…Taylor et al . [ 26 ] reported a LC rate of 95% with a median follow-up of 7.2 months (range, 1.3-54.3 months), and in a review, Delishaj et al . [ 30 ] described a median LC of 97% in HDR-BT study.…”

“…In our study, no statistically significant difference between definitive and adjuvant treatment groups (data not shown) was observed. In some cohorts of elderly patients, surgical resection was associated with higher complications and worse results [ 26 , 30 ]. According to the literature, surface HDR-BT is considered particularly tailored for elderly population, often with poor performance status and/or concomitant comorbidities; therefore, often unfit for surgery or longer RT.…”