Interstitial HDR Brachytherapy in the Treatment of Non-Melanocytic Skin Cancers around the Eye

Abstract

Background: Eyelid tumors are rare skin cancers, the most common of which is basal cell carcinoma characterized primarily by local growth. In addition to surgery, radiotherapy is among the basic methods of treatment. External beam radiotherapy is associated with the risk of complications within ocular structures, especially the lens. In the case of interstitial brachytherapy, it is possible to administer a high dose to the clinical target volume (CTV), while reducing it in the most sensitive structures. Methods: This paper presents the results of an analysis of 28 patients treated with interstitial high dose rate (HDR) brachytherapy for skin cancers of the upper and lower eyelid; medial and lateral canthus; and the cheek, nose and temples with the infiltration of ocular structures. The patients were treated according to two irradiation schedules: 49 Gy in 14 fractions of 3.5 Gy twice a day for 7 days of treatment, and 45 Gy in 5 Gy fractions twice a day for 5 days. The mean follow-up was 22 months (3–49 months). Results: two patients (6%) had a relapse: a local recurrence within the irradiated area in one of them, and metastases to lymph nodes in the other. The most common early complication was conjunctivitis (74%), and the most common late complication was dry eye syndrome (59%). Conclusions: Interstitial HDR brachytherapy for skin cancers of the upper and lower eyelid; medial and lateral cants; and the cheek, nose and temples with infiltration of ocular structures is a highly effective, short and relatively low burden type of treatment.

ORIFICE (Interventional Radiotherapy for Face Aesthetic Preservation) Study: Results of Interdisciplinary Assessment of Interstitial Interventional Radiotherapy (Brachytherapy) for Periorificial Face Cancer

“…One the largest and most recent articles is by Cisek et al, who confirmed the effectiveness of the exclusive periorbital interstitial IRT, with excellent results in terms of local control as well as functional and cosmetic outcomes in their series including 28 patients [ 31 ].…”

High dose rate brachytherapy in nonmelanoma skin cancer—Systematic review

“…Supreme precision is especially required in facial region. Cisek et al reported treatment outcomes of 28 patients with eyelid NMSCs treated with HDR BT 36 . One local recurrence was reported with median follow up 22 months.…”

“…Patients selected for BT usually are disqualified from operation because of age, tumor location or high tumor volume. Patel et al directly compared BT to Mohs microsurgery in a matched pair cohort study 36 . One hundred and eighty‐eight patients received BT, 181 patients Mohs surgery.…”

“…Cisek et al published treatment outcomes of interstitial BT of 28 patients with tumors in eyelid region. One G3 acute radiation toxicity, and dry eye syndrome was dominant late complication (59%) 36 …”

“…Cisek et al published treatment outcomes of interstitial BT of 28 patients with tumors in eyelid region. One G3 acute radiation toxicity, and dry eye syndrome was dominant late complication (59%) 36. 3 | CONCLUSIONSHDR BT emerges as safe and efficient organ sparing treatment method of nonmelanoma skin cancer, noninferior to surgery, with mild and transient adverse effects and good cosmetic outcome.…”