Non-melanoma skin cancer treated with HDR Valencia applicator: clinical outcomes

Abstract

PurposeRadiotherapy (RT) has played a significant role in treating non melanoma skin cancer (NMSC). High-dose-rate brachytherapy (HDR-BT) approaches have a paramount relevance due to their adaptability, patient protection, and variable dose fractionation schedules. Several innovative applicators have been introduced to the brachytherapy community. The Valencia applicator is a new superficial device that improves the dose distribution compared with the Leipzig applicator. The purpose of this work is to assess the tumor control, cosmesis, and toxicity in patients with NMSC treated with the Valencia applicator and a new regimen of hypofractionation.Material and methodsFrom January 2008 to March 2010, 32 patients with 45 NMSC lesions were treated with the Valencia applicator in the Hospital La Fe. The gross tumor volume was visually assessed, but the tumor depth was evaluated using ultrasound imaging. All lesions for the selected cases were limited to 4 mm depth. The prescription dose was 42 Gy in 6 or 7 fractions (biologically effective dose [BED] ≈ 70 Gy), delivered twice a week.ResultsNinety-eight percent of the lesions were locally controlled at 47 months from treatment. Ninety-three percent of patients were out at least 36 months from treatment. The treatment was well tolerated in all cases. The highest skin toxicity was grade 1 RTOG/EORTC, having resolved with topical treatment at 4 weeks in all but one case which required 2 months. There were no grade 2 or higher late adverse events.ConclusionsIn patients with superficial basal cell carcinoma lesions less than 25 mm in maximum diameter, HDRBT treatment with the Valencia applicator using a hypofractionated regimen provides excellent results, for both cosmetic and local control at a minimum of 3 years follow-up. Moreover, the shorter hypofractionated regimen facilitates compliance, which is very relevant for the elderly patients in our series. Valencia applicators offer a simple, safe, quick, and attractive nonsurgical treatment option.

Electronic brachytherapy for superficial and nodular basal cell carcinoma: a report of two prospective pilot trials using different doses

“…This is delivered twice weekly with a minimum interval of 48 hours. Tormo et al [10] also showed good toxicity results in patients treated in 6 or 7 fractions. Although most brachytherapy treatment schemas in the literature use 8 to 12 fractions [35,36,37,38,39,40], the fractionation used in this study does not result in a higher toxicity or a poorer cosmesis in comparison with a more fractionated treatment.…”

“…In radionuclide-based brachytherapy some applicators exist, which shield the radiation emitted by the 192 Ir source except for the region that needs to be irradiated. Among them, the Valencia applicators [10] were designed specifically to produce a collimated and homogeneous dose distribution within the patient's skin [33]. Compared to these applicators, EBT has the advantage of a shorter treatment time (2.5 minutes compared to 5 to 10 minutes), lower penumbra (i.e.…”

“…As opposed to an EBT system, the latter are based on a 192 Ir radio active source and a surface-specific applicator, which have been shown to provide excellent results in terms of control rate and cosmesis [10].…”

Radiotherapy treatment for nonmelanoma skin cancer

“…At a median follow-up of 5.5 years, the local control rate was 98% (232/ 236). Similarly, Tormo et al reported a series of 32 NMSC patients treated with 42 Gy in 6-7 fractions using the Valencia applicator [53], with a 98% local control rate at around 4 years. The skin toxicity was all Grade 1, and resolved within 1-2 months.…”

Commissioning and quality assurance procedures for the HDR Valencia skin applicators

“…Specific shielded applicators have been developed to focus the absorbed dose to the tumor volume, thus reducing absorbed dose to the surrounding healthy tissues. This is the case of the Valencia skin applicators (Nucletron, an Elekta company, Elekta AB, Stockholm, Sweden) [2, 3, 4, 5, 6, 7, 8, 9, 10, 11]. They are tungsten cup shaped, in which the source has one single dwell position that incorporates a flattering filter providing a homogenous dose distribution at a given depth (see Figure 1).…”