Review: the reemergence of brachytherapy as treatment for non-melanoma skin cancer

Abstract

Electronic brachytherapy (EBT) has seen a significant rise in use over the past few years in treating non-melanoma skin cancer (NMSC). However, the current literature in EBT remains scarce. Existing data on high-dose rate brachytherapy (HDR-BT) with surface applicators is often used to justify its efficacy and safety. In this review we study the two treatment modalities on their efficacy in treating NMSC and we explore the reasons behind the recent uprise in EBT. A literature review using PubMed was performed for articles published until January 2017 studying efficacy of HDR-BT and EBT for treating NMSC. HDR-BT demonstrated effective local control ranging from 96.2% to 100% up to 66 months of follow-up with acceptable cosmesis. For EBT, local control rates ranged from 90% to 100% with generally favorable tolerance and cosmesis outcome after roughly one year. While longer term data on EBT is needed, its short term efficacy shows promise as a possible alternative to surgery or other radiation therapy in a select group of patients.

High dose brachytherapy with non sealed 188Re (rhenium) resin in patients with non-melanoma skin cancers (NMSCs): single center preliminary results.

“…Electronic brachytherapy with sealed solid sources is an alternative method that showed excellent results. Its limitation is mainly due to the difficulty to treat large lesions or lesions with nonplanar concave or convex surfaces (the nose, ears, lips, external genitals) [ 5 ].…”

High-dose-rate plesiotherapy with customized molds in non-melanoma skin cancer: efficacy and safety at 10 years—single institution experience

“…For lesions of less than 4 cm in diameter and an invasion depth of less than 5 mm, contact brachytherapy, also known as plesiotherapy, is indicated. Brachytherapy techniques have been used to treat skin cancer for more than a century [ 18 ], but in recent years, it has become increasingly common, as a growing body of evidence supports its efficacy and safety [ 19 ]. These studies report excellent local control, which varies from 83.3 to 98% or even 100% of cases, depending on the scheme used and the tumor histology, site, size, and depth [ 20 ].…”

Non-melanoma Skin Cancer Treated by Contact High-dose-rate Radiotherapy (Brachytherapy): A Mono-institutional Series and Literature Review

“…Despite the aforementioned advantages, especially in some settings, it should be noted that cHDR-RT has a limited spread in the clinical practice across the different countries (36,37). However, it is interesting to note the actual trend on the use of cHDR-RT in NMSC, showing a renewed interest (38). In particular, cHDR-RT has been demonstrated to be a valid therapeutic option especially in cases of extreme stress for the health systems (39).…”