Two years results of electronic brachytherapy for basal cell carcinoma

Abstract

PurposeThe use of radiation therapy (RT) for non-melanoma skin cancer (NMSC) has been changing throughout the last century. Over the last decades, the use of radiotherapy has surged with the development of new techniques, applicators, and devices. In recent years, electronic brachytherapy (eBT) devices that use small x-ray sources have been introduced as alternative to radionuclide dependence. Nowadays, several devices have been incorporated, with a few series reported, and with a short follow-up, due to the recent introduction of these systems. The purpose of this work is to describe the clinical results of our series after two years follow-up with a specific eBT system.Material and methodsThis is a prospective single-center, non-randomized pilot study, to assess clinical results of electronic brachytherapy in basal cell carcinoma using the Esteya® system. In 2014, 40 patients with 60 lesions were treated. Patient follow-up on a regular basis was performed for a period of two years.ResultsTwenty-six patients with 44 lesions achieved two years follow-up. A complete response was documented in 95.5% of cases. Toxicity was mild (G1 or G2) in all cases, caused by erythema, erosion, or alopecia. Cosmesis was excellent in 88.6% of cases, and good in the rest. Change in pigmentation was the most frequent cosmetic alteration.ConclusionsThis work is special, since the equipment’s treatment voltage was 69.5 kV, and this is the first prospective study with long term follow-up with Esteya®. These preliminary report show excellent results with less toxicity and excellent cosmesis. While surgery has been the treatment of choice, certain patients might benefit from eBT treatment. These are elderly patients with comorbidities or undergoing anticoagulant treatment as well as those who simply refuse surgery or might have other contraindications.

The feasibility of using ultrasound during follow-up for superficial non-melanoma skin cancers after electronic brachytherapy

“…Therefore, physicians may not have visualized or palpated PR if there was a subtle residual disease on clinical exam. However, our outcomes and toxicities were similar to 2 year results for BCC eBT [ 30 ]. Also, the use of US imaging is operator dependent.…”

On the use of the absorbed depth‐dose measurements in the beam calibration of a surface electronic high‐dose‐rate brachytherapy unit, a Monte Carlo‐based study

“…Surface high‐dose‐rate electronic brachytherapy (eBT) has become an effective treatment option for the nonmelanoma skin cancer, achieving excellent control rates and good cosmetic results . A surface eBT system consists mainly of two components: an x‐ray tube, which accelerates electrons in the energy range between 50 and 70 kVp and a surface applicator (between 10 and 50 mm diameters) positioned directly in contact with the skin.…”

Management of keratinocyte carcinoma - Special considerations in the elderly

“…HDR-BT offers the benefit of convenience over other forms of RT and a compressed treatment schedule of 5 to 10 sessions as opposed to external beam RT, which may require 20 to 30 daily treatments (Bhatnagar et al., 2016, Kohler-Brock et al., 1999). Electronic BT and superficial RT devices use a low-energy x-ray source rather than an ionized source and allow for minimal protective shielding requirements and tighter treatment margins (Ballester-Sánchez et al., 2017, Bhatnagar et al., 2016).…”

“…Treatment of primary SCCs with RT produces cure rates of 90% to 93% (Bichakjian et al., 2017b). Local control rates of KCs treated with ionized (iridium) or electronic HDR-BT are high, ranging from 72% to 100%, and many studies report success rates of well over 90% (Ballester-Sánchez et al., 2017, Delishaj et al., 2016, Olek Jr et al., 2018, Tormo et al., 2014).…”

“…Disadvantages of RT include cutaneous, radiation-induced side effects and very frequent (daily to bi-weekly) appointments for several weeks, which can be very burdensome for elderly patients, especially those who live far away from treatment centers and do not drive. (Ballester-Sánchez et al., 2017). Common acute adverse effects include radiation dermatitis, pruritus, ulcerations, desquamation, and erythema.…”