HDR brachytherapy with individual epithetic molds for facial skin cancer: techniques and first clinical experience

• Published in: International journal of dermatology Vol. 60; no. 6; pp. 717 - 723
• Main Authors: Diefenhardt, Markus, Chatzikonstantinou, Georgios, Meissner, Markus, Köhn, Janett, Scherf, Christian, Trommel, Martin, Licher, Jörg, Ramm, Ulla, Rödel, Claus, Tselis, Nikolaos
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-06-2021
• Subjects: Brachytherapy; Cancer; Conjunctivitis; Dosage; Molds; Organs; Patients; Radiation dosage; Radiation therapy; Skin cancer; Skin diseases; Surgery; Toxicity
• ISSN: 0011-9059; 1365-4632
• DOI: 10.1111/ijd.15492

Background
Facial skin cancer lesions in close proximity to critical organs require further development of radiotherapeutic techniques for highly conformal treatment, especially when treating elderly frail patients. We report on our treatment technique and first clinical experience for patients with perinasal/periorbital skin cancer treated with individualized epithetic mold high‐dose‐rate brachytherapy (BRT).
Methods
From January 2019, patients with complex shaped or unfavorably located skin cancer not eligible for surgery or external beam radiotherapy (RT) were screened for mold‐based BRT. Six patients were identified. Toxicity and clinical response were documented during therapy and posttreatment follow‐up.
Results
Median patient age was 80 years (74–92 years). Median prescription dose was 42 Gy (range, 33–44 Gy) delivered in once‐daily fractions of 3 or 4 Gy. Two patients had treatment interruptions caused by acute conjunctivitis grade 2 and a nontreatment‐related cardiac event, respectively. At a median follow‐up of 335 days (96–628 days), no ≥ grade 2 late toxicity was documented with all patients showing complete clinical response.
Conclusions
High‐dose‐rate BRT with individualized epithetic molds for perinasal/periorbital skin cancer is a well‐tolerated and safe treatment option for patients not eligible for primary surgery or definitive external beam RT because of comorbidities or tumor location.