PO116

Brachytherapy Pub Date : 2023-09-01 DOI:10.1016/j.brachy.2023.06.217

Mustafa M. Basree, Charles Wallace, Jessica Schuster, Jessica Miller, Michael Lawless, Juliet L. Aylward, Yaohui Xu, Kristin Bradley, Randall J. Kimple, Adam Burr

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Either the 2 or 3 cm Valencia applicator was used to treat 25 of 27 lesions with a prescription depth of 3 mm. The Valencia was fixed in place using a clamp and patients were immobilized using a custom head sponge. The other two lesions were treated using a custom array of catheters in Aquaplast and a Freiburg flap. Baseline characteristics and treatment-related variables were summarized using descriptive statistics. Acute and late radiation toxicities were graded using RTOG Common Toxicity Criteria. Local control was evaluated using the Kaplan Meier method. Results Twenty-one patients were identified (n=11 F; n=10 M), with twenty-seven lesions. Median age 81 years (range, 55 to 104), with 85.2% basal- and 14.8% squamous-cell carcinoma. Median follow up was 10.1 months (1.0 to 31.8). Treated lesions were located on the face (n=14), head (n=6), lower extremity (n=5), and neck (n=2), with median lesion size of 8 millimeters (2.5 to 30). Patients were treated with median 40 Gy (40 to 48.5) in 8 fractions (5 to 16) prescribed to depth of 3 mm (3 to 5). RTOG grade 1 skin toxicity (mild erythema) was present in 17 lesions and grade 2 toxicity (brisk erythema) was present in 10 lesions. The most common late toxicity was hypopigmentation in 3 patients. One patient developed a late grade 3 ulcer in a poorly perfused lower limb. Local control was 95.7% on a per lesion basis at one year with a marginal failure in 1/27 lesions. Conclusions Our initial experience with non-melanoma skin brachytherapy has shown good local control with an acceptable safety profile in a predominantly elderly population. Treatment of non-melanoma skin cancers on the lower extremity in elderly patients remains an ongoing challenge due to the risk of late toxicity. Further studies are needed to compare the acute and late toxicity of surface brachytherapy to widely available external beam techniques such as electron beam radiation therapy. Currently, the excellent local control and short treatment courses provide a great treatment option for superficial, early stage non-melanoma skin cancers. Non-melanoma skin cancer is the most common cancer worldwide and its treatment in the elderly can pose significant challenges. We established a skin brachytherapy program primarily to treat older patients using the hypofractionated courses and superficial treatment depth afforded by this technique. Here we describe the first patients treated at our institution, including our initial oncologic results and toxicities. This is a single-institution retrospective review of non-melanoma skin cancer patients treated at our institution from March 2020 to October 2022 with high dose rate brachytherapy with iridium-192. Either the 2 or 3 cm Valencia applicator was used to treat 25 of 27 lesions with a prescription depth of 3 mm. The Valencia was fixed in place using a clamp and patients were immobilized using a custom head sponge. The other two lesions were treated using a custom array of catheters in Aquaplast and a Freiburg flap. Baseline characteristics and treatment-related variables were summarized using descriptive statistics. Acute and late radiation toxicities were graded using RTOG Common Toxicity Criteria. Local control was evaluated using the Kaplan Meier method. Twenty-one patients were identified (n=11 F; n=10 M), with twenty-seven lesions. Median age 81 years (range, 55 to 104), with 85.2% basal- and 14.8% squamous-cell carcinoma. Median follow up was 10.1 months (1.0 to 31.8). Treated lesions were located on the face (n=14), head (n=6), lower extremity (n=5), and neck (n=2), with median lesion size of 8 millimeters (2.5 to 30). Patients were treated with median 40 Gy (40 to 48.5) in 8 fractions (5 to 16) prescribed to depth of 3 mm (3 to 5). RTOG grade 1 skin toxicity (mild erythema) was present in 17 lesions and grade 2 toxicity (brisk erythema) was present in 10 lesions. The most common late toxicity was hypopigmentation in 3 patients. One patient developed a late grade 3 ulcer in a poorly perfused lower limb. Local control was 95.7% on a per lesion basis at one year with a marginal failure in 1/27 lesions. Our initial experience with non-melanoma skin brachytherapy has shown good local control with an acceptable safety profile in a predominantly elderly population. Treatment of non-melanoma skin cancers on the lower extremity in elderly patients remains an ongoing challenge due to the risk of late toxicity. Further studies are needed to compare the acute and late toxicity of surface brachytherapy to widely available external beam techniques such as electron beam radiation therapy. 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引用次数: 0

Abstract

Purpose Non-melanoma skin cancer is the most common cancer worldwide and its treatment in the elderly can pose significant challenges. We established a skin brachytherapy program primarily to treat older patients using the hypofractionated courses and superficial treatment depth afforded by this technique. Here we describe the first patients treated at our institution, including our initial oncologic results and toxicities. Materials and Methods This is a single-institution retrospective review of non-melanoma skin cancer patients treated at our institution from March 2020 to October 2022 with high dose rate brachytherapy with iridium-192. Either the 2 or 3 cm Valencia applicator was used to treat 25 of 27 lesions with a prescription depth of 3 mm. The Valencia was fixed in place using a clamp and patients were immobilized using a custom head sponge. The other two lesions were treated using a custom array of catheters in Aquaplast and a Freiburg flap. Baseline characteristics and treatment-related variables were summarized using descriptive statistics. Acute and late radiation toxicities were graded using RTOG Common Toxicity Criteria. Local control was evaluated using the Kaplan Meier method. Results Twenty-one patients were identified (n=11 F; n=10 M), with twenty-seven lesions. Median age 81 years (range, 55 to 104), with 85.2% basal- and 14.8% squamous-cell carcinoma. Median follow up was 10.1 months (1.0 to 31.8). Treated lesions were located on the face (n=14), head (n=6), lower extremity (n=5), and neck (n=2), with median lesion size of 8 millimeters (2.5 to 30). Patients were treated with median 40 Gy (40 to 48.5) in 8 fractions (5 to 16) prescribed to depth of 3 mm (3 to 5). RTOG grade 1 skin toxicity (mild erythema) was present in 17 lesions and grade 2 toxicity (brisk erythema) was present in 10 lesions. The most common late toxicity was hypopigmentation in 3 patients. One patient developed a late grade 3 ulcer in a poorly perfused lower limb. Local control was 95.7% on a per lesion basis at one year with a marginal failure in 1/27 lesions. Conclusions Our initial experience with non-melanoma skin brachytherapy has shown good local control with an acceptable safety profile in a predominantly elderly population. Treatment of non-melanoma skin cancers on the lower extremity in elderly patients remains an ongoing challenge due to the risk of late toxicity. Further studies are needed to compare the acute and late toxicity of surface brachytherapy to widely available external beam techniques such as electron beam radiation therapy. Currently, the excellent local control and short treatment courses provide a great treatment option for superficial, early stage non-melanoma skin cancers. Non-melanoma skin cancer is the most common cancer worldwide and its treatment in the elderly can pose significant challenges. We established a skin brachytherapy program primarily to treat older patients using the hypofractionated courses and superficial treatment depth afforded by this technique. Here we describe the first patients treated at our institution, including our initial oncologic results and toxicities. This is a single-institution retrospective review of non-melanoma skin cancer patients treated at our institution from March 2020 to October 2022 with high dose rate brachytherapy with iridium-192. Either the 2 or 3 cm Valencia applicator was used to treat 25 of 27 lesions with a prescription depth of 3 mm. The Valencia was fixed in place using a clamp and patients were immobilized using a custom head sponge. The other two lesions were treated using a custom array of catheters in Aquaplast and a Freiburg flap. Baseline characteristics and treatment-related variables were summarized using descriptive statistics. Acute and late radiation toxicities were graded using RTOG Common Toxicity Criteria. Local control was evaluated using the Kaplan Meier method. Twenty-one patients were identified (n=11 F; n=10 M), with twenty-seven lesions. Median age 81 years (range, 55 to 104), with 85.2% basal- and 14.8% squamous-cell carcinoma. Median follow up was 10.1 months (1.0 to 31.8). Treated lesions were located on the face (n=14), head (n=6), lower extremity (n=5), and neck (n=2), with median lesion size of 8 millimeters (2.5 to 30). Patients were treated with median 40 Gy (40 to 48.5) in 8 fractions (5 to 16) prescribed to depth of 3 mm (3 to 5). RTOG grade 1 skin toxicity (mild erythema) was present in 17 lesions and grade 2 toxicity (brisk erythema) was present in 10 lesions. The most common late toxicity was hypopigmentation in 3 patients. One patient developed a late grade 3 ulcer in a poorly perfused lower limb. Local control was 95.7% on a per lesion basis at one year with a marginal failure in 1/27 lesions. Our initial experience with non-melanoma skin brachytherapy has shown good local control with an acceptable safety profile in a predominantly elderly population. Treatment of non-melanoma skin cancers on the lower extremity in elderly patients remains an ongoing challenge due to the risk of late toxicity. Further studies are needed to compare the acute and late toxicity of surface brachytherapy to widely available external beam techniques such as electron beam radiation therapy. Currently, the excellent local control and short treatment courses provide a great treatment option for superficial, early stage non-melanoma skin cancers.

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PO116

非黑色素瘤皮肤癌是世界上最常见的癌症，其在老年人中的治疗可能会带来重大挑战。我们建立了一个皮肤近距离治疗方案，主要用于治疗老年患者，使用该技术提供的低分割疗程和浅表治疗深度。在这里，我们描述了在我们机构治疗的第一批患者，包括我们最初的肿瘤结果和毒性。材料和方法这是一项针对2020年3月至2022年10月在我院接受高剂量率近距离放疗的非黑色素瘤皮肤癌患者的单机构回顾性研究。2或3cm瓦伦西亚涂抹器用于治疗27个病变中的25个，处方深度为3mm。使用夹子固定Valencia，使用定制的头部海绵固定患者。另外两个病变使用Aquaplast定制导管阵列和Freiburg皮瓣进行治疗。使用描述性统计总结基线特征和治疗相关变量。采用RTOG通用毒性标准对急性和晚期辐射毒性进行分级。采用Kaplan Meier方法评价局部控制。结果共发现21例患者(n=11 F;n=10 M)， 27个病变。中位年龄81岁(55 ~ 104岁)，85.2%为基底细胞癌，14.8%为鳞状细胞癌。中位随访时间为10.1个月(1.0 ~ 31.8)。治疗的病灶位于面部(n=14)、头部(n=6)、下肢(n=5)和颈部(n=2)，病灶大小中位数为8毫米(2.5 ~ 30)。患者接受中位剂量40 Gy(40至48.5)的治疗，分为8个部分(5至16)，规定深度为3mm(3至5)。17个病变出现RTOG 1级皮肤毒性(轻度红斑)，10个病变出现2级毒性(剧烈红斑)。最常见的晚期毒性为3例色素沉着降低。1例患者下肢灌注不良并发晚期3级溃疡。一年后，每个病灶的局部控制率为95.7%，1/27病灶的边缘失败。结论:我们对非黑色素瘤皮肤近距离放疗的初步经验表明，在以老年人为主的人群中，局部控制良好，安全性可接受。由于晚期毒性的风险，老年患者下肢非黑色素瘤皮肤癌的治疗仍然是一个持续的挑战。需要进一步的研究来比较表面近距离放射治疗与广泛使用的外束技术(如电子束放射治疗)的急性和晚期毒性。目前，良好的局部控制和短疗程为浅表、早期非黑色素瘤皮肤癌提供了很好的治疗选择。非黑色素瘤皮肤癌是世界上最常见的癌症，其在老年人中的治疗可能会带来重大挑战。我们建立了一个皮肤近距离治疗方案，主要用于治疗老年患者，使用该技术提供的低分割疗程和浅表治疗深度。在这里，我们描述了在我们机构治疗的第一批患者，包括我们最初的肿瘤结果和毒性。这是一项针对2020年3月至2022年10月在我院接受高剂量率近距离放疗的非黑色素瘤皮肤癌患者的单机构回顾性研究。2或3cm瓦伦西亚涂抹器用于治疗27个病变中的25个，处方深度为3mm。使用夹子固定Valencia，使用定制的头部海绵固定患者。另外两个病变使用Aquaplast定制导管阵列和Freiburg皮瓣进行治疗。使用描述性统计总结基线特征和治疗相关变量。采用RTOG通用毒性标准对急性和晚期辐射毒性进行分级。采用Kaplan Meier方法评价局部控制。21例患者被确定(n=11 F;n=10 M)， 27个病变。中位年龄81岁(55 ~ 104岁)，85.2%为基底细胞癌，14.8%为鳞状细胞癌。中位随访时间为10.1个月(1.0 ~ 31.8)。治疗的病灶位于面部(n=14)、头部(n=6)、下肢(n=5)和颈部(n=2)，病灶大小中位数为8毫米(2.5 ~ 30)。患者接受中位剂量40 Gy(40至48.5)的治疗，分为8个部分(5至16)，规定深度为3mm(3至5)。17个病变出现RTOG 1级皮肤毒性(轻度红斑)，10个病变出现2级毒性(剧烈红斑)。最常见的晚期毒性为3例色素沉着降低。1例患者下肢灌注不良并发晚期3级溃疡。一年后，每个病灶的局部控制率为95.7%，1/27病灶的边缘失败。我们对非黑色素瘤皮肤近距离放疗的初步经验表明，在以老年人为主的人群中，局部控制良好，安全性可接受。非黑色素瘤皮肤癌是世界上最常见的癌症，其在老年人中的治疗可能会带来重大挑战。我们建立了一个皮肤近距离治疗方案，主要用于治疗老年患者，使用该技术提供的低分割疗程和浅表治疗深度。在这里，我们描述了在我们机构治疗的第一批患者，包括我们最初的肿瘤结果和毒性。材料和方法这是一项针对2020年3月至2022年10月在我院接受高剂量率近距离放疗的非黑色素瘤皮肤癌患者的单机构回顾性研究。2或3cm瓦伦西亚涂抹器用于治疗27个病变中的25个，处方深度为3mm。使用夹子固定Valencia，使用定制的头部海绵固定患者。另外两个病变使用Aquaplast定制导管阵列和Freiburg皮瓣进行治疗。使用描述性统计总结基线特征和治疗相关变量。采用RTOG通用毒性标准对急性和晚期辐射毒性进行分级。采用Kaplan Meier方法评价局部控制。结果共发现21例患者(n=11 F;n=10 M)， 27个病变。中位年龄81岁(55 ~ 104岁)，85.2%为基底细胞癌，14.8%为鳞状细胞癌。中位随访时间为10.1个月(1.0 ~ 31.8)。治疗的病灶位于面部(n=14)、头部(n=6)、下肢(n=5)和颈部(n=2)，病灶大小中位数为8毫米(2.5 ~ 30)。患者接受中位剂量40 Gy(40至48.5)的治疗，分为8个部分(5至16)，规定深度为3mm(3至5)。17个病变出现RTOG 1级皮肤毒性(轻度红斑)，10个病变出现2级毒性(剧烈红斑)。最常见的晚期毒性为3例色素沉着降低。1例患者下肢灌注不良并发晚期3级溃疡。一年后，每个病灶的局部控制率为95.7%，1/27病灶的边缘失败。结论:我们对非黑色素瘤皮肤近距离放疗的初步经验表明，在以老年人为主的人群中，局部控制良好，安全性可接受。由于晚期毒性的风险，老年患者下肢非黑色素瘤皮肤癌的治疗仍然是一个持续的挑战。需要进一步的研究来比较表面近距离放射治疗与广泛使用的外束技术(如电子束放射治疗)的急性和晚期毒性。目前，良好的局部控制和短疗程为浅表、早期非黑色素瘤皮肤癌提供了很好的治疗选择。非黑色素瘤皮肤癌是世界上最常见的癌症，其在老年人中的治疗可能会带来重大挑战。我们建立了一个皮肤近距离治疗方案，主要用于治疗老年患者，使用该技术提供的低分割疗程和浅表治疗深度。在这里，我们描述了在我们机构治疗的第一批患者，包括我们最初的肿瘤结果和毒性。这是一项针对2020年3月至2022年10月在我院接受高剂量率近距离放疗的非黑色素瘤皮肤癌患者的单机构回顾性研究。2或3cm瓦伦西亚涂抹器用于治疗27个病变中的25个，处方深度为3mm。使用夹子固定Valencia，使用定制的头部海绵固定患者。另外两个病变使用Aquaplast定制导管阵列和Freiburg皮瓣进行治疗。使用描述性统计总结基线特征和治疗相关变量。采用RTOG通用毒性标准对急性和晚期辐射毒性进行分级。采用Kaplan Meier方法评价局部控制。21例患者被确定(n=11 F;n=10 M)， 27个病变。中位年龄81岁(55 ~ 104岁)，85.2%为基底细胞癌，14.8%为鳞状细胞癌。中位随访时间为10.1个月(1.0 ~ 31.8)。治疗的病灶位于面部(n=14)、头部(n=6)、下肢(n=5)和颈部(n=2)，病灶大小中位数为8毫米(2.5 ~ 30)。患者接受中位剂量40 Gy(40至48.5)的治疗，分为8个部分(5至16)，规定深度为3mm(3至5)。17个病变出现RTOG 1级皮肤毒性(轻度红斑)，10个病变出现2级毒性(剧烈红斑)。最常见的晚期毒性为3例色素沉着降低。1例患者下肢灌注不良并发晚期3级溃疡。一年后，每个病灶的局部控制率为95.7%，1/27病灶的边缘失败。我们对非黑色素瘤皮肤近距离放疗的初步经验表明，在以老年人为主的人群中，局部控制良好，安全性可接受。由于晚期毒性的风险，老年患者下肢非黑色素瘤皮肤癌的治疗仍然是一个持续的挑战。需要进一步的研究来比较表面近距离放射治疗与广泛使用的外束技术(如电子束放射治疗)的急性和晚期毒性。目前，良好的局部控制和短疗程为浅表、早期非黑色素瘤皮肤癌提供了很好的治疗选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Brachytherapy

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