Efficacy and cosmetic outcomes of high-dose-rate brachytherapy in the treatment of nasal carcinomas: a retrospective analysis.

Abstract

Background: Basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) are the most common non-melanoma skin cancers, frequently affecting the facial region. High-Dose Rate (HDR) interstitial brachytherapy (iBT) offers a promising alternative to surgery, particularly in cosmetically sensitive areas like the nasal region. This study evaluates the clinical efficacy and esthetic outcomes of HDR iBT in the treatment of nasal BCC and cSCC.

Methods: This retrospective analysis included 10 patients with histologically confirmed primary nasal BCC or cSCC treated with HDR iBT between May 2021 and February 2023. Patients received HDR iBT as either a definitive treatment or post-surgery, depending on clinical indications. The treatment involved image-guided placement of interstitial catheters, with individualized dosimetric planning following GEC-ESTRO and ASTRO guidelines. Prescribed doses ranged from 40 to 45 Gy, delivered in 9-10 fractions.

Results: The cohort consisted of 80% male patients, with a median age of 69 years (IQR:49-83), and an equal distribution of BCC and cSCC. After a median follow-up of 23.5 months (IQR:19.5-31), all patients were alive, with a 90% complete response rate. Two patients experienced locoregional recurrences, successfully managed with salvage therapy. Acute toxicities included dermatitis (100%, with 60% grade 3) and pain (50%). Late toxicities were minimal, limited to grade 1 fibrosis (30%) and edema (20%). Esthetic outcomes, assessed via the Global Esthetic Improvement Scale, were excellent in most cases.

Conclusion: HDR iBT demonstrates high efficacy with favorable cosmetic outcomes, offering a viable, minimally invasive alternative to surgery for nasal BCC and cSCC.