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Skin Brachytherapy

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Handbook of Image-Guided Brachytherapy

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Abstract

Basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC), collectively known as nonmelanoma skin cancer (NMSC), comprise the most prevalent group of malignancies in the United States. Treatment options include surgical resection, cryosurgery, electrocautery, radiotherapy, and a variety of topical agents. Skin surface brachytherapy, delivered via either radionuclide or electronic brachytherapy, has dosimetric advantages over traditional external beam radiation therapy. This chapter provides a short rationale for treatment, describes potential toxicities, and outlines details of target delineation, dose, fractionation, and delivery.

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References

  1. Stern RS. Prevalence of a history of skin cancer in 2007: results of an incidence-based model. Arch Dermatol. 2010;146(3):279–82.

    Article  PubMed  Google Scholar 

  2. Lansbury L, Bath-Hextall F, Perkins W, Stanton W, Leonardi-Bee J. Interventions for non-metastatic squamous cell carcinoma of the skin: systematic review and pooled analysis of observational studies. BMJ. 2013;347:f6153–3.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7–30.

    Article  PubMed  Google Scholar 

  4. Rogers HW, Weinstock MA, Harris AR, Hinckley MR, Feldman SR, Fleischer AB, et al. Incidence estimate of nonmelanoma skin cancer in the United States, 2006. Arch Dermatol. 2010;146(3):283–7.

    Article  PubMed  Google Scholar 

  5. Silva JJ, Tsang RW, Panzarella T, Levin W, Wells W. Results of radiotherapy for epithelial skin cancer of the pinna: the Princess Margaret Hospital experience, 1982-1993. Int J Radiat Oncol Biol Phys. 2000;47(2):451–9.

    Article  CAS  PubMed  Google Scholar 

  6. Koplin L, Zarem HA. Recurrent basal cell carcinoma: a review concerning the incidence, behavior, and management of recurrent basal cell carcinoma, with emphasis on the incompletely excised lesion. Plast Reconstr Surg. 1980;65(5):656.

    Article  CAS  PubMed  Google Scholar 

  7. Hwang IM, Leung HWC. Dosimetry characteristics of Leipzig applicators. In: Mould RF, Gurtler MW, editors. Proceedings of the 1st far east radiotherapy treatment planning workshop. Veenendaal: Nucletron-Oldelft; 1996. p. 88–9.

    Google Scholar 

  8. Kwan W, Wilson D, Moravan V. Radiotherapy for locally advanced basal cell and squamous cell carcinomas of the skin. Int J Radiat Oncol Biol Phys. 2004;60(2):406–11.

    Article  PubMed  Google Scholar 

  9. Lo JS, Snow SN, Reizner GT, Mohs FE, Larson PO, Hruza GJ. Metastatic basal cell carcinoma: report of twelve cases with a review of the literature. J Am Acad Dermatol. 1991;24(5):715–9.

    Article  CAS  PubMed  Google Scholar 

  10. Locke J, Karimpour S, Young G, Lockett MA, Perez CA. Radiotherapy for epithelial skin cancer. Int J Radiat Oncol Biol Phys. 2001;51(3):748–55.

    Article  CAS  PubMed  Google Scholar 

  11. Brantsch KD, Meisner C, Schönfisch B, Trilling B, Wehner-Caroli J, Röcken M, et al. Analysis of risk factors determining prognosis of cutaneous squamous-cell carcinoma: a prospective study. Lancet Oncol. 2008;9(8):713–20.

    Article  PubMed  Google Scholar 

  12. Lansbury L, Leonardi-Bee J, Perkins W, Goodacre T, Tweed JA, Bath Hextall FJ. Interventions for non-metastatic squamous cell carcinoma of the skin. In: Lansbury L, editor. Cochrane database of systematic review. Chicheste: Wiley; 2010;(4). p. CD007869.

    Google Scholar 

  13. Goyal U, Kim Y, Tiwari HA, Witte R, Stea B. A pilot study of ultrasound-guided electronic brachytherapy for skin cancer. J Contemb Brachytherapy. 2015;7(5):374–80.

    Article  Google Scholar 

  14. Sayler E, Eldredge-Hindy H, Dinome J, Lockamy V, Harrison AS. Clinical implementation and failure mode and effects analysis of HDR skin brachytherapy using Valencia and Leipzig surface applicators. Brachytherapy. 2015;14(2):293–9.

    Article  PubMed  Google Scholar 

  15. Skowronek J. Brachytherapy in the treatment of skin cancer: an overview. Postepy Dermatol Alergol. 2015;32(5):362–7.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Arenas M, Arguís M, Díez-Presa L, Henríquez I, Murcia-Mejía M, Gascón M, et al. Hypofractionated high-dose-rate plesiotherapy in nonmelanoma skin cancer treatment. Brachytherapy. 2015;14(6):859–65.

    Article  PubMed  Google Scholar 

  17. Ballester-Sánchez R, Pons-Llanas O, Candela-Juan C, Celadá-Álvarez FJ, Barker CA, Tormo-Micó A, et al. Electronic brachytherapy for superficial and nodular basal cell carcinoma: a report of two prospective pilot trials using different doses. J Contemb Brachytherapy. 2016;8(1):48–55.

    Article  Google Scholar 

  18. Bhatnagar A. Nonmelanoma skin cancer treated with electronic brachytherapy: results at 1 year. Brachytherapy. 2013;12(2):134–40.

    Article  PubMed  Google Scholar 

  19. Debois JM. Cesium-137 brachytherapy for epithelioma of the skin of the nose: experience with 370 patients. J Belge Radiol. 1994;77(1):1–4.

    CAS  PubMed  Google Scholar 

  20. Delishaj D, Laliscia C, Manfredi B, Ursino S. Non-melanoma skin cancer treated with high-dose-rate brachytherapy and Valencia applicator in elderly patients: a retrospective case series. J Contemp Brachytherapy. 2015;7(6):437–44.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Guix B, Finestres F, Tello J, Palma C, Martínez A, Guix J, et al. Treatment of skin carcinomas of the face by high-dose-rate brachytherapy and custom-made surface molds. Int J Radiat Oncol Biol Phys. 2000;47(1):95–102.

    Article  CAS  PubMed  Google Scholar 

  22. Gauden R, Pracy M, Avery AM, Hodgetts I, Gauden S. HDR brachytherapy for superficial non-melanoma skin cancers. J Med Imaging Radiat Oncol. 2013;57(2):212–7.

    Article  PubMed  Google Scholar 

  23. Köhler-Brock A, Prager W, Pohlmann S, Kunze S. [The indications for and results of HDR afterloading therapy in diseases of the skin and mucosa with standardized surface applicators (the Leipzig applicator)]. Strahlenther Onkol. 1999;175(4):170–4.

    Article  PubMed  Google Scholar 

  24. Paravati AJ, Hawkins PG, Martin AN, Mansy G, Rahn DA, Advani SJ, et al. Clinical and cosmetic outcomes in patients treated with high-dose-rate electronic brachytherapy for nonmelanoma skin cancer. Pract Radiat Oncol. 2015;5(6):e659–64.

    Article  PubMed  Google Scholar 

  25. Sedda AF, Rossi G, Cipriani C, Carrozzo AM, Donati P. Dermatological high-dose-rate brachytherapy for the treatment of basal and squamous cell carcinoma. Clin Exp Dermatol. 2008;33(6):745–9.

    Article  CAS  PubMed  Google Scholar 

  26. Svoboda VHJ, Kovarik J, Morris F. High dose-rate microselectron molds in the treatment of skin tumors. Int J Radiat Oncol Biol Phys. 1995;31(4):967–72.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Banner MD Anderson Cancer Center, 2946 E Banner Gateway Dr, Gilbert, AZ, 85234, USA

    Anna Likhacheva MD, MPH

Authors
  1. Anna Likhacheva MD, MPH
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Corresponding author

Correspondence to Anna Likhacheva MD, MPH .

Editor information

Editors and Affiliations

  1. Department of Radiation Oncology, University of California Davis Medical Center, UC Davis Comprehensive Cancer Center, Sacramento, California, USA

    Jyoti Mayadev

  2. Department of Radiation Oncology, University of California Davis Medical Center, UC Davis Comprehensive Cancer Center, Sacramento, California, USA

    Stanley H. Benedict

  3. Division of Brachytherapy, Gynecologic and Sarcoma Services, Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California, USA

    Mitchell Kamrava

Appendix

Appendix

Skin Cancer Case Study 15.1: Leipzig Applicator (Elekta, Nucletron®, Stockholm, Sweden)

A 61-year-old female presented to the attention of her dermatologist with complaints of a slowly enlarging pearly skin lesion on the left nasal ala (Fig. 15.5). Lesion size at the time of biopsy was 8 mm in greatest dimension. She was averse to having surgical intervention and was treated with definitive radiation therapy

Fig. 15.5.
figure 5

Nodular basal cell carcinoma located on the left nasal ala in a 61-year-old woman. Central crater is the result of a shave biopsy

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She received skin surface radionuclide-based brachytherapy using a Leipzig applicator (Fig. 15.6). A thermoplastic mask was used to immobilize the patient during treatment. Lead shielding was using to protect the eyes, the upper lip, and nasal septum from scattered radiation. She was treated to a total of 40 Gy in 8 fractions, delivered twice a week, at least 72 h apart. The dose was prescribed to 3 mm (Fig. 15.7)

Fig. 15.6.
figure 6

Daily treatment setup showed the Leipzig Applicator (Elekta, Nucletron®, Stockholm, Sweden), lead shielding, and thermoplastic mask with a cutout for the nose

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Fig. 15.7.
figure 7

Depth-dose profile for a 2 cm Leipzig Applicator (Elekta, Nucletron®, Stockholm, Sweden). (Used with permission from Pérez-Calatayud J, Granero D, Baleester F, Puchades V, Casal E, Soriano A, Crispin V. A dosimetric study of Leipzig applicators. International Journal of Radiation Oncology* Biology* Physics. 2005 June 1; 62(2):579–584)

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She tolerated treatment well. She developed erythema, dry desquamation, and skin edema as the result of treatment (Fig. 15.8). She also complained of two episodes of self-limited nosebleeds

Fig. 15.8.
figure 8

Appearance of treatment site on the last day of treatment

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At 4-month follow-up, there was no evidence of residual or recurrent disease (Fig 15.9). There was mild hypopigmentation in the treated area. She was very pleased with the cosmetic outcome

Fig. 15.9.
figure 9

Appearance of treatment site on the last day of treatment at 4 months after RT course

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Skin Cancer Case Study 15.2: Freiburg Flap (Elekta, Nucletron®, Stockholm, Sweden)

A 61-year-old male with long-standing history of ultraviolet exposure and multiple diagnoses of nonmelanoma skin cancers. Biopsies of bilateral ala revealed well-differentiated squamous cell carcinoma (Fig. 15.10)

Fig. 15.10.
figure 10

Superficial well-differentiated squamous cell carcinoma affecting the tip of the nose and extending onto bilateral nasal ala

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The patient received 40 Gy in 8 fractions on a twice-a-week basis using a Freiburg flap (Elekta, Nucletron®, Stockholm, Sweden). A thermoplastic mask was used to immobilize the patient during treatment. The flap was sewn to the matrix of the Freiburg flap (Elekta, Nucletron®, Stockholm, Sweden). Lead shielding was used to protect the cheeks, eyes, and the upper lip (Fig. 15.11). The dose was prescribed to 3 mm depth (Fig. 15.12)

Fig. 15.11.
figure 11

Daily setup included thermoplastic mask, to which a Freiberg flap (Elekta, Nucletron®, Stockholm, Sweden) was sewn. Lead shielding was used to protect uninvolved surrounding structures from scattered dose

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Fig. 15.12.
figure 12

Radiation treatment plan showing catheter reconstruction and expected dose distribution

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The patient developed erythema and dry desquamation at the end of his treatment course (Fig. 15.13)

Fig. 15.13.
figure 13

Clinical appearance of the skin after on the last treatment day

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At 10 months after RT, there was no evidence of residual disease (Fig. 15.14)

Fig. 15.14.
figure 14

At 10 months after RT, there was no evidence of disease. Mild hypopigmentation in the treated area

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Likhacheva, A. (2017). Skin Brachytherapy. In: Mayadev, J., Benedict, S., Kamrava, M. (eds) Handbook of Image-Guided Brachytherapy. Springer, Cham. https://doi.org/10.1007/978-3-319-44827-5_15

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  • DOI: https://doi.org/10.1007/978-3-319-44827-5_15

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-44825-1

  • Online ISBN: 978-3-319-44827-5

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