Transcript Comparison of HDR brachytherapy, orthovoltage x

Comparison of HDR Brachytherapy, Orthovoltage X-ray, and Electron Beam Radiation in the Treatment of
Non-Melanoma Skin Cancers: A Single Institution Experience of Individualized Radiation Therapy
L.R. Rosen1, A. Willett1,2, B.W. Fischer-Valuck1,2, S. Katz1, M. Durci1, T. Wu1, 1 Willis Knighton Cancer
Center, Shreveport, LA, 2 Louisiana State University School of Medicine – Shreveport, Shreveport, LA
Introduction
Non-melanoma skin cancers (NMSC) are the most common malignancies in the United States.
Current treatment options include surgery, topical medications and radiation therapy. HDR
brachytherapy has recently emerged as a treatment option, particularly for anatomically
challenging locations as well as for patients who require fewer treatments.
Methods
All patients treated with RT had biopsy proven squamous cell carcinoma (46%) or basal cell
carcinoma (54%) with a cohort limited to Stages I or II NMSC in the head, neck or extremities.
Acute skin toxicity was evaluated throughout treatment. Local control rates and physician graded
cosmetic outcome (poor, fair, good, excellent) were also monitored.
Treatment
Median
Dose
Median
Fractions
Orthovoltage
X-rays
52
13
Low cost;
Narrow penumbra
Electrons
54
15
Availability
HDR
Brachytherapy
42
7
Anatomically challenging
locations; Less fractions
Advantages
Results
Treatment
*Evans et al
IJROBP 1997
Local
Control
Cosmetic
Outcome*
Acute
Toxicity**
Orthovoltage
X-rays
100%
95%
1.9%
Electron Beam
98%
93%
4.8%
HDR Brachytherapy
100%
96%
3.8%
*Good or Excellent
based on RTOG
Cosmesis Criteria
BCCA
BCCA
before BCCA
after
BCCA
before
4Gy
of 18
6 MeV
Day
912ofx100kV
13
x 4Gy
Day BCCA
0
Day
**Grade 3 or 4 in
Common Terminology
Criteria for Adverse
Events
Discussion
Multiple radiation modalities provide excellent local control and cosmetic outcome in
patients with NMSC, and acute toxicity is tolerable. Individualized treatment based on
anatomical location, cosmetic outcome desired, and patient preference should be considered
when utilizing RT in the treatment of NMSC.
BCCA before BCCA after 7 x 7Gy
BCCA
BCCA
BCCA
7 x 7Gy of
IR192
of HDR
IR192
HDR
BCCA
after
12
x
4Gy
of
6 MeV
8 Days After 35 Days After 84 Days
After