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Soo Park, MD
Soo Park, MD
Posted: Tuesday, January 18, 2022
A team in Spain has chronicled its successful decade-long experience of treating patients with small, stage I non-melanoma skin cancers efficaciously using high-dose–rate contact brachytherapy with surface applicators—called plesiotherapy—distinguished by the custom molds they created to treat irregular areas. In Clinical and Translational Oncology, M. Algara López, MD, PhD, of the Universitat Autònoma, Barcelona, and colleagues described the use of this treatment in 70 patients between September 2008 and February 2018, either exclusively or following excision in those with risk factors for recurrence. The complete response rate of those receiving plesiotherapy alone was 95.8%, and recurrence (retreated successfully) occurred in 5.7%, at a mean follow-up of 96.2 months.
Plesiotherapy can be used on small skin cancers located on irregular surfaces, unlike other techniques such as noncustomized surface applicators, the authors noted. “We planned the treatment using two CT scans: the first to delineate the lesion and the second after placing the thermoplastic mold. Fusing the two CT images enables planning of the target volume and pinpointing where the catheters are in the mold,” they stated. Catheter placement was crucial to “ensure the correct dose distribution and limit the dose [to] at-risk organs.”
All treated lesions were less than 4 cm in diameter and less than 5 mm deep. Of all 70 patients (mean age, 79 years), 85.7% had basal cell carcinomas, and 80% of the lesions were in the nasal area.
Fractionation schemes ranged from 66 Gy in daily fractions of 2 Gy, for younger patients seeking the best cosmetic outcome to 40 Gy in 10 fractions, to maximize comfort in the older, less healthy patients. The typical regimen was 54 Gy in fractions of 3 Gy, administered three times weekly.
High-dose–rate plesiotherapy had acceptable toxicity, according to the team. Although chronic toxicity appeared in 26.6% of patients, its severity was limited to grade 1 or 2, explained Dr. López and co-investigators. It was generally asymptomatic and superficial, self-limiting, and resolved fully shortly after treatment ended.
Disclosure: The study authors reported no conflicts of interest.
Clinical and Translational Oncology
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