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High–Dose-Rate Afterloading Brachytherapy for Basal and Squamous Cell Carcinomas

By: Celeste L. Dixon
Posted: Monday, February 22, 2021

High–dose-rate afterloading brachytherapy, using Leipzig-style surface applicators, may help to overcome some of the challenges associated with using superficial radiation to successfully address localized basal cell and squamous cell carcinomas, according to reviewed results of its use in treating 71 patients with 101 lesions at the AC Camargo Cancer Center in Sao Paulo, Brazil. The retrospective study of these cases, treated between March 2013 and December 2018, was published in the Journal of Contemporary Brachytherapy by Leticia Gobo Silva, MD, MSc, and colleagues.

The patients’ mean age was 80 years, and more than two-thirds of the lesions were basal cell carcinomas. All patients had refused or were not candidates for surgery. The 3-year overall survival for the entire cohort was 94.5%, with 3-year and 5-year actuarial local control rates of 97.9% and 87.2%, respectively, the authors reported. Notably, “on univariate analysis, treatments with an equivalent dose to 2 Gy (EQD2) less than 50 Gy (P < .001) and dose per fraction smaller than 3 Gy (P < .001) were found to be statistically significant predictive factors of a worse outcome,” they wrote. Of the 71 patients, 3 died of local or distant disease progression.

All patients experienced grade 1 or 2 adverse effects. Grade 3 acute and late adverse effects occurred in nine and four patients, respectively, but no patients experienced grade 4 acute or late adverse effects.

Overall, concluded Dr. Silva and co-investigators, high–dose-rate afterloading brachytherapy provides “excellent” local control and offers patients a convenient treatment schedule as well. “The most effective regimen, in terms of dose and fractionation, to treat superficial non-melanoma skin cancer with [this method] remains uncertain, but a moderate minimum EQD2 dose of 50 Gy should be used,” they stated.

Disclosure: The study authors reported no conflicts of interest.



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