The Department of Radiotherapy of Hospital de Santa Maria has already published in Brachytherapy, the journal of American Society of Brachytherapy, the results of 17 cases of eyelid carcinomas treated with high-dose-rate interstitial brachytherapy. It is the publication with the largest number of basal cell carcinomas undergoing this type of treatment and the second largest in terms of total number of lesions, including basal and squamous cell carcinomas. With a median followup of 40 months, the local control rate was 94.1%, similar to that achieved with other treatments, including surgery. Functional and cosmetic results were considered good to excellent in most patients.
Brachytherapy can be applied as the sole treatment in patients without surgical indication or in situations that surgery could compromise the cosmetic, or it can be used as adjuvant to surgery (in high-risk lesions or with inadequate surgical margins). It can also be indicated in salvage of local recurrences.
Compared to low-dose-rate, high-dose-rate brachytherapy has the advantages of reducing the treatment time, allowing optimization of the dose distribution and the radiation protection of health professionals.
Statistical analysis concluded that recurrent lesions and large volumes of tissue receiving higher doses are associated with worse results in terms of tumor control and cosmetics, respectively.
Authors and Affiliations:
Virgínia Mareco(1), MD, Laurentiu Bujor(1,2), MD, André N. Abrunhosa-Branquinho(1), MD, MSc, Miguel Reis Ferreira(1), MD, PhD (c), Tiago Ribeiro(3), MSc, Ana Luisa Cardoso Vasconcelos(1), MD, Cidalina Reis Ferreira(4), MD, Marília Jorge(1), MD, HOD
(1)Department of Radiotherapy, (3)Medical Physics Unit, and (4)Ophtalmology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, EPE, Lisbon, Portugal
(2)Present address: Service D'Oncologie-Radiotherapie, Centre Hospitalier Universitaire
de Fort de France, Martinique
Abstract:
Purpose: To report the experience and the outcomes of interstitial high-dose-rate (HDR) brachytherapy (BT) of eyelid skin cancer at the Department of Radiotherapy of Hospital de Santa Maria in Lisbon.
Methods amd Materials: Seventeen patients (pts; mean age, 73.75 years) who underwent eyelid interstitial HDR BT with an 192Ir source between January 2011 and February 2013 were analyzed. Lesions were basal (94%) and squamous (6%) cell carcinomas, on lower (88%) or upper (6%) eyelids, and on inner canthus (6%). T-stage was Tis (6%), T1 (46%), T2 (36%), and T3a (12%). The purpose of BT was radical (12%), adjuvant to surgery (71%), or salvage after surgery (18%). The BT implant and treatment planning were based on the Stepping Source Dosimetry System. The median total dose was 42.75 Gy (range, 32–50 Gy), with a median of 10 fractions (range, 9–11 fractions), twice daily, 6 h apart. The median V100 was 2.38 cm3 (range, 0.83–5.59 cm3), and the median V150 was 1.05 cm3 (range, 0.24–3.12 cm3).
Results: At a median followup of 40 months (range, 7–43 months), the local control was 94.1%. There was one local recurrence and one non-related death. The BT was well tolerated. Madarosis was the most common late effect (65% of pts) and was related with higher values of V100 (p = 0.027). Cosmetic outcomes were good and excellent in 70% of pts.
Conclusions: Interstitial HDR BT is a feasible and safe technique for eyelid skin cancers, with good local control. Recurrent lesions and higher volumes receiving the prescribed dose were associated with worse outcomes.
Journal: Brachytherapy
