Robert Sinha, MD, Steven Kurtzman, MD, Neil McIlmoil, RTT, Greg Morganroth, MD; California Skin Institute; Western Radiation Oncology
Background: There are over 3.0 million cases of nonmelanoma skin cancer (NMSC) diagnosed each year in the United States. Multiple treatment options exist for the treatment of these patients, including excisional surgery, curettage, Mohs micrographic surgery, cryotherapy, topical chemotherapy, and radiotherapy. We describe the outcomes of patients treated at a large private dermatology practice with electronic brachytherapy (eBx) who had a minimum follow-up duration of 1 year.
Methods: A retrospective review of patients with NMSC treated with eBx in a large dermatology practice between January 2012 and September 2012 was performed. All patients had a biopsy to confirm the diagnosis of NMSC prior to treatment. Patients received between 40 Gy and 45 Gy in 3-Gy to 4-Gy fractions, delivered three times per week. The treatment was delivered with a Xoft Axxent controller (50-kV source). Photographs were taken to document treatment outcomes at all follow-up visits.
Results: A total of 58 patients with 74 lesions were identified. The median age was 76 years. There were 53 (72%) facial lesions, 18 (24%) lower extremity lesions, 2 (2.7%) upper extremity lesions, and 1 (1.3%) truncal lesion. There were 40 T1 lesions, 32 T2 lesions, and 2 Tis lesions. Follow-up ranged from 12 to 19 months with a median follow-up of 16 months. Local control was 98.6% in this patient population. Delayed wound healing (> 3 months post-treatment) occurred in four (5.4%) lesions, all lower-extremity tumors. Cosmesis was rated as good to excellent at all treated sites except for two (2.7%) who developed hypopigmentation. These two patients were treated to a dose of 40 Gy in 10 fractions.
Conclusions: Early experience at a large dermatology practice treating NMSC in the office setting with eBx shows excellent local control and acceptable cosmetic outcomes. Patients with lower-extremity lesions are at higher risk of developing delayed wound healing. Careful patient selection and dose selection should be considered in these patients. eBx is an effective treatment in NMSC and offers patients an effective nonsurgical option.