Elsevier

Brachytherapy

Volume 14, Issue 4, July–August 2015, Pages 554-564
Brachytherapy

Interstitial high-dose-rate brachytherapy in eyelid cancer

https://doi.org/10.1016/j.brachy.2015.03.005Get rights and content

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 and 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.

Introduction

Eyelid skin malignancies present 5–9% of all skin cancers. Surgery has been the main option of treatment, but radiation therapy is important in adjuvant setting and might be an alternative approach in selected cases.

Low-dose-rate (LDR) brachytherapy (BT) has been the type of BT most commonly used to treat eyelid cancer [1], [2]. Because of the recent implementation, there are only four reports in the literature describing the use of high-dose-rate (HDR) BT in eyelid carcinoma [3], [4], [5], [6]. The aim of this article was to report the results of the Department of Radiotherapy of Hospital de Santa Maria, in Lisbon, with interstitial HDR BT in the treatment of eyelid skin cancers; assess the tumor control, cosmesis, and toxicity; and compare them with other published series.

Section snippets

Patient selection

Between January 2011 and February 2013, 19 immunocompetent patients (pts) were submitted to interstitial 192Ir HDR BT of the eyelid in the Department of Radiotherapy. Two pts were excluded from the analysis because the eyelid tumor was an extension of a lesion of the nose. Tumors arising in the canthi were included in this study. Therefore, 17 lesions were analyzed (Table 1, Table 2).

There was a male predominance (88%), and the majority of the tumors arose in the lower eyelid (88%). Only one

Epidemiology

Cutaneous BCC and SCC are the most common cancers in the world. They account for 95% of nonmelanoma skin cancer (NMSC) and 90% of all skin cancers [14], [15], and its incidence is increasing worldwide up to 10% per annum [16], [17]. In Portugal, the annual incidence is 70 and 10 new cases per 100,000 people for BCC and SCC, respectively (15). In 2012, the South Region Cancer Registry (Registo Oncológico Regional do Sul) notified 3997 cases of BCC and 1514 cases of SCC.

More than 75% of skin

Local control and survival

The median followup was 40 months (range, 7–43 months). Pts who received primary BT had complete response. One pt underwent clinical local recurrence, histology-unproven, at 36 months of the salvage combined surgery and BT (40 Gy in 10 fr) after multiple salvage surgeries of a BCC on the lower eyelid; this pt was a 96-year-old man, bedridden, under palliative care because of multiple comorbidities (Patient Number 5 in Table 4). Consequently, the local control was 94.1% at the followup time, and

Discussion

BCC is the most common worldwide histology: BCC accounts for 75% of NMSC and SCC accounts for the remaining majority of cases [17], [32]. The present study presents the largest number of cases of eyelid BCC (94%) submitted to HDR interstitial BT and reported in the literature. Although it is the second largest review of eyelid HDR BT in relation to the number of evaluated lesions, 17 vs. 20 tumors in the study of Azad et al. (3), the latter reported only 10% of eyelid BCC. There are only four

Acknowledgments

The authors acknowledge Dr. Ana Miranda and Dr. Alexandra Mayer-da-Silva from the South Region Cancer Registry (Registo Oncológico Regional do Sul), Lisbon, Portugal, for providing the most updated epidemiologic information.

They also thank Prof. Luís Prudêncio from the Medical Physics Unit, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, EPE, Lisbon, for the technical assistance.

References (47)

  • R. Malhotra et al.

    The Australian Mohs database: Periocular squamous cell carcinoma

    Ophthalmology

    (2004)
  • A. Narayana et al.

    High-dose-rate interstitial brachytherapy in recurrent and previously irradiated head and neck cancers—preliminary results

    Brachytherapy

    (2007)
  • J.J. Mazeron et al.

    GEC-ESTRO recommendations for brachytherapy for head and neck squamous cell carcinomas

    Radiother Oncol

    (2009)
  • M. Alam et al.

    The use of brachytherapy in the treatment of nonmelanoma skin cancer: A review

    J Am Acad Dermatol

    (2011)
  • R.D. Lovett et al.

    External irradiation of epithelial skin cancer

    Int J Radiat Oncol Biol Phys

    (1990)
  • P.J. Fitzpatrick et al.

    Basal and squamous cell carcinoma of the eyelids and their treatment by radiotherapy

    Int J Radiat Oncol Biol Phys

    (1984)
  • J.O. Archambeau et al.

    Pathophysiology of irradiated skin and breast

    Int J Radiat Oncol Biol Phys

    (1995)
  • A. Ginot et al.

    Normal tissue tolerance to external beam radiation therapy: Skin

    Cancer Radiother

    (2010)
  • K.H. Pigott et al.

    Sweat gland function as a measure of radiation change

    Radiother Oncol

    (2000)
  • B.D. Lawenda et al.

    Permanent alopecia after cranial irradiation: Dose-response relationship

    Int J Radiat Oncol Biol Phys

    (2004)
  • M. Ferré et al.

    Brachytherapy dose calculation

    Cancer Radiother

    (2013)
  • L. De Cicco et al.

    Postoperative management of keloids: Low-dose-rate and high-dose-rate brachytherapy

    Brachytherapy

    (2014)
  • C. Hennequin et al.

    Cancer Radiother

    (2013)
  • Cited by (13)

    • Acute and late complications and toxicities of skin brachytherapy

      2021, Brachytherapy
      Citation Excerpt :

      Necrosis was not reported in either of the studies. Both studies indicated excellent/optimal/good cosmesis in up to 70% of cases and satisfactory in 12–23% of cases (26,34). Eight percent of patients felt that cosmesis was unsatisfactory in the series by Krengli et al. (34).

    • High-dose-rate brachytherapy for facial skin cancer: Outcome and toxicity assessment for 71 cases

      2021, Brachytherapy
      Citation Excerpt :

      The median total dose was 42.75 Gy (range 32–50), with a median of 10 fractions (range 9–11), twice daily, 6-hours apart (BEDs of 50.4–75 Gy). Madarosis was the most common late effect (65% of patients) (21). Ghadjar et al. (22) reports a series of LDR BT (70 patients) and HDR (33 patients for lip tumors).

    • GEC-ESTRO ACROP recommendations in skin brachytherapy

      2018, Radiotherapy and Oncology
      Citation Excerpt :

      With LDR, doses of 60 Gy for BCC and 70 Gy for SCC achieved a local control rate over 96% with 18% local side effects (significantly more frequent in recurrent lesions) [55,56]. HDR BT for eyelid targets was reported in small number of patients with local control rates over 94% [57–59]. In 2015, a systematic review analysed six publications and concluded that BT is well tolerated, the local control is high (median: 95.2%), the toxicity is acceptable and the functional-cosmetic outcome is good [60].

    • Skin Brachytherapy (Contact and Interventional Radiotherapy)

      2023, Non-melanoma Skin Cancer: Essentials for Oncologists
    View all citing articles on Scopus
    View full text