Interstitial high-dose-rate brachytherapy in eyelid cancer
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.
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