Olek David, El-Ghamry Moataz N, Deb Niloyjyoti, Thawani Nitika, Shaver Courtney, Mutyala Subhakar
Department of Radiation Oncology, Baylor Scott & White Health, Temple, TX.
Department of Radiation Oncology, Baylor Scott & White Health, Temple, TX.
Brachytherapy. 2018 May-Jun;17(3):601-608. doi: 10.1016/j.brachy.2018.01.002. Epub 2018 Feb 15.
Nonmelanoma skin cancer is the most commonly diagnosed malignancy in the United States. A modern version of surface brachytherapy, "topographic applicator brachytherapy" (TAB), can be used to treat early-stage nonmelanoma skin cancer (ES-NMSC). The purpose of this study was to evaluate the acute toxicity, chronic toxicity, and recurrence rates of patients with ES-NMSC treated with TAB.
From 2010 to 2013, 172 patients with 273 ES-NMSC tumors were consecutively treated with TAB. A custom applicator was created using a thermoplastic mold with Harrison Anderson Mick applicators. Dose fractionation schemes included 40 Gy in eight fractions delivered twice per week or 48 Gy in 16 fractions delivered four times per week.
Of the 273 tumors treated, 23.8% were located on the nose, 54.2% were basal cell carcinoma, 76.2% were Stage I, 89.3% were treated definitively, 98.9% completed treatment, and 75.5% received 40 Gy in eight fractions. Median followup was 25.0 months (0.5-71.0 months). Maximum acute toxicity was G0, 0.4%; G1, 33.3%; G2, 48.7%; G3, 12.1%; and G4, 5.1%. Local recurrence was 4.8% at 25 months, with median time to recurrence being 9 months. There was no regional or distant metastasis documented during the followup. Chronic toxicities included erythema (4.4%), chronic ulceration (4.0%), telangiectasia (2.6%), and pigmentation changes (2.2%).
TAB was able to provide excellent local control (95.2%) with low rates of Grades 3 and 4 toxicities for treatment of ES-NMSC. TAB is a reasonable alternative to surgical resection when there is concern of poor cosmesis/wound healing.
非黑色素瘤皮肤癌是美国最常被诊断出的恶性肿瘤。一种现代版的表面近距离放射疗法，即“地形施源器近距离放射疗法”（TAB），可用于治疗早期非黑色素瘤皮肤癌（ES-NMSC）。本研究的目的是评估接受TAB治疗的ES-NMSC患者的急性毒性、慢性毒性和复发率。
2010年至2013年，172例患有273个ES-NMSC肿瘤的患者连续接受了TAB治疗。使用带有哈里森·安德森·米克施源器的热塑性模具制作定制施源器。剂量分割方案包括每周两次给予8次分割的40 Gy，或每周4次给予16次分割的48 Gy。
在接受治疗的273个肿瘤中，23.8%位于鼻部，54.2%为基底细胞癌，76.2%为I期，89.3%接受了根治性治疗，98.9%完成了治疗，75.5%接受了8次分割的40 Gy。中位随访时间为25.0个月（0.5 - 71.0个月）。最大急性毒性为G0，0.4%；G1，33.3%；G2，48.7%；G3，12.1%；G4，5.1%。25个月时局部复发率为4.8%，复发的中位时间为9个月。随访期间未记录到区域或远处转移。慢性毒性包括红斑（4.4%）、慢性溃疡（4.0%）、毛细血管扩张（2.6%）和色素沉着变化（2.2%）。
TAB能够为ES-NMSC的治疗提供出色的局部控制（95.2%），3级和4级毒性发生率较低。当担心美容效果/伤口愈合不佳时，TAB是手术切除的合理替代方法。
