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Barnes EA, Tsao MN, Taggar AS, Ravi A, Paudel MR. Optimizing surface mould brachytherapy for treatment of nasal basal cell carcinoma using customized applicators. Brachytherapy 2023; 22:665-672. [PMID: 37277286 DOI: 10.1016/j.brachy.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/23/2023] [Accepted: 05/04/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE Surface mould brachytherapy (SMBT) is ideal in treating superficial skin cancer over the curved surface of the nasal ala. We describe the process of initiating and optimizing SMBT treatment at our institution including clinical workflow, generation of three dimensional (3D) printed custom applicators, and clinical outcomes. METHODS AND MATERIALS Planning CT scans were used to acquire images for delineating target volumes. The applicator was designed with customized catheter positioning (3-5mm from target) to cover target volume while sparing dose to organs at risk (OAR) such as adjacent skin and nasal mucosa. Applicators were 3D printed, with transparent resin to aid visualization of underlying skin. Dosimetric parameters evaluated included CTV D90, CTV D0.1cc, and D2cc to OARs. Clinical outcomes assessed were local control, acute and late toxicity (Common Terminology Criteria for Adverse Events v5.0 [CTCAEv5.0]), and cosmesis (Radiation Therapy Oncology Group [RTOG]). RESULTS Ten patients were treated with SMBT with a median followup of 17.8 months. Dose prescription was 40 Gy in 10 daily fractions. Mean CTV D90 was 38.5 Gy (range 34.7-40.6), mean CTV D0.1cc 49.2 Gy (range 45.6-53.5), which was <140% of the prescription dose in all patients. Treatment was well tolerated, with acceptable Grade 2 acute, Grade 0-1 late skin toxicity, and good-excellent cosmesis for all patients. Two patients experienced local failure, and both underwent surgical salvage. CONCLUSIONS SMBT was successfully planned and delivered for superficial nasal BCC using 3D printed custom applicators. Excellent target coverage was achieved while minimizing dose to OAR. Toxicity and cosmesis rates were good-excellent.
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Affiliation(s)
- Elizabeth A Barnes
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
| | - May N Tsao
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Amandeep S Taggar
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Ananth Ravi
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Moti R Paudel
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Momeni N, Ali Boroomand M, Roozmand Z, Namiranian N, Hamzian N. Normal tissue complication probability of acute eyelids erythema following radiotherapy of head and neck cancers and skull-base tumors. Phys Med 2023; 112:102621. [PMID: 37329741 DOI: 10.1016/j.ejmp.2023.102621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/19/2023] Open
Abstract
PURPOSE Radiation therapy is broadly used as one of the main treatment methods for patients with head and neck cancers and skull base tumors. However, it can lead to normal tissue complications. Therefore, this study aimed to model normal tissue complication probability (NTCP) of eyelid skin erythema after radiation therapy. METHODS The dataset of 45 patients with head and neck and skull base tumors was prospectively collected from their dose-volume histograms (DVHs). Grade 1 + eyelid skin erythema based on the Common Terminology Criteria for Adverse Events (CTCAE 4.0) was evaluated as the endpoint after a three-month follow-up. The Lyman-Kutcher-Burman (LKB) radiobiological model was developed based on generalized equivalent uniform dose (gEUD). Model parameters were calculated by maximum likelihood estimation. Model performance was evaluated by ROC-AUC, Brier score and Hosmer-Lemeshow test. RESULTS After three months of follow-up, 13.33% of patients experienced eyelids skin erythema grade 1 or more. The parameters of the LKB model were: TD50 = 30 Gy, m = 0.14, and n = 0.10. The model showed good predictive performance with ROC-AUC = 0.80 (CI:0.66-0.94) and a Brier score of 0.20. CONCLUSIONS In this study, NTCP of eyelid skin erythema was modeled based on the LKB radiobiological model with good predictive performance.
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Affiliation(s)
- Nastaran Momeni
- Department of Medical Physics, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Ali Boroomand
- Clinical oncology department, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Zahra Roozmand
- Department of Medical Physics, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nasim Namiranian
- Diabetes research center of Alikhani, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Nima Hamzian
- Department of Medical Physics, School of Medicine, Shahid Sadoughi Universi of Medical Sciences, Yazd, Iran.
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Rembielak A, Mansy G, Barnes EA, Licher J, Tselis N. Advances in Skin Brachytherapy: Cosmesis and Function Preservation. Clin Oncol (R Coll Radiol) 2023:S0936-6555(23)00057-2. [PMID: 36894382 DOI: 10.1016/j.clon.2023.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 02/01/2023] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
Skin brachytherapy represents an excellent alternative treatment for patients with non-melanoma skin cancers. It offers superior conformity of dose distribution with rapid dose fall off, reducing the risk of radiotherapy-related treatment toxicity. A smaller treatment volume in brachytherapy, when compared with external beam radiotherapy, is conducive for hypofractionation, which is an attractive option for decreasing outpatient visits to the cancer centre, especially for elderly and frail patients. Skin brachytherapy is an excellent option to preserve function and cosmesis, especially in skin cancers located in the head and neck region. Electronic brachytherapy, image-guided superficial brachytherapy and 3D printed moulds are all emerging advances in skin brachytherapy.
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Affiliation(s)
- A Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| | - G Mansy
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, California, USA
| | - E A Barnes
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - J Licher
- Department of Radiotherapy and Oncology, University Hospital Frankfurt am Main, Frankfurt, Germany
| | - N Tselis
- Department of Radiotherapy and Oncology, University Hospital Frankfurt am Main, Frankfurt, Germany
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Rodríguez Villalba S, Guirado LLorente D, Sanz Cazorla A, Perez-Calatayud J, Rembielak A. HDR brachytherapy in keratinocyte skin carcinomas - Single center experience with analysis of clinical, dosimetric, and radiobiological factors in acute skin toxicity. Brachytherapy 2023; 22:108-119. [PMID: 36376228 DOI: 10.1016/j.brachy.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/09/2022] [Accepted: 10/07/2022] [Indexed: 11/13/2022]
Abstract
PURPOSE Radiotherapy techniques have been utilized to treat keratinocyte skin carcinoma (KSC). The objective of this study was to report the results of patients with KSC treated with HDR brachytherapy, with a variety of techniques and applicators. A statistical analysis of clinical, radiobiological, and technical factors has been made to analyze those factors related to skin acute toxicity, focused on acute epithelitis G3. METHODS AND MATERIALS Between February 2005 and August 2020, 93 patients with 120 histologically proven KSC have been treated in our Institution. BT treatment has been performed using superficial BT/plesiotherapy (Valencia applicator (22%), flaps (48%), customized molds (4%) or interstitial techniques (26%)). The indications of BT were primary/definitive in 38 treatments (32%) or adjuvant/postoperative in 82 (68%). In 14 (17%) of the 82 operated patients a skin graft. Mean comparison t tests were performed for quantitative variables, and percentage comparison Chi2 tests for qualitative. Multivariate binomial logistic regression models were done. RESULTS Median follow-up was 36.5 months (range 5-141). Local control was achieved in 110 treatments (92%). Acute toxicity, dermatitis, was G1 7%; G2, 57% and G3 38%. The main factors statistically associated to the appearance of dermatitis G3 were the total dose, the volume treated, and the use of manufactured flaps. The main protective factor against dermatitis G3 was implant of skin graft. CONCLUSIONS In KSC BT the use of manufactured flap is accompanied by greater EG3, only with a relationship with the volume of treatment and total dose.
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Affiliation(s)
| | - Damian Guirado LLorente
- Instituto de Investigación Biosanitaria (Ibs.Granada). Unidad de Radiofísica, Hospital Universitario Clínico San Cecilio. Granada, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Granada, Spain.
| | | | - José Perez-Calatayud
- Radiotherapy Department, Hospital Clínica Benidorm, Benidorm, Alicante, Spain; Radiotherapy Department, La Fe University and Polytechnic Hospital. Valencia, Spain.
| | - Agata Rembielak
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK.
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Benkhaled S, Van Gestel D, Gomes da Silveira Cauduro C, Palumbo S, del Marmol V, Desmet A. The State of the Art of Radiotherapy for Non-melanoma Skin Cancer: A Review of the Literature. Front Med (Lausanne) 2022; 9:913269. [PMID: 35833108 PMCID: PMC9272768 DOI: 10.3389/fmed.2022.913269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Due to the general aging population and the fashion trend of sun exposure, non-melanoma skin cancer (NMSC) is rising. The management of NMSC is difficult and necessitates a multidisciplinary team (i.e., pathologists, dermatologists, medical oncologists, surgeons, and radiation oncologists). When surgery is not an option or will cause unacceptably functional morbidity, radiation therapy (RT) may be a preferable tissue-preserving option. Whether used alone or in conjunction with other treatments, RT has been shown to be quite effective in terms of cosmetic results and local control. Contact hypofractionated RT, brachytherapy, and electronic brachytherapy are all promising new treatments. However, rigorous, randomized trials are missing, explaining the disparity in dose, fractionation, and technique recommendations. Therefore, it is essential that interdisciplinary teams better understand RT modalities, benefits, and drawbacks. Our review will provide the role and indications for RT in patients with NMSC.
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Affiliation(s)
- Sofian Benkhaled
- Department of Radiation-Oncology, Institut Jules Bordet-Université Libre de Bruxelles, Brussels, Belgium
- *Correspondence: Sofian Benkhaled
| | - Dirk Van Gestel
- Department of Radiation-Oncology, Institut Jules Bordet-Université Libre de Bruxelles, Brussels, Belgium
| | | | - Samuel Palumbo
- Department of Radiation-Oncology, Jolimont Hospital, La Louvière, Belgium
| | - Veronique del Marmol
- Department of Dermatology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Antoine Desmet
- Department of Radiation-Oncology, Institut Jules Bordet-Université Libre de Bruxelles, Brussels, Belgium
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