Findings presented at the annual meeting of the Radiological Society of North America (RSNA) on Dec. 4, 2019, suggest that high-dose-rate brachytherapy for treating elderly patients with common skin cancers can provide excellent cure rates and cosmetic outcomes.
A press release from the RSNA explains that while squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) are highly curable and less deadly than melanoma, their most common treatments—including surgical removal and external beam radiation therapy—can be costly, disfiguring, and not ideal for older patients.
“For elderly patients who do not heal as well and may have additional medical problems, surgery may not be the best option," said Dr. Ashwatha Narayana, chairman of the department of radiation oncology at Northern Westchester Hospital in Mount Kisco, N.Y., in the release. “If the affected area is the tip of the nose, ear or on the eyelid, multiple surgeries and skin grafting may be required.”
High-dose-rate brachytherapy, in this case, involves a precise dose of radiation is delivered to the cancerous cells in the skin. A custom-fit mould is made to be placed on top of the tumour, in which catheters that will carry the radioactive material are embedded at precisely calculated depths and positions. Treatment is delivered in six three-minute sessions spaced over two weeks. This contrasts with typical external radiation therapy which can involve six weeks of sessions lasting up to six hours.
“Treatment with external beam radiation therapy can be too long and painful for elderly patients,” Dr. Narayana said. “It also exposes healthy tissue around the lesion to radiation, which can increase side effects. Brachytherapy delivers a higher dose of radiation directly to the tumour while sparing healthy tissue nearby.”
Dr. Narayana said that patients treated with brachytherapy have minimal recovery time, and experience few to no side effects. They typically can return to normal activities after their procedure.
In the presented study, 70 patients, aged 70 to 100 years (median age 85 years) with early-stage BCC and SCC were treated with brachytherapy. A total of 81 lesions (BCC: 53, SCC: 28) on the nose, face, forehead, scalp, ear, neck and legs were treated between 2013 and 2019. Lesions ranged in size from 3 to 26 mm with a median size of 10 mm.
The patients were followed for up to four years, with a median follow-up of two years.
“We had a cure rate of 96% in patients with squamous cell carcinoma and 98% in patients with basal cell carcinoma, and cosmetic outlook was excellent in 90% of cases,” Dr. Narayana said. “This is a great treatment option compared to surgery.”
While brachytherapy is a well-recognized treatment that is used routinely to treat other types of cancers, Dr. Narayana said it has failed to catch on for the treatment of non-melanoma skin cancers on the face and neck.
“High-dose-rate brachytherapy is a powerful way of treating skin cancers in both elderly and younger patients,” he said. “The results are impressive.”