High-dose brachytherapy for elderly patients with nonmelanoma skin cancer produces excellent cure rates and cosmetic outcomes, according to a new study presented at the 2019 annual meeting of the Radiological Society of North America (RSNA) (Abstract SSM24-02).

“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.”

— Ashwatha Narayana, MD

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“For elderly patients [with nonmelanoma skin cancers] who don't heal as well and may have additional medical problems, surgery may not be the best option,” said study author Ashwatha Narayana, MD, Chairman of the Department of Radiation Oncology at Northern Westchester Hospital. “If the affected area is the tip of the nose, ear, or on the eyelid, multiple surgeries and skin grafting may be required.”

In high-dose brachytherapy, a precise dose of radiation is delivered to the cancerous cells through catheters implanted into a custom-fitted applicator. Unlike a 6-week course of external-beam radiation therapy—in which treatment sessions can last up to 6 hours—a course of high-dose brachytherapy includes six 3-minute sessions over 2 weeks.

“Treatment with external-beam radiation therapy can be too long and painful for elderly patients,” said Dr. Narayana. “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 tumor while sparing healthy tissue nearby.”

Study Details

In the study, radiologists used high-dose-rate brachytherapy to treat 70 patients between the age of 70 and 100 (median age = 85 years) with early-stage basal cell and squamous cell carcinoma. A total of 81 lesions (basal cell carcinoma = 53, squamous cell carcinoma = 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 of 10 mm. Patients were followed for up to 4 years (median follow-up = 2 years).

Results

“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,” said Dr. Narayana. “This is a great treatment option compared to surgery.” One patient with squamous cell carcinoma and one patient with basal cell carcinoma experienced disease recurrence at 3 and 6 months from the time of therapy, respectively—both the recurrences were > 2 cm in size and involved a lower extremity.

Minor late effects in included hypopigmentation (in three patients), hyperpigmentation (in two), telangiectasia (in two), and atrophy of the skin (in one). Two patients experienced wound breakdown 12 and 14 months after completion of therapy.

Despite being a well-recognized treatment that is used routinely to treat other types of cancers, Dr. Narayana said brachytherapy has failed to catch on for the treatment of nonmelanoma skin cancers on the face and neck. He hopes results of his study and future research will help raise awareness of high-dose-rate brachytherapy as an alternative to surgery and external-beam radiation therapy. According to Dr. Narayana, patients treated with brachytherapy have minimal recovery time and typically experience few or no side effects that can be associated with the treatment, such as nausea, hair loss, or diarrhea. They can also return to normal activities after the procedure.

“High-dose-rate brachytherapy is a powerful way of treating skin cancers in both elderly and younger patients,” he concluded. “The results are impressive.”

Disclosure: For full disclosures of the study authors, visit meeting.rsna.org/program.