Treatment of facial cutaneous carcinoma with high-dose rate contact brachytherapy with customized molds

BACKGROUND: The main treatment given for initial stage facial epitheliomas is surgery, although there are alternatives. We present our results with Ir-192 high dose rate (HDR) contact brachytherapy. METHODS AND MATERIALS: Fifty-one epitheliomas, with a mean size of 1.5 cm and a maximum thickness of 3 mm, were treated with HDR contact brachytherapy by means of customized molds, with plastic tubes on bolus for fiat surfaces and on wax molds for the nose. A total dose of 48-57 Gy, 3-4 Gy/fraction three times a week, was administered. RESULTS: After a median followup of 45 months, five tumors relapsed (9.8%), four of them on the tip of the nose. The 5-year actuarial local control rate was 89%, 100% for flat surfaces, and 83% for the nose. All of them were salvaged with surgery. The treatment was well tolerated, 21.6% developed severe acute toxicity, with good or very good late cosmetic results. CONCLUSION: HDR contact brachytherapy is a good alternative to treat facial epitheliomas with a maximum thickness of 3 mm. Tip of the nose tumors are not well covered with this technique and a different procedure is required. (C) 2011 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.