High-dose-rate brachytherapy for facial skin cancer: Outcome and toxicity assessment for 71 cases

PURPOSE: In France, the reference technique for skin cancer was low-dose-rate brachytherapy (BT) delivered via iridium wire. At the end of their commercialization in 2015 we have replaced them by high-dose-rate (HDR) BT via interstitial catheters. We assessed efficacy and tolerance as soon as this technique was implemented. METHODS AND MATERIALS: Patients received 7 Gy on the first day, followed by 8 x 4 Gy over the next 4 days for exclusive BT and 9 x 4 Gy over 5 days for post-operative BT. RESULTS: Sixty-six patients of median age 81 years received a total of 58 primary BT and 13 post-operative BT for non-melanoma facial skin cancers. Implantation was without difficulty. Median follow up was 15.3 months. Two patients died of intercurrent diseases before first follow up. For the others, 98.5% showed complete response and 3% local recurrence after a median of 20.5 months. Four patients had grade 3 acute dermatitis and three patients had grade 3 mucositis. All the Grade 3 toxicities were resolved within 3 months. A late significant hypopigmentation occurred in 4 patients. CONCLUSIONS: HDR BT is efficient and well-tolerated with good cosmetic results. HDR catheters are similar with iridium wires in terms of technical difficulty. (C) 2021 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.