Nonmelanoma skin cancer treated with electronic brachytherapy: results at 1 year.

Brachytherapy. 2013 Mar-Apr;12(2):134-40.

Bhatnagar A.

Department of Radiation Oncology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.



PURPOSE: We report clinical outcomes at 1 year or more after high-dose-rate (HDR) electronic brachytherapy (EBT) using surface applicators for the treatment of nonmelanoma skin cancer (NMSC).

METHODS AND MATERIALS: From July 2009 to April 2012, 122 patients with 171 NMSC lesions were treated with EBT to a dose of 40Gy in eight fractions, delivered twice weekly. At followup, patients were assessed for acute and late toxicities, cosmesis, and local control.

RESULTS: Treatment of 171 lesions was completed in 122 patients with a mean age 73 years. There have been no recurrences to date with a mean followup of 10 months (range, 1-28 months). Followup data at 1 year or more were available for 46 lesions in 42 patients. Hypopigmentation (all Grade 1) was present in 5 (10.9%) of 46 lesions at 1 year. Other late effects at 1 year included dry desquamation, alopecia, and rash dermatitis, which occurred in 1 (2.2%), 1 (2.2%), and 3 (6.5%) of 46 lesions, respectively. No Grade 3 or higher adverse events were observed at any time point. Cosmesis was evaluated at 1 year for 42 of 46 lesions and was excellent for 39 (92.9%) and good for 3 (7.1%) of the 42 evaluable lesions.

CONCLUSIONS: Treatment of NMSC with HDR EBT using surface applicators was effective with no recurrences, good to excellent cosmesis, and acceptable toxicities at 1 year or more after treatment. HDR EBT provides a convenient nonsurgical treatment option for NMSC patients.



Nonmelanoma skin cancer (NMSC) is the most common malignancy and affects 2-3 million people each year in the United States (1). Although NMSC has a low mortality rate, its incidence continues to rise; it significantly affects quality of life and has a substantial financial impact on the health care system (1-3). Treatment options include surgery, radiation therapy, and topical agents, with surgery providing the most frequently used treatment. Radiation therapy may especially be used when NMSC is located in areas such as the eyelid, ear, or nose that may result in disfigurement if surgical options are used (4).

A variety of radiation therapy techniques have been used to treat NMSC (5). The techniques include superficial xrays, orthovoltage x-rays, megavoltage photons, electron beam irradiation, and high-dose-rate (HDR) brachytherapy with surface applicators. 192Ir-HDR brachytherapy using surface molds has been used in the treatment of 136 patients with NMSC with a 5-year local control rate of 98% and no severe early or late complications (6). HDR electronic brachytherapy (EBT) was developed in the last decade to provide patients with a shorter treatment schedule and physicians with a more convenient form of radiotherapy that does not require radioactive isotopes or dedicated treatment vaults. In addition to NMSC, Xoft HDR EBT has been used to treat patients with early stage breast cancer, endometrial cancer and cervical cancer. It utilizes a proprietary miniaturized x-ray as the radiation source that delivers precise treatment directly to cancerous areas while sparing healthy tissue and organs. In total, for all clinical applications, over 3,000 patients have been successfully treated with the Xoft system.

In our study, the treatment of NMSC with Xoft HDR EBT with surface applicators was effective with no recurrences in 171 NMSC lesions treated in 122 patients with good to excellent cosmesis and acceptable toxicities at 1 year or more after treatment. Photos of 4 representative patients are shown below.

Patient 1: Squamous cell carcinoma on right cheek treated with 40 Gy to a 5 mm depth.

Ajay Bhatnagar-p1

Patient 2: Squamous cell carcinoma below left eye treated with 40 Gy to a 3 mm depth.

Ajay Bhatnagar-p2

Patient 3: Basal cell carcinoma on right nostril and nasal bridge treated with 40 Gy to a 5 mm depth.

Ajay Bhatnagar-p3

Patient 4: Squamous cell carcinoma on right antihelix treated with 40 Gy to a 3 mm depth.

Ajay Bhatnagar-p4


[1] Rogers HW, Martin A. Incidence estimate of nonmelanoma skin cancer in the United States, 2006. Arch Dermatol 2010;146: 283-287.

[2] SkinCancerNet: What is skin cancer? Schaumberg, IL: American Academy of Dermatology. Available at: Accessed March 17, 2012.

[3] Lomas A, Leonardi-Bee J, Bath-Hextall F. A systematic review of worldwide incidence of nonmelanoma skin cancer. Br J Dermatol 2012;166:1069-1080.

[4] What you need to know about melanoma and other skin cancers. NIH Publication No. 10-7625. Available at: Accessed May 21, 2012.

[5] Lovett RD, Perez CA, Shapiro SJ, et al. External radiation of epithelial skin cancer. Int J Radiat Oncol Biol Phys 1990;19:235-242.

[6] Guix B, Finestres F, Tello J, et al. Treatment of skin carcinomas of the face by high dose rate brachytherapy and custom made surface molds. Int J Radiat Oncol Biol Phys 2000;47:95-102.

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