Valentina Lancellotta1, Gyoergy Kovács2, Luca Tagliaferri3, Elisabetta Perrucci4, Agata Rembielak5, Luca Stingeni6, Marta Tramontana6, Katharina Hansel6, Giuseppe Colloca7, Simonetta Saldi8, Vincenzo Valentini9, Cynthia Aristei10. 1. Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy. Electronic address: valentina.lancellotta@unipg.it. 2. Interdisciplinary Brachytherapy Unit, University of Lübeck/UKSH, Lübeck, Germany. 3. Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia - Gemelli ART (Advanced Radiation Therapy), Interventional Oncology Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy. 4. Radiation Oncology Division, Perugia General Hospital, Perugia, Italy. 5. Clinical Oncologist, The Christie NHS Foundation Trust, Manchester M20 4BX, United Kingdom. 6. Section of Clinical, Allergological and Venereological Dermatology Department of Medicine, University of Perugia, Perugia, Italy. 7. Polo Scienze Oncologiche ed Ematologiche, Fondazione Policlinico Universitario Agostino Gemelli, GIOGER (Gruppo Italiano di Oncologia Geriatrica), Università Cattolica del Sacro Cuore, Rome, Italy. 8. Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy. 9. Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Gemelli ART (Advanced Radiation Therapy) - Interventional Oncology Center, Università Cattolica del Sacro Cuore, Rome, Italy. 10. Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy.
Abstract
OBJECTIVE: Non-melanoma skin cancer (NMSC) has been rapidly increasing in incidence over the past 30 years. Mainstays of treatment remain surgery and radiotherapy, particularly in older and/or frail patients (≥75 years old) that often require a personalized treatment strategy using innovative biotechnologies. High-dose-rate interventional radiotherapy (HDR-IRT) seems to be an excellent option for NMSC. MATERIAL AND METHODS: Nineteen aged patients with advanced, biopsy proven NMSC were treated with exclusively HDR-IRT. A personalized double-layer mould of thermoplastic mask material was applied to the skin surface. Plastic tubes were fixed on the mould in appropriate geometry over the target area. Planning computed tomography (CT) images were acquired with 2.5 mm slice thickness and transmitted to the planning system. Treatment intention was to deliver ≥95% of the prescribed dose to the Planning Target Volume (PTV), accepting 90% as satisfactory. Toxicities were assessed using the Common Terminology Criteria for Adverse Events scale (CTCAE) v. 4.0. RESULTS: Median age was 86 years. Acute toxicity: Grade 2 erythema appeared in all 19 patients. Towards the end of each treatment schedule, epidermolysis developed which was resolved within 6 weeks of completing HDR-IRT. Late toxicity: Grade 1 skin atrophy, pigmentation changes and alopecia in field were observed in all patients. At last follow-up, all patients were disease free. CONCLUSIONS: Personalized HDR-IRT appears to be safe and effective for frail older patients and a valid alternative to supportive care for those with contraindication to surgery. Future investigations using also large database analysis seem to be advisory.
OBJECTIVE:Non-melanoma skin cancer (NMSC) has been rapidly increasing in incidence over the past 30 years. Mainstays of treatment remain surgery and radiotherapy, particularly in older and/or frail patients (≥75 years old) that often require a personalized treatment strategy using innovative biotechnologies. High-dose-rate interventional radiotherapy (HDR-IRT) seems to be an excellent option for NMSC. MATERIAL AND METHODS: Nineteen aged patients with advanced, biopsy proven NMSC were treated with exclusively HDR-IRT. A personalized double-layer mould of thermoplastic mask material was applied to the skin surface. Plastic tubes were fixed on the mould in appropriate geometry over the target area. Planning computed tomography (CT) images were acquired with 2.5 mm slice thickness and transmitted to the planning system. Treatment intention was to deliver ≥95% of the prescribed dose to the Planning Target Volume (PTV), accepting 90% as satisfactory. Toxicities were assessed using the Common Terminology Criteria for Adverse Events scale (CTCAE) v. 4.0. RESULTS: Median age was 86 years. Acute toxicity: Grade 2 erythema appeared in all 19 patients. Towards the end of each treatment schedule, epidermolysis developed which was resolved within 6 weeks of completing HDR-IRT. Late toxicity: Grade 1 skin atrophy, pigmentation changes and alopecia in field were observed in all patients. At last follow-up, all patients were disease free. CONCLUSIONS: Personalized HDR-IRT appears to be safe and effective for frail older patients and a valid alternative to supportive care for those with contraindication to surgery. Future investigations using also large database analysis seem to be advisory.
Authors: Anna Rita Alitto; Luca Tagliaferri; Valentina Lancellotta; Andrea D'Aviero; Antonio Piras; Vincenzo Frascino; Francesco Catucci; Bruno Fionda; Christian Staackmann; Simonetta Saldi; Vincenzo Valentini; Gyorgy Kovacs; Cynthia Aristei; Giovanna Mantini Journal: In Vivo Date: 2020 May-Jun Impact factor: 2.155