Sarcoma and Cutaneous Tumors

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MO_21_2739 - Definitive Treatment of a Risky Region: The Efficacy and Toxicities of High Dose Rate Brachytherapy for Non-Melanomatous Skin Cancers of the Extremities

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Definitive Treatment of a Risky Region: The Efficacy and Toxicities of High Dose Rate Brachytherapy for Non-Melanomatous Skin Cancers of the Extremities
K. Stang1, C. Hentz1, A. D. Gliniewicz1, I. Rashed1, R. Hutten1, R. Tung2, D. Eilers2, M. L. Mysz1, and B. Emami1; 1Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, 2Department of Dermatology, Loyola University Medical Center, Maywood, IL

Purpose/Objective(s): Surgical resection of non-melanomatous skin cancers (NMSC) of the extremity, which often occur in the elderly, can lead to poor wound healing particularly in patients with vascular disease and poor circulation. Superficial high dose rate (HDR) brachytherapy (BT) offers a potential advantage by delivering conformal dose with quick falloff, minimizing dose to normal tissue. However, there is a paucity of data using this technique. We investigated the clinical outcomes and acute and late toxicities of HDR BT for NMSC of the extremities.

Materials/Methods: We performed a retrospective cohort study of patients with NMSC of the extremity treated with HDR BT using a Freiburg flap surface applicator as part of a prospectively maintained database. We prescribed a dose of 8-40 Gy in 2-16 fractions delivered twice weekly, to a depth of 3-5mm to new (n=22) or recurrent (n=5) extremity NMSCs, dose dependent on histology and size. Patient reported pain and physician reported skin toxicity scores (CTCAE v4.0) were recording during treatment, at early (≤3 mos since treatment) and late (>3 months) follow-up.

Results: A total of 27 cases of NMSC of the extremity were treated between April 2016 and December 2017, with a median follow-up of 8.2 months. The median patient age was 83 years. 18 cases were squamous cell carcinoma (CA), 4 basal cell CA, 3 Merkel cell CA, and 2 cutaneous T-cell lymphoma. The most common lesion size was 1.1-2 cm. 26 cases were treated with definitive HDR, and 1 case was treated with adjuvant HDR post-operatively. 52% of patients had a history of CAD or PVD. 41% of patients were smokers. At last follow-up, there was resolution of 100% of the treated lesions, with 100% local control. During treatment, 67% of patients reported no pain, 18.5% mild and 14.8% moderate pain. At early follow-up, 85% of patients reported no pain, 15% mild pain. At late follow-up, only 1 patient reported mild pain. No patient reported severe pain during or after treatment. Acute toxicity was reported as none in 33% of cases, grade 1 in 30%, grade 2 in 30%, grade 3 in 7% (moist confluent desquamation). These were managed with silvadene cream and wound care, and all grade 3 reactions improved by late follow-up. Late skin toxicity was reported as 18.5% grade 1, 4% grade 2. In patients with comorbid CAD or PVD, acute toxicity was reported as none in 50% of cases, grade 1 in 15%, grade 2 in 21%, and grade 3 in 14%. There were no late grade ≥3 toxicities. All cases had late patient and physician-reported cosmesis as Excellent.

Conclusion: In patients with NMSC of the extremity treated with HDR skin BT, outcomes and toxicity were excellent overall, including in patients with vascular disease comorbidities, with slightly higher acute toxicity, but similar low rates of late toxicity and primary lesion control as those without. Longer follow-up is anticipated to further assess for delayed toxicities.

Author Disclosure: K. Stang: None. A.D. Gliniewicz: None. I. Rashed: None. R. Tung: None.

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