The role of personalized Interventional Radiotherapy (brachytherapy)in the management of older patients with non-melanoma skin cancer

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.