Introduction
Non-melanoma skin cancers of the face are at high-risk for local recurrence and metastatic spread. While surgical interventions such as Mohs microsurgery are considered the standard of care, this modality has the potential for high rates of toxicity in sensitive areas of the face. Catheter flap high-dose-rate (HDR) brachytherapy has shown promising results, with high rates of local control and acceptable cosmetic outcomes.

Material and methods
Patients with non-melanoma skin cancers (NMSC) located on the face were treated with 40 Gy in 8 fractions, given twice weekly via catheter flap HDR brachytherapy. Clinical target volume (CTV) included the visible tumor plus a margin of 5 mm in all directions, with no additional planning target volume (PTV) margin.

Results
Fifty patients with 53 lesions on the face were included, with a median follow-up of 15 months. All were considered high-risk based on NCCN guidelines. Median tumor size and thickness were 18 mm and 5 mm, respectively. Median PTV volume and D90 were 1.7 cc and 92%, respectively. Estimated rate of local control at twelve months was 92%. Three patients (5%) experienced acute grade 2 toxicity. Two patients (4%) continued to suffer from chronic grade 1 skin toxicity at 12 months post-radiotherapy (RT), with an additional two patients (4%) experiencing chronic grade 2 skin toxicity. Forty-nine lesions (92%) were found to have a good or excellent cosmetic outcome with complete tumor remission.

Conclusions
CT-based flap applicator brachytherapy is a valid treatment option for patients with NMSC of the face. This modality offers high rates of local control with acceptable cosmetic outcomes and low rates of toxicity.



中文翻译：

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基于计算机断层扫描的皮瓣近距离放射治疗面部非黑色素瘤皮肤癌

 介绍

面部非黑色素瘤皮肤癌局部复发和转移扩散的风险很高。虽然莫氏显微手术等外科手术被认为是标准治疗方法，但这种方式在面部敏感区域有可能产生高毒性。导管瓣高剂量率 (HDR) 近距离放射治疗已显示出可喜的结果，具有较高的局部控制率和可接受的美容效果。

 材料与方法

面部非黑色素瘤皮肤癌 (NMSC) 患者接受分 8 次 40 Gy 的治疗，每周两次通过导管皮瓣 HDR 近距离放射治疗。临床靶区 (CTV) 包括可见肿瘤加上所有方向 5 毫米的边缘，没有额外的计划靶区 (PTV) 边缘。

 结果

研究纳入了 50 名面部有 53 个病变的患者，中位随访时间为 15 个月。根据 NCCN 指南，所有这些都被视为高风险。肿瘤的中位大小和厚度分别为 18 毫米和 5 毫米。中位 PTV 体积和 D90 分别为 1.7 cc 和 92%。预计 12 个月时的局部控制率为 92%。三名患者 (5%) 经历了急性 2 级毒性。放疗 (RT) 后 12 个月，两名患者 (4%) 继续患有慢性 1 级皮肤毒性，另外两名患者 (4%) 经历慢性 2 级皮肤毒性。发现 49 个病灶 (92%) 具有良好或极好的美容效果，肿瘤完全缓解。

 结论

基于 CT 的皮瓣近距离放射治疗是面部 NMSC 患者的有效治疗选择。这种方式提供了高局部控制率、可接受的美容效果和低毒性率。