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Skin cancers are the most common malignancy in humans with increasing incidence. The likelihood of developing basal cell carcinoma increases with age. Patients 50 – 80 years of age are affected most often. Surgery remains the standard of care for BCC. However, brachytherapy provides an effective alternative for selected patients.

A retrospective analysis of 99 patients treated with HDR 192-Ir brachytherapy in years 2006 – 2018. All selected patients were ≥75 years old at the beginning of the treatment and diagnosed with basal cell skin cancer. A total of 142 tumours were treated. A single lesion was treated in 69 patients, in 24 patients – 2 lesions, in 4 patients – more than 3 lesions. In 81% of cases BT was a primary treatment, in 14.1% – a salvage treatment due to recurrence after surgery, in 4.9% – adjuvant treatment after non-radical surgery. In 74% of cases the tumour was in area “H”, in 19% – area “M”, and in 7% – area “L”. Individual multi-catheter mould was used in 66.2% of cases and HAM applicator in 33.8%. Patients were treated with afterloader HDR brachytherapy system, with a total dose of 35 – 50 Gy (mean and median – 45 Gy) delivered in 7 – 10 fractions (mean and median – 9), fraction dose was 5 Gy in all cases. Overall treatment time (OTT) ranged from 18 to 45 days (mean and median – 28 days). Patients were followed for radiation toxicity and local failures. Kaplan-Meier estimator and log-rank test were used for statistical analysis.

Median follow-up was 38 months (range 0 – 118 months). Recurrence was observed in 6.3% of cases, with the 5-year disease-free survival rate of 86.5%. DFS was poorer in more advanced lesions (p<0,0001). Local failure was observed in 3 cases. Acute toxicity was assessed in 97.2% of cases, late – in 96.5%. Acute toxicity grade 0 and 1 was observed in 71.1% of cases, in 16.2% grade 4 was reported. Late complications grade 0 and 1 were described in 76% of cases, grade 4 – only in 5.7%. A total dose of 45 Gy was most effective and provided the best DFS (p=0.027). Neither OTT nor treatment sequence had any impact on DFS (p=0.55 and p=0.91 respectively). 

HDR 192-Ir surface brachytherapy in the treatment of basal cell skin cancer in patients ≥75 years of age is an effective and safe treatment modality. With a very high disease-free survival and good tolerance, it is a valuable alternative to surgery.