Superficial HDR brachytherapy for skin lesions involving the finger – The Christie experience
OC-0019
Abstract
Superficial HDR brachytherapy for skin lesions involving the finger – The Christie experience
Authors: Agata Rembielak1, James Bedford2, Stuart Wilson3
1The Christie NHS Foundation Trust, Clinical Oncology, Manchester, United Kingdom; 2Manchester University NHS Foundation Trust, The Manchester Hand Centre, Manchester, United Kingdom; 3Manchester University NHS Foundation Trust, Plastic Surgery, Manchester, United Kingdom
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Purpose or Objective
The standard of care for treatment of skin cancer and
refractory precancerous conditions located on the finger is largely surgical
management. Surgery usually involves digits/finger amputation or wide local
excision with reconstruction. Many patients are elderly and/or frail.
Non-invasive methods of treatment are often the preferred option due to
favourable cosmetic and/or functional outcomes and improved patient compliance.
External beam radiotherapy in finger location is challenging due to depth-dose characteristics in curved surfaces and close target
location to joints and bones. HDR brachytherapy (BT) is a well-established
non-invasive alternative treatment option delivering high radiation dose to the
target with rapid dose fall-off in normal surrounding tissues. We report The
Christie experience with HDT BT in the finger location over the past 6 years.
Material and Methods
From Jan 2014 to Sept 2020, 13 patients (7 males
and 5 females) underwent radical superficial HDR BT to the finger. There were 9 skin SCCs: 5 postoperative
and 4 definitive. One patient had BCC and 3 patients had progressive refractory Bowen’s disease. The
median age at the time of BT was 71 years (range 52 – 95).
The patients were treated with a total dose of 30–34 Gy at 100%
isodose in 8 fractions twice a day at least 6 hours apart. Target area was marked out by visual inspection,
palpation and high frequency skin ultrasound. All patients were treated with
The Christie mould technique: a flap mounted over an individually
designed mould composed of a pre-calculated number of layers of thermoplastic
material. Patients were
followed for at least 2-3 years for treatment toxicity, cosmetic results, and
local failures. Acute toxicity was graded
using the CTC AE, v. 4.0 and
cosmetic outcomes were classified using the RTOG cosmetic rating scale.
Results
Average follow-up from completion of the treatment was
23.5 months (2-36 months). All patients had an acute reaction to the BT: desquamation, crusting and erythema grade 1 or 2. One
patient developed acute grade 3 wet desquamation. All acute toxicity was
resolved within 2 months after treatment. Late toxicity was reported in 6
patients: slight/moderate atrophy, pigmentation change and grade 1 or 2 teleangiectasia. No cosmetic or functional results
worse than good were observed. 11 patients had no evidence of recurrence in
follow-up. 2 patients proceeded to salvage surgery due to either no response to
BT or local recurrence at 4 months after BT. 2/11 patients passed away due to
non-cancer related causes.
Conclusion
HDR mould BT is a valid non-invasive alternative to surgical management of skin cancer and refractory precancerous conditions located on the finger. It has its role particularly in elderly where PS and comorbidities may preclude surgery and short treatment duration can help with patient compliance. With appropriate patient selection skin HDR BT with customized surface moulds offers a good outcome and favourable cosmetic results with function preservation.