Online

WCB 2021 - Online

Session Item

Saturday
May 08
08:45 - 10:00
Optimal treatment for periorificial high risk non-melanoma skin cancer
Agata Rembielak, United Kingdom;
Gerald Fogarty, Australia
0250
Debate
09:00 - 09:15
This house believes that radiotherapy/brachytherapy should be considered for lip high risk non-melanoma skin cancer
Ashwini Budrukkar, India
SP-0091

Abstract

This house believes that radiotherapy/brachytherapy should be considered for lip high risk non-melanoma skin cancer
Authors: Ashwini Budrukkar(Tata Memorial Hospital, Department of Radiation Oncology, Mumbai, India)
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Abstract Text

Management of periorificial tumours is challenging due to its location and impact on functional and cosmetic outcome. For early stage lip cancers single modality treatment either surgery or radiation therapy (RT) is considered.  While for advanced disease combined modality treatment which includes surgery, RT with or without chemotherapy is considered. Various surgical series have reported excellent local control rates and overall survival in the range of 65-90%. However the main issue with surgery is cosmetic and functional impairment.

Brachytherapy with its ability to deliver high dose to the tumour bed and rapid fall off of the dose beyond the target appears to be a suitable method for treatment of lip cancers. Brachytherapy for lip cancer is performed under anaesthesia. Typically 2 plane implants are done with needles inserted in submucosal and subcutaneous planes. This ensures adequate coverage of the target. There have been many series which have used low dose rate brachytherapy (LDR) for lip cancers. All these series have reported local control rates in the range of 75-95%. Additional advantage of brachytherapy is  preservation of functional outcome as well as cosmetic outcome. These have a large impact on quality of life of patients especially social interactions and eating in public.

Since last 2 decades there has been change from LDR to pulse dose rate (PDR) or high dose rate (HDR) brachytherapy. HDR brachytherapy has an advantage of short treatment time, radiation protection to the staff and convenience for the patients. Various fractionation schedules have been used for treatment of lip cancer with dose per fraction ranging from 3.5Gy to 5Gy per fraction. The local control rates of HDR series are in the range of 85-95%. Although the data of HDR is limited, it has been associated with lesser bone and soft tissue toxicity which has been one of the major concerns with brachytherapy.

One of the drawbacks of brachytherapy is the lack of management of neck. In situations where neck managements appears necessary combined external beam RT and brachytherapy can be considered as on option and has shown encouraging outcomes.

Overall brachytherapy appears to be an excellent modality of treatment for management of lip cancers resulting in comparable local control rates with surgery with better cosmetic and functional outcomes. Hence brachytherapy should be considered as the standard of care and surgery should be reserved for salvage in lip cancers.