There is an
increasing incidence of Basal cell carcinoma (BCC) and Squamous cell carcinoma
(SCC) on the external nose. Surgery is the main treatment but often face
problems with respect to cosmetic defects and non-radical resection.
Brachytherapy
(BT) can be used in the primary treatment to preserve cosmetic appearance and
to treat with appropriate margins. Brachytherapy are also indicated in tumor
recurrence after surgery and in case of non-radical resection.
Long-term
local control rate (LCR) in literature is 90-95 %. Treatment time is short 1-2
weeks.
There are
different BT techniques available such as -Surface BT (Valencia applicator or
Mould BT), -interstitial BT (trans-nasal or along nasal) or a combination of
both.
The choice
of BT technique is depending on; -thickness of the tumor, -location on the nose
(cartilage part vs bony part), - tumor growth (flat part, curvature part, exophytic
part), -extension to peri-nasal areas (upper lip, cheek, medial eye corner).
Usually a
full dose of BT is prescribed like 60 Gy PDR (0.83 Gy/ 2nd hour) or 45, 5 Gy
HDR (3.5 Gy 2fx/d) (GEC-ESTRO recommendations for head/neck BT RTO 20016:10 and
skin RTO 2018:126.) Own experience 1998-2019 in 121 patients confirms published
results of 93.4 % long-term LCR.
Side
effects are uncommon and include: septum perforation, telangiectasia, atrophy
and sclerosis.
Multidisciplinary
conferences and teaching of plastic surgeons about potential benefits of BT are
fundamental to avoid unnecessary mutilation.
