Function preservation with Image Adapted Brachytherapy (IABT) N. Dinapoli
The “eyelid question”: Brachytherapy in non melanoma skin cancer • Uncommon tumor • Small anatomy • Surgery as gold standard • Brachytherapy as conservative approach or for surgery unfit patients
The “eyelid question”: Brachytherapy in non melanoma skin cancer • Basal cell carcinoma ( BCC ): 90% • Squamous cell carcinoma ( SCC ) • Sebaceous cell carcinoma • Merkel cell tumour
The “eyelid question”: Brachytherapy in non melanoma skin cancer Other sites 25-10% Medial canthus 25-30% Lower-eyelid 50-60%
NMSC – Therapeutic options • Surgery • Radiotherapy • Cryotherapy • Curettage • Electrodissection • Photodynamic therapy • Laser ablation Murchison AP, Clin Experiment Ophthalmol. 2011
NMSC – Therapeutic options • Surgery : gold standard • Radiotherapy • Cryotherapy • Curettage • Electrodissection • Photodynamic therapy • Laser ablation Murchison AP, Clin Experiment Ophthalmol. 2011
NMSC – Therapeutic options • Surgery • Radiotherapy : surgical unfit patients • Cryotherapy • Curettage • Electrodissection • Photodynamic therapy • Laser ablation Murchison AP, Clin Experiment Ophthalmol. 2011
NMSC – Treatment aims • Tumor control • Function preservation • Cosmetic results
BRT in NMSC of eyelid Frakulli R, J Contemp Brachytherapy. 2015
BRT in NMSC of eyelid • No randomized trials • No systematic reviews • No metanalyses Frakulli R, J Contemp Brachytherapy. 2015
BRT in NMSC of eyelid: treatment • LDR: 249/243 • HDR: 45/45 Frakulli R, J Contemp Brachytherapy. 2015
BRT in NMSC of eyelid: outcomes • Excellent Local Control: 75.6% - 100% Frakulli R, J Contemp Brachytherapy. 2015
BRT in NMSC of eyelid: outcomes • High rate of optimal functional outcome despite presence of some frequent late toxicity (epilation) Frakulli R, J Contemp Brachytherapy. 2015
BRT in NMSC of eyelid: conclusions • LC is reported as crude rate (except for one paper) • LC rate are good (75.6% - 100%) • Despite lack of unique toxicity and functional reporting scale toxicity and functional outcome seem accetable • Cosmetic/functional outcome seem related to overall dose (reported as V 100 >2cc, or V 150 >1cc) Frakulli R, J Contemp Brachytherapy. 2015 Mareco V, Brachytherapy. 2015
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