title: HDR brachytherapy for superficial non-melanoma skin cancers.
abstract: BACKGROUND
  Our initial experience using recommended high dose per fraction skin brachytherapy (BT) treatment schedules, resulted in poor cosmesis. This study aimed to assess in a prospective group of patients the use of Leipzig surface applicators for High Dose Rate (HDR) brachytherapy, for the treatment of small non-melanoma skin cancers (NMSC) using a protracted treatment schedule.
  
  
  METHODS
  Treatment was delivered by HDR brachytherapy with Leipzig applicators. 36 Gy, prescribed to between 3 to 4 mm, was given in daily 3 Gy fractions. Acute skin toxicity was evaluated weekly during irradiation using the Radiation Therapy Oncology Group criteria. Local response, late skin effects and cosmetic results were monitored at periodic intervals after treatment completion.
  
  
  RESULTS
  From March 2002, 200 patients with 236 lesions were treated. Median follow-up was 66 months (range 25-121 months). A total of 162 lesions were macroscopic, while in 74 cases, BT was given after resection because of positive microscopic margins. There were 121 lesions that were basal cell carcinomas, and 115 were squamous cell carcinomas. Lesions were located on the head and neck (198), the extremities (26) and trunk (12). Local control was 232/236 (98%). Four patients required further surgery to treat recurrence. Grade 1 acute skin toxicity was detected in 168 treated lesions (71%) and grade 2 in 81 (34%). Cosmesis was good or excellent in 208 cases (88%). Late skin hypopigmentation changes were observed in 13 cases (5.5%).
  
  
  CONCLUSIONS
  Delivering 36 Gy over 2 weeks to superficial NMSC using HDR brachytherapy is well tolerated and provides a high local control rate without significant toxicity.
authors.affiliation: Launceston General Hospital, Launceston, Tasmania, Australia. ruth.gauden@dhhs.tas.gov.au
authors.forename: Ruth
authors.initials: R
authors.lastname: Gauden
authors.forename: Martin
authors.initials: M
authors.lastname: Pracy
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Avery
authors.forename: Ian
authors.initials: I
authors.lastname: Hodgetts
authors.forename: Stan
authors.initials: S
authors.lastname: Gauden
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000295:instrumentation / Q000706:statistics & numerical data*; D015897:Comorbidity; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000453:epidemiology / Q000532:radiotherapy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000517:prevention & control*; D015995:Prevalence; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000295:instrumentation / Q000706:statistics & numerical data; D011832:Radiation Injuries / Q000453:epidemiology*; D012307:Risk Factors; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000532:radiotherapy*; D013648:Tasmania / Q000453:epidemiology; D016896:Treatment Outcome