title: Clinical and cosmetic outcomes in patients treated with high-dose-rate electronic brachytherapy for nonmelanoma skin cancer.
abstract: OBJECTIVE
  To retrospectively analyze clinical and cosmetic outcomes in patients treated for nonmelanoma skin cancer (NMSC) with high-dose-rate (HDR) electronic brachytherapy (EBT) using surface applicators.
  
  
  METHODS
  We identified 127 patients who had 154 NMSC lesions, 149 of which were basal cell carcinoma, treated with HDR EBT at our institution between July 2012 and March 2014. Lesions were treated to 40 Gy in 8 fractions. Local control, acute toxicity, late toxicity, and cosmetic outcomes were analyzed retrospectively. Acute and late toxicities were graded using the Common Terminology Criteria for Adverse Events, version 4.0. Cosmetic outcomes were graded using a standard scale based on the Radiation Therapy Oncology Group and European Organization for Research and Treatment of Cancer Late Radiation Morbidity Scoring Schema.
  
  
  RESULTS
  Median (range) follow-up from completion of treatment was 16.1 (3.4-34.8 months). The overall crude recurrence rate was 1.3% (n = 2). Grade 0 to 1 acute radiation dermatitis was observed in 52.6% of treated lesions (n = 81), grade 2 in 34.4% (n = 53), and grade 3 in 13.0% (n = 20). No acute toxicity greater than grade 3 was observed and all acute toxic events resolved after treatment. Grade 0 to 1 late toxicity was observed in 94.2% of cases (n = 145), and grade 2 in 5.8% (n = 9). No late toxicity greater than grade 2 was observed. Across the 152 controlled lesions, cosmetic results were excellent in 94.2% of treated lesions (n = 145), good in 3.3% (n = 5), fair in 0.7% (n = 1), and poor in 0.7% (n = 1).
  
  
  CONCLUSIONS
  HDR EBT confers promising local control, minimal toxicity, and excellent cosmesis in our institutional experience. It should be considered ideal for NMSC of the head and neck, particularly for basal cell carcinoma involving central facial locations where surgical cosmesis may be inferior.
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California San Diego Moores Cancer Center, La Jolla, California.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Paravati
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California San Diego Moores Cancer Center, La Jolla, California.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Hawkins
authors.affiliation: Keck School of Medicine at University of Southern California, Los Angeles, California.
authors.forename: Amanda N
authors.initials: AN
authors.lastname: Martin
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California San Diego Moores Cancer Center, La Jolla, California.
authors.forename: Gina
authors.initials: G
authors.lastname: Mansy
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California San Diego Moores Cancer Center, La Jolla, California.
authors.forename: Doug A
authors.initials: DA
authors.lastname: Rahn
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California San Diego Moores Cancer Center, La Jolla, California.
authors.forename: Sunil J
authors.initials: SJ
authors.lastname: Advani
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California San Diego Moores Cancer Center, La Jolla, California.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Hoisak
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California San Diego Moores Cancer Center, La Jolla, California.
authors.forename: Irena
authors.initials: I
authors.lastname: Dragojevic
authors.affiliation: Department of Otolaryngology, Kaiser Permanente, San Diego, San Diego, California.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Martin
authors.affiliation: Department of Dermatology, Kaiser Permanente, San Diego, San Diego, California.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Miller
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California San Diego Moores Cancer Center, La Jolla, California. Electronic address: psanghvi@ucsd.edu.
authors.forename: Parag
authors.initials: P
authors.lastname: Sanghvi
mesh_terms: D000328:Adult; D001828:Body Image; D001918:Brachytherapy; D002280:Basal Cell Carcinoma / Q000532:radiotherapy*; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D004954:Esthetics; D006801:Humans; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000532:radiotherapy*