title: Non-melanoma skin cancer treated with high-dose-rate brachytherapy and Valencia applicator in elderly patients: a retrospective case series.
abstract: OBJECTIVE
  The incidence of non-melanoma skin cancer (NMSC) has been increasing over the past 30 years. Basal cell carcinoma and squamous cell carcinoma are the two most common subtypes of NMSC. The aim of this study was to estimate tumour control, toxicity, and aesthetic events in elderly patients treated with high-dose-rate (HDR) brachytherapy (BT) using Valencia applicator.
  
  
  METHODS
  From January 2012 to May 2015, 57 lesions in 39 elderly eligible patients were enrolled. All the lesions had a diameter ≤ 25 mm (median: 12.5 mm) and a depth ≤ 4 mm. The appropriate Valencia applicator, 2 or 3 cm in diameter was used. The prescribed dose was 40 Gy in 8 fractions (5 Gy/fraction) in 48 lesions (group A), and 50 Gy in 10 fractions (5 Gy/fraction) in 9 lesions (group B), delivered 2/3 times a week. The biological effective dose (BED) was 60 Gy and 75 Gy, respectively.
  
  
  RESULTS
  After median follow-up of 12 months, 96.25% lesions showed a complete response and only two cases presented partial remission. Radiation Therapy Oncology Group - European Organization for Research and Treatment of Cancer (RTOG/EORTC) G 1-2 acute toxicities were observed in 63.2% of the lesions: 56.3% in group A and 77.7% in group B. Late G1-G2 toxicities was observed in 19.3% of the lesions: 18.8% in group A and 22.2% in group B, respectively. No G3 or higher acute or late toxicities occurred. In 86% of the lesions, an excellent cosmetic result was observed (87.5% in group A and 77.8% in group B). Six lesions had a good cosmetic outcome and only 2.3% presented a fair cosmetic impact.
  
  
  CONCLUSIONS
  The treatment of NMSC with HDR-BT using Valencia surface applicator is effective with excellent and good cosmetics results in elderly patients. The hypofractionated course appears effective and no statistical differences were observed between the two groups analysed.
authors.affiliation: Department of Radiotherapy.
authors.forename: Durim
authors.initials: D
authors.lastname: Delishaj
authors.affiliation: Department of Radiotherapy.
authors.forename: Concetta
authors.initials: C
authors.lastname: Laliscia
authors.affiliation: Department of Radiotherapy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Manfredi
authors.affiliation: Department of Radiotherapy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ursino
authors.affiliation: Department of Radiotherapy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Pasqualetti
authors.affiliation: Department of Radiotherapy.
authors.forename: Ezio
authors.initials: E
authors.lastname: Lombardo
authors.affiliation: Medical Physics.
authors.forename: Franco
authors.initials: F
authors.lastname: Perrone
authors.affiliation: Section of Statistics, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Morganti
authors.affiliation: Department of Radiotherapy.
authors.forename: Fabiola
authors.initials: F
authors.lastname: Paiar
authors.affiliation: Department of Radiotherapy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Fabrini
keywords: HDR brachytherapy; Valencia applicator; skin brachytherapy; skin cancer
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