High dose rate brachytherapy with customized applicators for malignant facial skin lesions.
OBJECTIVE
Brachytherapy is a well-known treatment in the management of skin tumors. For facial or scalp lesions, applicators have been developed to deliver non-invasive treatment. We present cases treated with customized applicators with high dose rate system.


METHODS
Patients with poor performance status treated for malignant skin lesions of the scalp or the facial skin between 2011 and 2014 were studied. Afterloading devices were chosen between Freiburg(®) Flap, silicone-mold or wax applicators. The clinical target volume (CTV) was created by adding margins to lesions (10mm to 20mm). The dose schedules were 25Gy in five fractions for postoperative lesions, 30Gy in six fractions for exclusive treatments and a single session of 8Gy could be considered for palliative treatments.


RESULTS
In 30 months, 11 patients received a treatment for a total of 12 lesions. The median age was 80 years. The median follow-up was 17 months and the 2-year local control rate was 91%. The mean CTV surface was 41.1cm(2) with a mean thickness of 6.1mm. We conceived three wax applicators, used our silicone-mold eight times and the Freiburg(®) Flap one time. We observed only low-grade radiodermitis (grade I: 50%, grade II: 33%), and no high-grade skin toxicity.


CONCLUSIONS
High dose rate brachytherapy with customized applicators for facial skin and scalp lesions is efficient and safe. It is a good modality to treat complex lesions in patients unfit for invasive treatment.
Department of radiotherapy, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54500 Vandœuvre-lès-Nancy, France. Electronic address: raphael.jumeau@gmail.com.
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R
Jumeau
Department of radiotherapy, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54500 Vandœuvre-lès-Nancy, France.
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Renard-Oldrini
Department of radiation physics, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54500 Vandœuvre-lès-Nancy, France.
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F
Courrech
Department of radiation physics, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54500 Vandœuvre-lès-Nancy, France.
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I
Buchheit
Department of radiology, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54500 Vandœuvre-lès-Nancy, France.
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G
Oldrini
Department of radiotherapy, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54500 Vandœuvre-lès-Nancy, France.
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Vogin
Department of radiotherapy, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54500 Vandœuvre-lès-Nancy, France.
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Peiffert
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000295:instrumentation* / Q000379:methods; D002280:Basal Cell Carcinoma / Q000532:radiotherapy; D018278:Carcinoma, Neuroendocrine / Q000532:radiotherapy; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy; D005153:Facial Neoplasms / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011855:Radiodermatitis / Q000209:etiology; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012535:Scalp; D012878:Skin Neoplasms / Q000532:radiotherapy*
Applicateurs personnalisés; Applicateurs superficiels; Contrôle local; Curiethérapie de haut débit de dose; Customized applicators; Dose optimization; HDR brachytherapy; Local control; Non-melanoma skin cancer; Néoplasies cutanées non-mélanomateuses; Optimisation de la dose; Surface molds