title: Non-melanoma skin cancer treated with high-dose-rate brachytherapy: a review of literature.
abstract: OBJECTIVE
  The incidence of non-melanoma skin cancer (NMSC) has been increasing over the past 30 years. There are different treatment options and surgical excision is the most frequent treatment due to its low rates of recurrence. Radiotherapy is an effective alternative of surgery, and brachytherapy (BT) might be a better therapeutic option due to high radiation dose concentration to the tumor with rapid dose fall-off resulting in normal tissues sparing. The aim of this review was to evaluate the local control, toxicity, and cosmetic outcomes in NMSC treated with high-dose-rate BT (HDR-BT).
  
  
  METHODS
  In May 2016, a systematic search of bibliographic database of PubMed, Web of Science, Scopus, and Cochrane Library with a combination of key words of "skin cancer", "high dose rate brachytherapy", "squamous cell carcinoma", "basal cell carcinoma", and "non melanoma skin cancer" was performed. In this systematic review, we included randomized trials, non-randomized trials, prospective and retrospective studies in patients affected by NMSC treated with HDR-BT.
  
  
  RESULTS
  Our searches generated a total of 85 results, and through a process of screening, 10 publications were selected for the review. Brachytherapy was well tolerated with acceptable toxicity and high local control rates (median: 97%). Cosmetic outcome was reported in seven study and consisted in an excellent and good cosmetic results in 94.8% of cases.
  
  
  CONCLUSIONS
  Based on the review data, we can conclude that the treatment of NMSC with HDR-BT is effective with excellent and good cosmetics results, even in elderly patients. The hypofractionated course appears effective with very good local disease control. More data with large-scale randomized controlled trials are needed to assess the efficacy and safety of brachytherapy.
authors.affiliation: Department of Translational Medicine, Division of Radiation Oncology - University of Pisa, Pisa, Italy.
authors.forename: Durim
authors.initials: D
authors.lastname: Delishaj
authors.affiliation: Clinical Oncologist, The Christie NHS Foundation Trust, Manchester, M20 4BX, United Kingdom.
authors.forename: Agata
authors.initials: A
authors.lastname: Rembielak
authors.affiliation: Department of Translational Medicine, Division of Radiation Oncology - University of Pisa, Pisa, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Manfredi
authors.affiliation: Department of Translational Medicine, Division of Radiation Oncology - University of Pisa, Pisa, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ursino
authors.affiliation: Department of Translational Medicine, Division of Radiation Oncology - University of Pisa, Pisa, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Pasqualetti
authors.affiliation: Department of Translational Medicine, Division of Radiation Oncology - University of Pisa, Pisa, Italy.
authors.forename: Concetta
authors.initials: C
authors.lastname: Laliscia
authors.affiliation: Department of Translational Medicine, Division of Radiation Oncology - University of Pisa, Pisa, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Orlandi
authors.affiliation: Department of Experimental and Clinical Medicine, Section of Statistics - University of Pisa, Pisa, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Morganti
authors.affiliation: Department of Translational Medicine, Division of Radiation Oncology - University of Pisa, Pisa, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Fabrini
authors.affiliation: Department of Translational Medicine, Division of Radiation Oncology - University of Pisa, Pisa, Italy.
authors.forename: Fabiola
authors.initials: F
authors.lastname: Paiar
keywords: HDR brachytherapy; radiotherapy; skin brachytherapy; skin cancer