Comparison of Electronic Brachytherapy and Mohs Micrographic Surgery for the Treatment of Early-stage Non-melanoma Skin Cancer: a Matched Pair Cohort Study

Overview

Journal J Contemp Brachytherapy

Date 2017 Sep 28

PMID 28951753

Citations 9

Authors

Rakesh Patel

Robert Strimling

Stephen Doggett

Mark Willoughby

Kenneth Miller

Lawrence Dardick

Erick Mafong

Affiliations

Soon will be listed here.

Abstract

Purpose: High-dose-rate electronic brachytherapy (EBT) provides a non-surgical treatment option for non-melanoma skin cancer (NMSC). This matched-pair cohort study compared the outcomes of treatment with EBT to those of Mohs micrographic surgery (MMS) in patients with NMSC.

Material And Methods: At four treatment centers, patients treated with EBT were case matched to patients treated with MMS based on retrospectively-collected patient age, lesion size, location and type, and year of treatment. Follow-up data were prospectively collected and included local recurrence, toxicities, cosmesis, and patient-reported outcomes.

Results: The 369 patients (188 in the EBT treatment group and 181 in the MMS treatment group) had 416 lesions (208 in the EBT group and 208 in the MMS group), including 226 basal cell carcinomas (BCC) and 190 squamous cell carcinomas (SCC). Most patients were Caucasian (98.9% and 99.5%) and male (65.4% and 66.3%) of median age 80.7 (range: 61-98) (EBT) and 76.8 (range: 51-98) years (MMS). Most lesions were size > 1 cm and ≤ 2 cm, and located on the head. At mean 3.4 years post-treatment, 99.5% of EBT, and 100.0% of MMS-treated lesions were free of recurrence ( = ns). One recurrence was noted in the EBT group. Physicians rated cosmesis as "excellent" or "good" in 97.6% of EBT-treated lesions, and 95.7% of MMS-treated lesions.

Conclusions: This matched-pair cohort study supports the use of EBT as an effective non-surgical treatment option for NMSC with equivalent recurrence rates and cosmetic outcomes to MMS in appropriately-selected patients with early stage NMSC at extended follow-up.

Citing Articles

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Gogineni E, Cai H, Carillo D, Rana Z, Bloom B, Potters L J Contemp Brachytherapy. 2021; 13(1):51-58.

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References

Chen J, Kempton S, Rao V . The Economics of Skin Cancer: An Analysis of Medicare Payment Data. Plast Reconstr Surg Glob Open. 2016; 4(9):e868. PMC: 5054999. DOI: 10.1097/GOX.0000000000000826. View

Alam M, Goldberg L, Silapunt S, Gardner E, Strom S, Rademaker A . Delayed treatment and continued growth of nonmelanoma skin cancer. J Am Acad Dermatol. 2010; 64(5):839-48. DOI: 10.1016/j.jaad.2010.06.028. View

Paravati A, Hawkins P, Martin A, Mansy G, Rahn D, Advani S . Clinical and cosmetic outcomes in patients treated with high-dose-rate electronic brachytherapy for nonmelanoma skin cancer. Pract Radiat Oncol. 2015; 5(6):e659-64. DOI: 10.1016/j.prro.2015.07.002. View

Gniadecki R, Glud M, Mortensen K, Bang B, Biskup E, Omland S . Favourable results of Mohs micrographic surgery for basal cell carcinoma. Dan Med J. 2015; 62(12):A5171. View

Ouhib Z, Kasper M, Calatayud J, Rodriguez S, Bhatnagar A, Pai S . Aspects of dosimetry and clinical practice of skin brachytherapy: The American Brachytherapy Society working group report. Brachytherapy. 2015; 14(6):840-58. DOI: 10.1016/j.brachy.2015.06.005. View

Rowe D, Carroll R, Day Jr C . Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip. Implications for treatment modality selection. J Am Acad Dermatol. 1992; 26(6):976-90. DOI: 10.1016/0190-9622(92)70144-5. View

Rowe D, Carroll R, Day Jr C . Mohs surgery is the treatment of choice for recurrent (previously treated) basal cell carcinoma. J Dermatol Surg Oncol. 1989; 15(4):424-31. DOI: 10.1111/j.1524-4725.1989.tb03249.x. View

Prager W, Pohlmann S, Kunze S . [The indications for and results of HDR afterloading therapy in diseases of the skin and mucosa with standardized surface applicators (the Leipzig applicator)]. Strahlenther Onkol. 1999; 175(4):170-4. View

Rogers H, Weinstock M, Feldman S, Coldiron B . Incidence Estimate of Nonmelanoma Skin Cancer (Keratinocyte Carcinomas) in the U.S. Population, 2012. JAMA Dermatol. 2015; 151(10):1081-6. DOI: 10.1001/jamadermatol.2015.1187. View

10.

Doggett S, Willoughby M, Willoughby C, Mafong E, Han A . Incorporation of Electronic Brachytherapy for Skin Cancer into a Community Dermatology Practice. J Clin Aesthet Dermatol. 2015; 8(11):28-32. PMC: 4689494. View

11.

Kauvar A, Cronin Jr T, Roenigk R, Hruza G, Bennett R . Consensus for nonmelanoma skin cancer treatment: basal cell carcinoma, including a cost analysis of treatment methods. Dermatol Surg. 2015; 41(5):550-71. DOI: 10.1097/DSS.0000000000000296. View

12.

Doggett S, Brazil J, Limova M, Press L, Smith S, Peck J . Electronic brachytherapy management of atypical fibroxanthoma: report of 8 lesions. J Contemp Brachytherapy. 2017; 9(2):158-160. PMC: 5437075. DOI: 10.5114/jcb.2017.65454. View

13.

Likhacheva A, Devlin P, Shirvani S, Barker C, Beron P, Bhatnagar A . Skin surface brachytherapy: A survey of contemporary practice patterns. Brachytherapy. 2016; 16(1):223-229. PMC: 5413362. DOI: 10.1016/j.brachy.2016.10.006. View

14.

Kauvar A, Arpey C, Hruza G, Olbricht S, Bennett R, Mahmoud B . Consensus for Nonmelanoma Skin Cancer Treatment, Part II: Squamous Cell Carcinoma, Including a Cost Analysis of Treatment Methods. Dermatol Surg. 2015; 41(11):1214-40. DOI: 10.1097/DSS.0000000000000478. View

15.

Cognetta A, Howard B, Heaton H, Stoddard E, Hong H, Green W . Superficial x-ray in the treatment of basal and squamous cell carcinomas: a viable option in select patients. J Am Acad Dermatol. 2012; 67(6):1235-41. DOI: 10.1016/j.jaad.2012.06.001. View

16.

Delishaj D, Rembielak A, Manfredi B, Ursino S, Pasqualetti F, Laliscia C . Non-melanoma skin cancer treated with high-dose-rate brachytherapy: a review of literature. J Contemp Brachytherapy. 2017; 8(6):533-540. PMC: 5241375. DOI: 10.5114/jcb.2016.64112. View

17.

Schulte K, Lippold A, Auras C, Bramkamp G, Breitkopf C, Elsmann H . Soft x-ray therapy for cutaneous basal cell and squamous cell carcinomas. J Am Acad Dermatol. 2005; 53(6):993-1001. DOI: 10.1016/j.jaad.2005.07.045. View

18.

Bhatnagar A . Nonmelanoma skin cancer treated with electronic brachytherapy: results at 1 year. Brachytherapy. 2013; 12(2):134-40. DOI: 10.1016/j.brachy.2012.08.003. View

19.

Steenrod A, Smyth E, Bush E, Chang A, Arron S, Helfrich Y . A Qualitative Comparison of Symptoms and Impact of Varying Stages of Basal Cell Carcinoma. Dermatol Ther (Heidelb). 2015; 5(3):183-99. PMC: 4580654. DOI: 10.1007/s13555-015-0081-6. View

20.

Caccialanza M, Piccinno R, Moretti D, Rozza M . Radiotherapy of carcinomas of the skin overlying the cartilage of the nose: results in 405 lesions. Eur J Dermatol. 2003; 13(5):462-5. View