Hdr Valencia Applicator In Nonmelanoma Skin Cancer: Clinical Outcomes

Non melanoma skin cancer (NMSC) is the most common malignancy. For many decades, radiation therapy (RT) has played a significant role in treating NMSC. High Dose Rate (HDR) brachytherapy (BT) approaches have a paramount relevance due to their adaptability, patient protection and variable dose fractionation schedules. Several innovative applicators have been introduced to the BT community and the use of skin BT has increased significantly. The Valencia applicator is a new superficial device that improves the dose distribution compared with the Leipzig applicator design. The purpose of this work is to assess the tumor control, cosmesis and toxicity events in patients with NMSC treated with the Valencia Applicator and a new regimen of hypofractionation. From January 2008 to March 2010, 32 patients with 45 NMSC were treated with the Valencia applicator. The GTV was visually assessed, but the tumor depth was evaluated using ultrasound imaging. All lesions for the selected cases were limited to 4 mm depth. The prescription dose was 42 Gy in 6 or 7 fractions (Biological effective dose (BED) ≈ 70 Gy), delivered twice a week. The 98% of the lesions were locally controlled at 47 months from treatment. The 93% of patients were out at least 36 months from treatment. Treatment was well tolerated in all cases. The highest skin toxicity was Grade 1 RTOG/EORTC, having resolved with topical treatment at 4 weeks in all but one case which required 2 months. There was not Grade 2 or higher late adverse events. When patients were consulted about their cosmetic impression, all except one (a young woman with hypopigmentation at abdominal location) were very satisfied. In patients with superficial BCC lesions less than 25 mm in maximum diameter, HDR BT treatment with Valencia Applicator using a hypofractionated regimen provides excellent results, for both cosmetic and local control at a minimum of 3 years follow-up. Moreover, the shorter, hypofractionated regimen facilitates compliance, which is very relevant for the elderly patients in our series. Valencia Applicators offer a simple, safe, quick and attractive nonsurgical treatment option.