HDR brachytherapy in keratinocyte skin carcinomas - Single center experience with analysis of clinical, dosimetric, and radiobiological factors in acute skin toxicity

Abstract

Purpose: Radiotherapy techniques have been utilized to treat keratinocyte skin carcinoma (KSC). The objective of this study was to report the results of patients with KSC treated with HDR brachytherapy, with a variety of techniques and applicators. A statistical analysis of clinical, radiobiological, and technical factors has been made to analyze those factors related to skin acute toxicity, focused on acute epithelitis G3. Methods and materials: Between February 2005 and August 2020, 93 patients with 120 histologically proven KSC have been treated in our Institution. BT treatment has been performed using superficial BT/plesiotherapy (Valencia applicator (22%), flaps (48%), customized molds (4%) or interstitial techniques (26%)). The indications of BT were primary/definitive in 38 treatments (32%) or adjuvant/postoperative in 82 (68%). In 14 (17%) of the 82 operated patients a skin graft. Mean comparison t tests were performed for quantitative variables, and percentage comparison Chi2 tests for qualitative. Multivariate binomial logistic regression models were done. Results: Median follow-up was 36.5 months (range 5-141). Local control was achieved in 110 treatments (92%). Acute toxicity, dermatitis, was G1 7%; G2, 57% and G3 38%. The main factors statistically associated to the appearance of dermatitis G3 were the total dose, the volume treated, and the use of manufactured flaps. The main protective factor against dermatitis G3 was implant of skin graft. Conclusions: In KSC BT the use of manufactured flap is accompanied by greater EG3, only with a relationship with the volume of treatment and total dose.