Dermatological high-dose-rate beta-brachytherapy for treatment of basal and squamous cell carcinomas and extramammary Paget's disease

Objectives Most non-melanoma skin tumors can be easily treated with conventional methods. However in eldery patients with large or multiple lesions satisfactory surgical treatment can be challenging. To offer a solution for these cases and in all cases where patients do not want a surgical approach we developed and evaluated an epidermal radionuclide-based radiation therapy.

Methods Dermatological high-dose-rate beta-brachytherapy (DBBR) is an epidermal brachytherapy based on beta-emitters enabling high-rate localized irradiation. A special resin containing Re-188 is applied with a special applicator on the skin tumor, protected by a thin plastic special foil to avoid any physical contact of the radioactive material with the skin. The irradiation time is calculated based on the area, the applied radioactivity and the target radiation dose. After the required time, the protective foil with the applied radioactivity is removed. The radiation triggers a generalized apoptosis and only few weeks after the application the lesion a scar-free healing can be observed. 45 patients (basal/squamous cell carcinomas, BCCs and SCCs as well as extramammary Paget's disease, EMPDs) were treated with this technique after histological confirmation of the non-melanoma skin tumor. Patients were then followed up, to evaluate wound healing as well as potential side-effects and recurrences.

Results 26 BCCs, 17 SCC and 2 EMPDs were treated with DBBR (32 head, 2 lip, 1 hand, 3 leg, 5 genitals, 2 multiple). 36 presented a clinical complete remission with 1, 8 with 2 and 1 with 3 applications. Besides the open wound following apoptosis, no side effects were reported. Wound healing was complete in 34-180 d. Follow-up of 12-75 months showed a single recurrence (due to bone involvement).

Conclusions DBBR is a quite promising alternative for treatment of BCCs, SCCs and EMPDs for all cases in which a surgical approach is not possible/recommendable or not chosen. $$graphic_80ADB168-E4B9-4A1B-8FE5-899867588E4A$$ $$graphic_FF8513A4-DEAC-4470-A9CA-95E0B34362DF$$