A small case series about safety and effectiveness of a hypofractionated electron beam radiotherapy schedule in five fractions for facial non melanoma skin cancer among frail and elderly patients
Abstract
Background: The aim of the study was to evaluate local control and toxicities of strongly hypofractionated electron beam radiotherapy (RT) in elderly and fragile patients with facial nonmelanoma skin cancer (NMSC).
Materials and methods: We enrolled patients aged ≥ 65 years with facial NMSC, Karnofsky Performance Status (KPS) ≥ 40 and life expectancy ≥ 6 months, amenable neither to daily RT nor surgery. Radiotherapy consisted of 35 Gy, delivered with 6 MeV electron beam, in 5 fractions of 7 Gy/day twice a week (tw). Prescription isodoses were 100% for cT1–cT2 and 90% for cT3–cT4. Objective response was assessed clinically 4 and 8 weeks after the end of RT and then monitored every 6 months. Side effects were assessed according to the CTCAE scale.
Results: 12 patients of median age 89.5 years with a total of 23 NMSC cN0 achieved a median follow-up time of 6 months (range 1–10), with total treatment compliance. 10/12 patients had a 40 ≤ KPS < 70 and 2/12 a 70 ≤ KPS < 90. 5/12 patients had synchronous lesions. 22/23 lesions were classified as T1–T2 and had complete response (CR), 1/23 as T4 with partial response (PR). Within 4 weeks after the end of treatment, G1 toxicity was reported for 12/23 lesions , G2 for 8/23, G3 for 3/23, G4 for 0/23, all disappeared 8 weeks later, with or without topical therapy. After last follow-up (1 June 2020) 1/12 patients died with PR from senile marasmus, 11/12 are alive with CR and widely tolerated toxicities.
Conclusions: Extreme hypofractionation of radiotherapy dose for facial NMSC is effective, safe and suitable for elderly patients.
Keywords: NMSCelectron beam radiotherapyelderly patientshypofractionated radiotherapyskin cancerbrachytherapy
References
- Wassberg C, Thörn M, Johansson AM, et al. Increasing incidence rates of squamous cell carcinoma of the skin in Sweden. Acta Derm Venereol. 2001; 81(4): 268–272.
- Goon PKC, Greenberg DC, Igali L, et al. Squamous Cell Carcinoma of the Skin has More Than Doubled Over the Last Decade in the UK. Acta Derm Venereol. 2016; 96(6): 820–821.
- Rogers HW, Weinstock MA, Feldman SR, et al. Incidence Estimate of Nonmelanoma Skin Cancer (Keratinocyte Carcinomas) in the U.S. Population, 2012. JAMA Dermatol. 2015; 151(10): 1081–1086.
- Boi S, Cristofolini M, Micciolo R, et al. Epidemiology of skin tumors: data from the cutaneous cancer registry in Trentino, Italy. J Cutan Med Surg. 2003; 7(4): 300–305.
- Busco S, Buzzoni C, Mallone S, et al. AIRTUM Working Group. Italian cancer figures — Report 2015: The burden of rare cancers in Italy. Epidemiol Prev. 2016; 40(1 Suppl 2): 1–120.
- Cognetta AB, Howard BM, Heaton HP, et al. 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): 1235–1241.
- Park SY, Kang S, Park JM, et al. Development and dosimetric assessment of a patient-specific elastic skin applicator for high-dose-rate brachytherapy. Brachytherapy. 2019; 18(2): 224–232.
- Skowronek J. Brachytherapy in the treatment of skin cancer: an overview. Postepy Dermatol Alergol. 2015; 32(5): 362–367.
- Scholten AN, Griep C, Davelaar J, et al. [Electron beam irradiation is effective in the treatment of skin carcinomas; a comparison with superficial roentgen therapy]. Ned Tijdschr Geneeskd. 1996; 140(8): 428–431.
- Pashazadeh A, Boese A, Friebe M. Radiation therapy techniques in the treatment of skin cancer: an overview of the current status and outlook. J Dermatolog Treat. 2019; 30(8): 831–839.
- van Hezewijk M, Creutzberg CL, Putter H, et al. Efficacy of a hypofractionated schedule in electron beam radiotherapy for epithelial skin cancer: Analysis of 434 cases. Radiother Oncol. 2010; 95(2): 245–249.
- Kwan W, Wilson D, Moravan V. Radiotherapy for locally advanced basal cell and squamous cell carcinomas of the skin. Int J Radiat Oncol Biol Phys. 2004; 60(2): 406–411.
- McPartlin AJ, Slevin NJ, Sykes AJ, et al. Radiotherapy treatment of non-melanoma skin cancer: a survey of current UK practice and commentary. Br J Radiol. 2014; 87(1043): 20140501.
- Chan S, Dhadda AS, Swindell R. Single fraction radiotherapy for small superficial carcinoma of the skin. Clin Oncol (R Coll Radiol). 2007; 19(4): 256–259.
- Orton CG, Ellis F. A simplification in the use of the NSD concept in practical radiotherapy. Br J Radiol. 1973; 46(547): 529–537.
- Silva JJ, Tsang RW, Panzarella T, et al. Results of radiotherapy for epithelial skin cancer of the pinna: the Princess Margaret Hospital experience, 1982-1993. Int J Radiat Oncol Biol Phys. 2000; 47(2): 451–459.
- Gunaratne DA, Veness MJ. Efficacy of hypofractionated radiotherapy in patients with non-melanoma skin cancer: Results of a systematic review. J Med Imaging Radiat Oncol. 2018; 62(3): 401–411.
- Zaorsky NG, Lee CT, Zhang E, et al. Hypofractionated radiation therapy for basal and squamous cell skin cancer: A meta-analysis. Radiother Oncol. 2017; 125(1): 13–20.
- Tsao MN, Tsang RW, Liu FF, et al. Radiotherapy management for squamous cell carcinoma of the nasal skin: the Princess Margaret Hospital experience. Int J Radiat Oncol Biol Phys. 2002; 52(4): 973–979.
- Veness M. Hypofractionated radiotherapy in older patients with non-melanoma skin cancer: Less is better. Australas J Dermatol. 2018; 59(2): 124–127.
- Simcock R, Thomas TV, Estes C, et al. COVID-19: Global radiation oncology's targeted response for pandemic preparedness. Clin Transl Radiat Oncol. 2020; 22: 55–68.
- Pelissero A, Russi EG, Melano A, et al. Facial basal cell carcinomas treated with hypo-fractionated radiotherapy: A retrospective analysis in 117 elderly patients. J Am Acad Dermatol. 2015; 73(1): 166–168.
- Russi EG, Pelissero A, Melano A, et al. Facial Basal Cell Carcinomas in Elderly Frail Patients Treated with Low Total-dose Radiotherapy. Anticancer Res. 2015; 35(9): 4949–4953.
- Jereczek-Fossa BA, Pepa M, Marvaso G, et al. AIRO (Italian Association of Radiotherapy and Clinical Oncology). COVID-19 outbreak and cancer radiotherapy disruption in Italy: Survey endorsed by the Italian Association of Radiotherapy and Clinical Oncology (AIRO). Radiother Oncol. 2020; 149: 89–93.