How skin cancer can be treated in fewer sessions using brachytherapy

Healthcare Perspective
Dr Guinot - Skin Cancer

Dr Guinot, Physician at Fundación Instituto Valenciano de Oncología in Valencia, talks about how the use of brachytherapy in treating skin cancer can be accomplished in fewer sessions than other methods.

Thumbnail: Dr Guidot explaining skin cancer and brachytherapy

Skin HDR Brachytherapy is a radiotherapy technique which is performed for certain types of basal cell or squamous cell skin cancers. It provides an effective alternative treatment with minimal side effects for selected patients and those who cannot be treated surgically.

It has been proven that radiotherapy is effective on areas with small tumors, that are located in time and that can be removed. In fact, it's the first option. But it isn't uncommon that, upon removal, an affected edge remains. And this edge will cause a relapse over time. So radiation therapy is indicated.

We have techniques for using external radiation therapy, using it every day for five or six weeks, and it's a good treatment.

We have proved that brachytherapy enables us to use those same tubes, or needles, instead of interstitials, instead of pins, so they are supported. So we put masks, and on these masks, plastic tubes, where the source of radiation will enter, which delivers said radiation to that area. During a session lasting a few minutes, radiation is given just as if it were external, but only in the most superficial area. So that, deep down, where the brain is, a low dose hits.

What advantage does it have?

Patients are often elderly. Older people, and on a stretcher with a fixed mask, lying down. Sometimes, it's not comfortable, it's not easy. Either they move, or they're restless. We've met patients with partial dementia and we've tried as hard as we could to put the masks on, without attaching them. We put the mask on so that the patient can be treated sitting down. They can even move their head and, even if the mask moves, they can be treated in a few minutes. and we're getting the same results. They're not better, they're just as good as external radiotherapy. But we've proved that, being more localized, we can shorten the number of sessions, so instead of having 30 sessions, we can have 12 sessions, 13 sessions, which enables better tolerance for eldery people who are treated.

Obviously, with large tumors, it is also proving to be useful and again, the advantage is that the area that is in contact with the tubes receives very high doses of radiation. With these, the tumor levels out and we really only have to treat the depth. It enables us to treat tumors in the nose, even tumors in the eyelit, tumors on the lip (positioning in this case, needles). It enables us to treat tumors. Their removal is a good treatment, but it can leave defects that force us to make flaps or that force us to cut. With brachytherapy, once it has been treated, the skin heals. It may remain slightly more depigmented, with the color remaining slightly altered, but the mobility function of the eyes, of the mouth, or of the area being treated, remains exactly the same as it was.

It provides a series of advantages and benefits, meaning that the skin brachytherapy, which is called plesiotherapy or contact brachytherapy, since nothing needs to be pinned, only supported, enables us to achieve excellent results, and with a tolerance and comfort, which for older people, is very very effective.

Skin cancer

Skin cancer is the out-of-control growth of abnormal cells in the epidermis, the outermost skin layer, caused by unrepaired DNA damage that triggers mutations. These mutations lead the skin cells to multiply rapidly and form malignant tumors.

Skin cancer is a growing concern as the population ages and individuals spend more time in the sun. More than 90 percent of skin cancers are caused by sun exposure. Countries like Spain and other Mediterranean regions, as well as Australia, have seen a significant prevalence of skin cancer. Skin cancer is also the most common form of cancer in the United States.

Skin cancers are divided into two major groups.

Nonmelanoma skin cancer

Nonmelanoma skin cancers (usually basal cell and squamous cell) are the most common cancers of the skin. Nonmelanoma skin cancer develops from all types of skin cells except melanocytes.

Melanoma skin cancer

Melanoma is almost always curable in its early stages, but is likely to spread to other parts of the body when left untreated. Melanoma is much less common than basal cell and squamous cell skin cancers, but it is much more serious.

The main types of skin cancer are basal cell carcinomas (BCC), squamous cell carcinomas (SCC),melanomas and Merkel cell carcinomas (MCC).

Squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) are the most common types of skin cancer, affecting 3 million Americans each year. Although they are highly curable and less dangerous than melanoma, they can be disfiguring and costly to treat. Treatments for squamous and basal cell carcinomas include surgical removal and conventional radiation therapy.

Radiation using high-dose-rate brachytherapy (HDR-BT) may serve as a superior alternative where surgical scars may be of cosmetic concern or in elderly patients with significant comorbidity.

Skin cancer treatment options

Radiotherapy has demonstrated its effectiveness in treating small tumors (kill cancer cells) that can be surgically removed. However, there are instances where residual affected edges remain after tumor removal, increasing the risk of recurrence over time. In such cases, radiation therapy becomes a recommended treatment option.

External radiation therapy, delivered over a period of several weeks, has proven to be a beneficial treatment approach. Additionally, brachytherapy offers a technique where tubes or needles are utilized, supported by masks and plastic tubes. These tubes allow for the precise delivery of radiation to the targeted area. The radiation is administered in a session lasting a few minutes, primarily affecting the superficial layers while minimizing radiation exposure to deeper regions such as the brain.

Skin brachytherapy offers a range of unique advantages that make it a powerful and effective treatment option for various skin cancer cases.

Unlike traditional external beam radiation, skin brachytherapy delivers targeted radiation directly to the cancerous area, providing several key benefits:

  1. Precise Targeting: the therapy allows for precise and focused radiation delivery to the tumor site, minimizing exposure to surrounding healthy tissues. This targeted approach helps reduce the risk of damage to adjacent organs and tissues, thereby enhancing treatment safety.
  2. Optimized Cosmetic Outcome: By concentrating radiation on the affected area, skin brachytherapy helps preserve the cosmetic appearance of the skin. This is particularly crucial for skin cancers located in cosmetically sensitive areas, such as the face, where maintaining the natural appearance is of utmost importance.
  3. Shorter Treatment Duration: Skin brachytherapy often involves a shorter treatment course compared to conventional external beam radiation therapy. This not only reduces the overall treatment time for patients but also contributes to improved convenience and comfort.
  4. Minimized Radiation Exposure: Brachytherapy enables controlled and localized radiation, which can result in lower radiation exposure to healthy tissues and organs underneath the skin. This is especially beneficial in cases where critical structures are in close proximity to the tumor.
  5. Enhanced Patient Comfort: The focused nature of skin brachytherapy reduces the potential for skin irritation and discomfort commonly associated with external radiation. Patients often experience fewer side effects and a more comfortable treatment experience.
  6. Suitability for Elderly Patients: Skin brachytherapy is particularly well-suited for elderly patients who may have difficulty undergoing surgery or extended treatment regimens. Its shorter duration and reduced invasiveness make it a viable option for this demographic.
  7. Preservation of Functionality: Skin brachytherapy aims to effectively treat skin cancer while preserving the function of nearby structures and organs. This is crucial for maintaining normal bodily functions and quality of life.
  8. Reduced Overall Treatment Costs: The shorter treatment duration and targeted approach of skin brachytherapy can contribute to cost savings compared to prolonged courses of external radiation or surgical interventions.

In conclusion, the advantages of skin brachytherapy lie in its precision, reduced side effects, improved cosmetic outcomes, and convenience. This innovative approach plays a significant role in providing patients with a highly effective and patient-centric treatment option for skin cancer.

The advantages of brachytherapy in treating elderly patients are significant. As older individuals often face challenges in staying still during treatment, brachytherapy offers a more flexible and comfortable approach. With the use of a fixed mask, patients can receive treatment while sitting, allowing for greater ease of movement, even if the mask shifts slightly. Remarkably, this alternative technique yields comparable results to external radiotherapy. Moreover, brachytherapy's localized nature allows for a reduced number of treatment sessions. Instead of undergoing 30 sessions, elderly patients can benefit from a shorter course of 12 or 13 sessions. This shortened treatment duration enhances tolerance and improves the overall experience for elderly individuals undergoing treatment.

Brachytherapy is a highly effective treatment method for skin tumors, well known for almost one hundred years, with a big number of confirmed published positive results. The complications rate is acceptable and treatment costs are low. Treatment is possible almost in all cases on an outpatient basis. In some tumors (great skin lesions in the scalp, near eyes or on the nose) BT allows for a great dose reduction in surrounding healthy tissues. Brachytherapy provides minimal dose delivery to surrounding healthy tissue, thus enabling good functional and cosmetic results.