S99
Brachytherapy - Head & neck, skin, eye
ESTRO 2026
treatment results, tumour control, toxicity and cosmetics for patients with carcinomas of the nose, not suitable for surgery, based on a new protocol introduced in 2001, combining external beam radiotherapy (ERT) and interstitial brachytherapy (IBT). Material/Methods: This retrospective study extends from 2001 until 2025, and includes all patients treated for carcinomas of the nasal region and where IBT was part of the treatment. The protocol prescribed a total dose of 51-54Gy including 30 Gy ERT over 10 days followed by 21-24 Gy IBT over 4 days. The protocol was used both where radiotherapy (RT) was the primary treatment and where RT was given after non-radical surgery. Assessments were made for each patient (depending on tumour type, size etc) why not all patients were treated according to the protocol. Results: One hundred and thirty-nine patients were registered, and follow-up time was 5,9 years (median) (max-min 21,7–0,1 years). 45,3 % were male patients and 54,7 % were female and median age was 75,9 years (max-min 101,7-22,7 years). Forty-seven patients had SCC, 4 adnexa tumours, one a Merkel cell carcinoma (group A) and 87 BCC (group B). Many patients had large tumours, encompassing the entire nose or part of the cheek and upper lip. More than half of patients, 55% had RT after non-radical surgery. 68 patients are alive today. In group A 43 patients had tumour control (83%) while 4 patients (8%) died of their disease. No patient had distant relapse. Acute and late toxicity was low. Cosmetics were assessed based on a 4-grade scale and the results were good or excellent in most patients. For the patients, considered to have an outcome labelled as “worse”, 76% had surgery upfront. Conclusion: Our treatment protocol is an effective treatment with low toxicity and excellent cosmetic results even for patients with advanced tumours. To increase local control in patients with non-BCC, the impact of upfront immunotherapy should be explored. For aggressive BCC, the described protocol should be an alternative to surgery. Keywords: Nonmelanoma skin cancer, Nose, Outcome References: 1. Czerwinski M D, Jansen P P, Zwijnenburg E M, Al- Mamgani A, et al. Radiotherapy as nose preservation treatment strategy for cancer of the nasal vestibule: The Dutch experience, Radiotherapy and Oncology 164 (2021) 20–26
5-year organ preservation rate of 100%.Eleven patients developed disease recurrence and most recurrences (10/11) occurred within three years of treatment.Acute toxicities included 116 grade 1–2 and 8 grade 3 events, most commonly dermatitis and mucositis. Late toxicities were limited to 127 grade 1–2 events, predominantly nxerostomia.Cox regression univariable analysis identified predictors of local failure, including T stage, type of surgery, surgical margin status, and cumulative EQD2 (cut-off: 69.3Gy). Other factors analyzed included histological grade, lymphovascular invasion, p16 status, timing of HDR- IRT, and systemic treatment. In multivariate analysis only the type of surgery remained a significant, independent determinant (HR 0.20, CI 0.50-0.84, p=0.027). No independent determinants were identified for regional or distant metastases.For determinants of grade ≥ 3 acute toxicities, Fisher’s exact test identified T stage, type of surgery, timing of HDR-IRT, cumulative EQD2 (cut-off 69.3Gy), and systemic treatment. In multivariable analysis, only cumulative EQD2 was a significant, independent determinant for grade ≥ 3 acute toxicity ( ω² =0.084, p=0.017. Conclusion: Integrating HDR-IRT and EBRT with organ-preserving surgery is an effective treatment approach for advanced nonmetastatic BOTSCC. Wider surgical excision was associated with improved local control. Cumulative total dose with EQD2 ≥ 69.3Gy correlated with an increased incidence of grade 3 acute toxicities. Keywords: brachytherapy; interventional radiotherapy Proffered Paper 1264 High risk skin carcinomas of the nose region treated with combined external beam radiotherapy and interstitial brachytherapy Josef Nilsson 1 , Signe Friesland 2,3 , Claes Mercke 2,3 1 Department of Nuclear Medicine and Medical Physics, Karolinska University Hospital, Stockholm, Sweden. 2 Department of Head, Neck, Lung and Skin Tumors, Karolinska University Hospital, Stockholm, Sweden. 3 Department of Oncology Pathology, Karolinska Institutet, Stockholm, Sweden Purpose/Objective: Surgical excision is the most frequent treatment for nonmelanoma skin cancer of the face, including basal cell (BCC) and squamous cell carcinomas (SCC). Problems with surgery arise when tumours are more advanced, when surgery can lead to significant aesthetic sequelae and need complex reconstructive procedures [1]. The same refers to patients where surgery is not radical or followed by an early recurrence. This retrospective study aims to analyze
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