S110
Brachytherapy - Head & neck, skin, eye
ESTRO 2026
Results:
Digital Poster 5159
Feasibility study on the use of contact brachytherapy with customized molds in extensive, irregular, ulcerated and exophytic non- melanoma skin lesions Susana Perez Echaguen 1 , Camilo Jose Sanz Freire 2 , Alejandro Vazquez Galiñanes 2 , Gustavo Adolfo Ossola Lentati 1 1 Radiation Oncology, CIBIR-Hospital San Pedro, Logroño, Spain. 2 Medical Physics, CIBIR-Hospital San Pedro, Lorgoño, Spain Purpose/Objective: Non-melanoma skin cancer (NMSC) accounts for approximately one-third of all cancer diagnoses, with incidence rising markedly in patients over 80 years of age. Surgical intervention may be contraindicated due to tumor location, lesion size, comorbidities, or patient preference, resulting in referral to Radiation Oncology departments. For lesions <5 mm in thickness, contact brachytherapy (BT) represents a valid therapeutic option, whereas interstitial BT is preferred for lesions >5 mm. However, in exceptionally large, extensive, and irregular lesions in frail patients, both interstitial BT and external beam radiotherapy (EBRT) may be contraindicated. We investigated the feasibility of contact BT in lesions exceeding the conventional treatment depth, leveraging the adaptability of customized molds to conform to the lesion
Treatment with customized molds achieved robust local tumor control with acceptable acute toxicity (Grade 3: 80%; Grade 2: 20%) and subacute toxicity (Grade 1: 100%). Complete response was observed in 100% of patients. Good to very good cosmetic outcomes were reported in 90% of cases, including exophytic, bleeding, and ulcerated lesions >5 mm thick, without compromise of patient quality of life. Among patients with survival exceeding 2 years, mild, asymptomatic telangiectasias and slight hypopigmentation were noted in the tumor bed. All treatments were administered on an outpatient basis. Conclusion: Contact BT using customized molds represents a feasible and effective therapeutic option for NMSC, including large lesions without deep tissue invasion, particularly when surgery, EBRT, or interstitial BT are contraindicated. Keywords: NMSC, molds References: [1]Guinot JL, Rembielak A, Perez - Calatayud J, Rodríguez - Villalba S, Skowronek J, Tagliaferri L, Guix B, Gonzalez - P érez V, Valentini V, Kovacs G; for the GEC - ESTRO ACROP group. GEC - ESTRO ACROP recommendations in skin brachytherapy. Radiother Oncol. 2018;126(3):377 - 385. doi:10.1016/j.radonc.2018.01.013.
throughout therapy. Material/Methods:
Since 2013, our department has implemented high- dose-rate (HDR) BT for cutaneous tumors, adhering to interstitial BT recommendations for lesions >5 mm in thickness and utilizing contact BT via Freiburg Flaps or Valencia applicators for lesions <5 mm [1]. A substantial proportion of patients referred from Plastic Surgery or Dermatology were unsuitable for surgical management due to frailty and significant comorbidities and were also not candidates for interstitial BT. Frail patients were therefore treated with custom-made silicone molds, delivering 5.5 Gy per fraction, twice weekly, for a total of 10 fractions, prioritizing patient comfort. Inclusion criteria comprised extensive, irregular, exophytic, ulcerated lesions >5 mm thick and multiple lesions lacking alternative treatment options. This cohort represented 10% of NMSC BT treatments at our institution (n=10, median age 90 years). Two patients were treated concurrently for multiple lesions using a single mold (maximum of 6 lesions treated simultaneously).
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