HDR Mould-Based Brachytherapy for Cutaneous Neoplasms: Toxicity, Long-Term Control, Cosmesis and PROMs

Area of Science:

• Oncology
• Radiation Oncology
• Dermatology

Background:

• Treating cutaneous neoplasms (CN) in older patients presents challenges due to limitations of traditional oncological resection and external beam radiotherapy (EBRT).
• High-dose-rate (HDR) mould-based brachytherapy (MbBT) using custom or 3D-printed moulds offers a potential alternative for CN management.
• This study evaluates the oncological outcomes and patient-reported outcome measures (PROMs) of HDR MbBT for CN in an older cohort.

Purpose of the Study:

• To assess the efficacy and safety of HDR MbBT for cutaneous neoplasms (CN) in elderly and frail patients.
• To evaluate oncological outcomes, including local recurrence rates.
• To analyze patient-reported outcome measures (PROMs) such as toxicity, quality of life, and cosmetic satisfaction.

Main Methods:

• A cohort study involving 64 patients with CN treated with HDR MbBT between January 2019 and March 2024.
• Patients were selected if deemed unsuitable for or refusing radical resection or definitive EBRT.
• Clinical evaluations for acute and late toxicity, oncological follow-up, and PROMs were conducted prospectively.

Main Results:

• The median patient age was 80 years, with various CN histologies including squamous cell carcinoma and basal cell carcinoma.
• After a median follow-up of 679 days, seven local recurrences (11%) were observed.
• 58% of patients reported good or excellent cosmetic results, and 36% found the treatment more tolerable than expected, with minimal severe late toxicity.

Conclusions:

• High-dose-rate MbBT is an effective treatment for cutaneous neoplasms (CN) in older, frail patients.
• The treatment demonstrates favorable oncological control and patient-reported outcomes, including good cosmetic results.
• MbBT is a well-tolerated therapeutic option for patients ineligible for surgery or definitive EBRT.