Authors' objectives: Nonmelanoma skin cancer (NMSC) is the most common malignancy in the white population. It primarily includes basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Surgical excision is the current standard of care for NMSC, but it causes scarring and may cause disfigurement. Complex plastic reconstruction can be necessary, particularly when a tumor is located on the nose, lips, ears, or eyelids. Since these skin cancers frequently arise on the face, a good cosmetic outcome is of paramount importance. Description of Technology: Brachytherapy is a type of localized radiation therapy that utilizes radioactive isotopes as the radiation source. The advantages of brachytherapy over standard external beam radiation therapy (EBRT) include its favorable dose distribution, thereby reducing exposure of healthy subcutaneous tissues, improving tumor radiation coverage, and resulting in fewer complications. For surface brachytherapy, a radioactive isotope is placed in immediate proximity to the tumor. Commonly used isotopes include iridium-192 (192Ir), cobalt-60 (60Co), and cesium-137 (137Cs). The radioisotope is exposed to the surface of the skin via a commercial applicator (e.g. Freiburg/French, Leipzig, or Valencia), a customized mold, or by taping catheters to the skin. The radioisotope is then added to the applicators either manually or by use of a remote-controlled radionuclide applicator system. There is no standardized dosing regimen. Although treatment regimens varied among the reviewed studies, some treated patients with daily radioactivity fractions delivered over several days for a total dose of approximately 40 gray (Gy). Patient Population: Surface brachytherapy is a treatment option for patients with skin cancer that cannot be removed surgically without causing severe disfigurement requiring cosmetic and reconstructive procedures. It is also suitable for patients with skin cancer tumors on anatomical curves (e.g., periorbital region, nasal bridge), tumors near critical organs, large tumors, and recurrent tumors following standard EBRT. Clinical Alternatives: NMSC is most commonly treated by surgical excision. Additional therapeutic methods include topical medications (e.g. imiquimod or 5-fluoruracil), cryotherapy, electrodessication and curettage, radiation therapy, photodynamic therapy, and Moh's micrographic surgery. A Hedgehog pathway inhibitor (vismodegib or sonidegib) can be used to treat locally-advanced BCC. Other types of brachytherapy not evaluated in this health technology assessment include electronic brachytherapy and interstitial brachytherapy.

Project Status: Completed

Year Published: 2016

URL for published report: The report may be purchased from: http://www.hayesinc.com/hayes/crd/?crd=50846

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: HAYES, Inc.

Contact Address: 157 S. Broad Street, Suite 200, Lansdale, PA 19446, USA. Tel: 215 855 0615; Fax: 215 855 5218

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Contact Email: saleinfo@hayesinc.com

Copyright: 2014 Winifred S. Hayes, Inc