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Feliciani G, Licciardello T, Guidi C, Del Duca M, Mazzotti G, Bellia SR, Ghigi G, Romeo A, Sarnelli A. Comparison of HDR-brachytherapy and tomotherapy for the treatment of non-melanoma skin cancers of the head and neck. Radiother Oncol 2025; 204:110703. [PMID: 39733970 DOI: 10.1016/j.radonc.2024.110703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 12/18/2024] [Accepted: 12/21/2024] [Indexed: 12/31/2024]
Abstract
PURPOSE This study aims to investigate and compare High Dose Rate Brachytherapy (HDR-BT) with Helical Tomotherapy (HT) treatment plans. The focus is on small target volumes near radiation-sensitive organs in the ocular region, to evaluate the advantages of these techniques in treating skin cancer. METHODS This retrospective observational analysis included patients who underwent skin cancer HDR-BT Freiburg flap treatment between 2019 and 2023. An expert radiation oncologist contoured the planning target volumes (PTVs) and marked their visible extension with a radio-opaque tin wire. Each patient had two treatment plans: an individually shaped HDR-BT surface mold and an HT calculation used specifically for this study. Quality assurance of treatment plan was performed in both HDR-BT and HT. The plans were then compared using organ at risk (OAR) maximum doses and the conformity index CI. Radiation oncologists assessed their quality using their routine workflow evaluation plan. RESULTS Twelve patients were selected for the inclusion in this study. HT provided more consistent target coverage than HDR-BT, with a statistically significant difference (p < 0.05) at t-test. HT showed higher CIs and maximum dose for the optic nerve, optic chiasm, and lens in the homolateral part. Radiation oncologists preferred the overall quality of HT treatment due to its superior PTV coverage, especially for convex surfaces, while maintaining effective OAR sparing. HDR-BT is preferred when concave surfaces are present. CONCLUSION HT offers more conformal treatment, although some OAR parameters are statistically significantly better with HDR-BT, which may also be superior for complex geometries.
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Affiliation(s)
- Giacomo Feliciani
- Medical Physics Unit, IRCCS, Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Italy.
| | - Tiziana Licciardello
- Medical Physics Unit, IRCCS, Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Italy.
| | - Claretta Guidi
- Medical Physics Unit, IRCCS, Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Italy.
| | - Massimo Del Duca
- Radiation Oncology Unit, IRCCS, Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Italy.
| | - Giorgio Mazzotti
- Medical Physics Unit, IRCCS, Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Italy.
| | - Salvatore Roberto Bellia
- Radiation Oncology Unit, IRCCS, Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Italy.
| | - Giulia Ghigi
- Radiation Oncology Unit, IRCCS, Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Italy.
| | - Antonino Romeo
- Radiation Oncology Unit, IRCCS, Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Italy.
| | - Anna Sarnelli
- Medical Physics Unit, IRCCS, Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Italy.
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Placidi E, Fionda B, Rosa E, Lancellotta V, Napolitano A, De Angeli M, Ciasca G, Pastore F, Gambacorta MA, Tagliaferri L, De Spirito M. Retrospective Dosimetric Comparison of HDR Interventional Radiotherapy (Brachytherapy) Versus Planning with VMAT and Electron Beam Therapy for Non-Melanoma Skin Cancer Treatment. APPLIED SCIENCES 2024; 14:10669. [DOI: 10.3390/app142210669] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2025]
Abstract
This study compares dosimetric outcomes of high-dose-rate (HDR) interventional radiotherapy (IRT) using Iridium-192, Volumetric Modulated Arc Therapy (VMAT), and electron beam therapy for non-melanoma skin cancer (NMSC). A retrospective analysis of 25 patients showed that IRT provided a significantly higher mean dose to the clinical target volume (CTV) compared to VMAT and electron beam therapy. IRT and VMAT had comparable V95%CTV coverage, whilst electron therapy was less feasible for large CTVs. IRT delivered higher surface doses while minimizing deep tissue exposure compared to partial arc VMAT. Our findings support IRT for personalized and effective NMSC treatment.
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Affiliation(s)
- Elisa Placidi
- UOC Fisica per le Scienze Della Vita, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Bruno Fionda
- UOC Degenze di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Enrico Rosa
- UOC Fisica per le Scienze Della Vita, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Theoretical and Applied Sciences, eCampus University, 22060 Novedrate, Italy
| | - Valentina Lancellotta
- UOC Degenze di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Antonio Napolitano
- Medical Physics Unit, Bambino Gesù Children’s Hospital, 00165 Rome, Italy
| | - Martina De Angeli
- UOC Degenze di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Gabriele Ciasca
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesco Pastore
- UOC Servizio di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Maria Antonietta Gambacorta
- UOC Servizio di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Luca Tagliaferri
- UOC Degenze di Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marco De Spirito
- UOC Fisica per le Scienze Della Vita, Dipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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3
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Sweeney RA, Goebeler M, Flentje M, Klement RJ. Brooke-Spiegler syndrome: radiotherapy as the last resort? Strahlenther Onkol 2023; 199:595-600. [PMID: 37103530 DOI: 10.1007/s00066-023-02077-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/12/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE To describe the case of successful radiotherapeutic treatment of a woman suffering from Brooke-Spiegler syndrome who had multiple disfiguring cylindromas on the entire scalp and further tumors on the trunk. METHODS After decades of treatment with conventional therapies including surgery and topically applied salicylic acid, the 73-year-old woman agreed to undergo radiotherapeutic treatment. She received 60 Gy to the scalp and 36 Gy to painful nodules in the lumbar spine region. RESULTS Over a follow-up period of 14 and 11 years, respectively, the scalp nodules almost completely regressed, while the lumbar nodules became painless and considerably smaller. Apart from alopecia, no late adverse effects of treatment remain. CONCLUSION This case should remind us of the potential role that radiotherapy could play in treating Brooke-Spiegler syndrome. The required dose for treatment of such extensive disease is still a matter of debate due to the scarcity of radiotherapeutic experience. This case demonstrates that for scalp tumors, 30 × 2 Gy can result in long-term tumor control, while other dose prescriptions may be adequate for tumors in other locations.
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Affiliation(s)
- Reinhart A Sweeney
- Department of Radiotherapy and Radiation Oncology, Leopoldina Hospital Schweinfurt, Robert-Koch-Straße 10, 97422, Schweinfurt, Germany
| | - Matthias Goebeler
- Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, 97080, Würzburg, Germany
| | - Michael Flentje
- Department of Radiotherapy and Radiation Oncology, University Hospital Würzburg, 97080, Würzburg, Germany
| | - Rainer J Klement
- Department of Radiotherapy and Radiation Oncology, Leopoldina Hospital Schweinfurt, Robert-Koch-Straße 10, 97422, Schweinfurt, Germany.
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Gruber I, Weidner K, Koelbl O. Noninvasive treatment of two deeply invasive cutaneous squamous cell carcinomas of the midface located close to the orbits with intensity-modulated arc therapy: A case report. Clin Case Rep 2022; 10:e6149. [PMID: 35898739 PMCID: PMC9309616 DOI: 10.1002/ccr3.6149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/06/2022] [Accepted: 07/16/2022] [Indexed: 11/20/2022] Open
Abstract
Definitive radiotherapy is a curative and noninvasive treatment modality for cutaneous squamous cell carcinomas of the midface when surgery has an impact on function and cosmetics. Volumetric modulated arc therapy provides optimal dose coverage for complex-shaped tumors without compromising adjacent organs at risk.
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Affiliation(s)
- Isabella Gruber
- Department of Radiation OncologyUniversity Hospital of University RegensburgRegensburgGermany
| | - Karin Weidner
- Department of Radiation OncologyUniversity Hospital of University RegensburgRegensburgGermany
| | - Oliver Koelbl
- Department of Radiation OncologyUniversity Hospital of University RegensburgRegensburgGermany
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Major T, Fröhlich G, Ágoston P, Polgár C, Takácsi-Nagy Z. The value of brachytherapy in the age of advanced external beam radiotherapy: a review of the literature in terms of dosimetry. Strahlenther Onkol 2021; 198:93-109. [PMID: 34724086 PMCID: PMC8789711 DOI: 10.1007/s00066-021-01867-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/03/2021] [Indexed: 12/29/2022]
Abstract
Brachytherapy (BT) has long been used for successful treatment of various tumour entities, including prostate, breast and gynaecological cancer. However, particularly due to advances in modern external beam techniques such as intensity-modulated radiotherapy (IMRT), volume modulated arc therapy (VMAT) and stereotactic body radiotherapy (SBRT), there are concerns about its future. Based on a comprehensive literature review, this article aims to summarize the role of BT in cancer treatment and highlight its particular dosimetric advantages. The authors conclude that image-guided BT supported by inverse dose planning will successfully compete with high-tech EBRT in the future and continue to serve as a valuable modality for cancer treatment.
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Affiliation(s)
- Tibor Major
- Radiotherapy Centre, National Institute of Oncology, Budapest, Hungary. .,Department of Oncology, Semmelweis University, Budapest, Hungary.
| | - Georgina Fröhlich
- Radiotherapy Centre, National Institute of Oncology, Budapest, Hungary.,Faculty of Science, Eötvös Loránd University, Budapest, Hungary
| | - Péter Ágoston
- Radiotherapy Centre, National Institute of Oncology, Budapest, Hungary.,Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Csaba Polgár
- Radiotherapy Centre, National Institute of Oncology, Budapest, Hungary.,Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Zoltán Takácsi-Nagy
- Radiotherapy Centre, National Institute of Oncology, Budapest, Hungary.,Department of Oncology, Semmelweis University, Budapest, Hungary
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