Interstitial high-dose-rate brachytherapy in eyelid cancer

PURPOSE: To report the experience and the outcomes of interstitial high-dose-rate (HDR) brachytherapy (BT) of eyelid skin cancer at the Department of Radiotherapy of Hospital de Santa Maria in Lisbon. METHODS AND MATERIALS: Seventeen patients (pts; mean age, 73.75 years) who underwent eyelid interstitial HDR BT with an Ir-192 source between January 2011 and February 2013 were analyzed. Lesions were basal (94%) and squamous (6%) cell carcinomas, on lower (88%) or upper (6%) eyelids, and on inner canthus (6%). T-stage was Tis (6%), T1 (46%), T2 (36%), and T3a (12%). The purpose of BT was radical (12%), adjuvant to surgery (71%), or salvage after surgery (18%). The BT implant and treatment planning were based on the Stepping Source Dosimetry System. The median total dose was 42.75 Gy (range, 32-50 Gy), with a median of 10 fractions (range, 9-11 fractions), twice daily, 6 h apart. The median V-100 was 2.38 cm(3) (range, 0.83-5.59 cm(3)), and the median V-150 was 1.05 cm(3) (range, 0.24-3.12 cm(3)). RESULTS: At a median followup of 40 months (range, 7-43 months), the local control was 94.1%. There was one local recurrence and one non-related death. The BT was well tolerated. Madarosis was the most common late effect (65% of pts) and was related with higher values of V-100 (p = 0.027). Cosmetic outcomes were good and excellent in 70% of pts. CONCLUSIONS: Interstitial HDR BT is a feasible and safe technique for eyelid skin cancers, with good local control. Recurrent lesions and higher volumes receiving the prescribed dose were associated with worse outcomes. (C) 2015 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.