Development of a method for treating lower-eyelid carcinomas using superficial high dose rate brachytherapy
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SCIENTIFIC PAPER
Development of a method for treating lower‑eyelid carcinomas using superficial high dose rate brachytherapy H. Stephens1,2 · C. Deans1,5 · D. Schlect1 · T. Kairn3,4 Received: 24 January 2020 / Accepted: 3 October 2020 © Australasian College of Physical Scientists and Engineers in Medicine 2020
Abstract In this study, a method was developed for delivering high dose rate (HDR) brachytherapy treatments to basal cell carcinomas (BCCs) as well as squamous cell carcinomas (SCCs) of the lower eyelid via superficial catheters. Clinically-realistic BCC/ SCC treatment areas were marked in the lower-eyelid region on a head phantom and several arrangements of catheters and bolus were trialled for treating those areas. The use of one or two catheters of different types was evaluated, and sources of dosimetric uncertainty (including air gaps) were evaluated and mitigated. Test treatments were planned for delivery with an iridium-192 source, using the Oncentra Brachy treatment planning system (Elekta AB, Stockholm, Sweden). Dose distributions were evaluated using radiochromic film. The proposed method was shown to be clinically viable, for using superficial HDR brachytherapy to overcome anatomical difficulties and create non-surgical treatments for BCC and SCC of the lower eyelid. Keywords Superficial · Custom mould · Brachytherapy · Skin cancer
Introduction Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) account for 90% of all eyelid malignancies, and 5–10% of skin cancer cases, with 50% of eyelid malignancies occurring in the lower eye region [1]. Surgery has long been the preferred method of treating BCC and SCC on other parts of the skin, however this presents a problem for eyelids due to the poor cosmetic outcomes, low levels of underlying tissue and longer recovery periods [2]. Early radiation treatment techniques (from the 1950s) included the
* H. Stephens [email protected] 1
Chermside Medical Complex, Ground Floor, 956 Gympie Road, Chermside, Qld 4032, Australia
2
School of Physical Sciences, University of Adelaide, North Terrace, Adelaide, SA 5005, Australia
3
Cancer Care Services, Royal Brisbane and Women’s Hospital, Herston, Qld 4029, Australia
4
Science and Engineering Faculty, Queensland University of Technology, Gardens Point, Qld 4001, Australia
5
Present Address: Icon Integrated Cancer Centre, 9 McLennan Ct, North Lakes, Qld, 4509, Australia
use of kV radiotherapy, cobalt-60 machines [3] and interstitial brachytherapy using Ir-192 wires [4]. Early high dose rate (HDR) interstitial treatments of eyelid carcinomas using implanted Ir-192 wires produced ‘definitive cure’ rates of up to 97.4% [4] However, radiation safety concerns [5] and technological developments have led to widespread abandonment of the use of Ir-192 wires. Today, HDR brachytherapy treatments are delivered using remote afterloaders, with small, reusable, high activity Ir-192 sources attached to drive wires. Interstitial HDR treatments using implanted needles and catheters have been
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