Abstract

Aim: Use of Surface Mould Brachytherapy in the treatment of skin and oral malignancies at our institution. Background: SMB offers a good therapeutic ratio helping in dose escalation of irradiationand higher Biologically equivalent doses. In this study, we share our institutional experience with SMB in different types of cancers. Materials and Methods: 15 Patients with oral, skin, and penile malignancies treated with SMB were analyzed from Jan 2019 to Sept 2023. Treatment was delivered using HDR Co 60 source with a customized mouldto a median dose of 48Gy in the radical setting and 15Gy as a boost with 2.5-3Gy/# twice a day. The treatment-related toxicities and response were noted. Results: 15 patients with various malignancies were evaluated. Eight patients received SMB alone while 7 patients external beam radiotherapy with SMB Boost. A Complete: Partial response ratio of about 80:20 was achieved. There were 3 local failures all in hard Palate patients. The acute toxicity outcomes were as follows - 12 patients of Grade 1 and 3 patients of Grade 2 toxicities. Late toxicities reported were Grade 1 in six patients, Grade 2 in 5 patients, and Grade 3 in one patient. Conclusion: Surface mould brachytherapy provides maximum local tumor control, is well-tolerated, and is a non-invasive, outpatient procedure for treatment in both radical settings and as a boost. It results in organ and function preservation and is a good alternative option for patients who are unwilling for surgery and who present with comorbidities.

• 1.   Svoboda VH, Kovarik J, Morris F. High doserate microselectronmolds in the treatment of skin tumors. Int J RadiatOncolBiolPhys 1995; 31: 967- 972.
• 2.   Allan E, Stanton A, Pye D et al. Fractionated high dose rate brachytherapy olds – a precise treatment for carcinoma of the pinna. RadiotherOncol 1998; 48: 277-281.
• 3.   Guix B, Finestres F, Tello J et al. Treatment of skin carcinomas of the face by high-dose-rate brachytherapy and custom-made surface molds. Int J RadiatOncolBiolPhys 2000; 47: 95-102.
• 4.   Maroñas M, Guinot JL, Arribas L et al. Treatment of facial cutaneous carcinoma with high-dose rate contact brachytherapy with customized molds. Brachytherapy 2011; 10: 221-227.
• 5.   Kudoh T, Ikushima H, Kudoh K et al. High-doserate brachytherapy for patients with maxillary gingival carcinoma using a novel customized intraoral mold technique. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 2010; 109: e102-108.
• 6.   Ariji E, Hayashi N, Kimura Y et al. Customized mold brachytherapy for oral carcinomas through use of high-dose-rate remote afterloading apparatus. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 1999; 87: 508-512.
• 7.   Mukherji A, Mourougan S, Saravannan K, et al. Dosimetric analysis and clinical outcomes in CTbased mould brachytherapy in early oral cancers in patients unfit for surgery. J Contemp Brachytherapy 2015; 7: 147-153.
• 8.   Takeda M, Shibuya H, Inoue T. The efficacy of gold- 198 grain mold therapy for mucosal carcinomas of the oral cavity. Acta Oncol 1996; 35: 463-467.
• 9.   Budrukkar A, Dasgupta A, Pandit P, Laskar SG, Murthy V, Upreti RR, Gupta T, Dholam K, Agarwal JP. Clinical outcomes with high-dose-rate surface mould brachytherapy for intra-oral and skin malignancies involving head and neck region. Journal of Contemporary Brachytherapy. 2017 Mar 23;9(3):242-50.
• 10.   Nishimura Y, Yokoe Y, Nagata, Y, Okajima K, Nishida M, Hiraoka M. High-dose-rate brachytherapy using molds for oral cavity cancer. The technique and its limitations. Int J Clin Oncol 1998; 3: 351-356.
• 11.   Unetsubo T, Matsuzaki H, Takemoto M, Katsui K, Hara M, Katayama N, Waki T, Kanazawa S, Asaumi JI. High-dose-rate brachytherapy using molds for lip and oral cavity tumors. Radiation Oncology. 2015 Dec;10(1):1-8.
• 12.   Marbán M, Crook J, Keyes M, Dubash R, Batchelar D. High-dose-rate brachytherapy for localized penile cancer: evolution of a technique. Brachytherapy. 2020 Mar 1;19(2):201-9.
• 13.   Clark CM, Furniss M, Mackay-Wiggan JM. Basal cell carcinoma: an evidence based treatment update. Am J Clin Dermatol. 2014 Jul:15(3):197-216.
• 14.   Delishaj D, Laliscia C, Manfredi B, Ursino S, Pasqualetti F, Lombardo E, Perrone F, Morganti R, Paiar F, Fabrini MG. Non-melanoma skin cancer treated with high-dose-rate brachytherapy and Valencia applicator in elderly patients: a retrospective case series. Journal of contemporary brachytherapy. 2015 Dec 1;7(6):437-44.

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