onc brain

Single-institution retrospective review of consecutive pts treated 1966-1997. 468 pts, 531 lesions; median f/u 5.8 yr (range 2-24).

Biopsy-proven epithelial skin cancer: 389 BCC, 142 SCC; 364 previously untreated, 167 recurrent. Median age 73 (BCC) and 72 (SCC).

Superficial x-rays 60%, electrons 19%, electrons + superficial 20%, megavoltage photons <2%. Volume was tumor plus microscopic extension, with an additional 1 cm margin depending on size; lead eye shields when near the eye, and bolus use evolved over time.

Local control (relapse-free from RT start), cosmesis (telangiectasia, pigment change, fibrosis) and complications.

Overall LC 89%; untreated 93% vs recurrent 80%. On multivariate analysis, fraction size (p=0.01), lesion diameter and histology (p<0.01) predicted local failure; modality did not (p=0.345).

Complications 5.8% overall (13% for lesions >5 cm), mainly soft-tissue necrosis: 9% of SCC vs 2% of BCC. Fair/poor cosmesis was 4% with superficial RT vs 12% electrons and 19% combination.

The same institution's 1986 series (Lovett et al.) found electrons worse on multivariate analysis. Here that association disappears, which the authors attribute to wider electron margins in later years. The <2 Gy/fx failure signal matches Silva et al. in pinna lesions.

Treatment spans three decades with evolving bolus and margin policy. The cosmesis data are missing for 15-25% of untreated lesions, and the SCC dose cells are small, so the absent SCC dose response may reflect low power.

The data support RT as definitive therapy for early BCC/SCC and put the main lever on fraction size and lesion size, not beam type. Recurrent SCC carries the poorest control and the most cosmetic cost, so failure at first treatment is expensive.

Retrospective single-institution series spanning three decades; modality chosen by lesion size, not randomized, so dose and modality associations are confounded. No surgical comparator.

Retrospective single-centre series, 434 tumours in 333 pts treated January 2001 to December 2006. Analysis per tumour; LRF and MFS as one minus cumulative incidence with death as competing risk.

Biopsy-proven BCC (n=332) or SCC (n=102), primary RT (n=386) or postop for residual disease (n=48). Median age 74.8y BCC, 78.3y SCC; 59.4% face, 22.4% elsewhere on head.

Electrons, 54 Gy/18 fx of 3 Gy (n=159) or 44 Gy/10 fx of 4.4 Gy (n=275), four fx per week. 4-12 MeV by tumour depth, tumour + 1 cm margin, copper foil to offset skin sparing.

No significant LRF difference between schedules in BCC (p=0.67) or SCC (p=0.46). T stage was the only factor associated with local recurrence (p=0.036); gender, age, histology, indication, site, dose and lesion number were not.

Toxicity not reported beyond cosmesis. In a 14-pt pilot, pt-scored good/fair cosmesis was 75% (54 Gy) and 100% (44 Gy), observer-scored 87% and 83%, no significant difference.

The authors cite RT local control of 87-97% for BCC and 56-91% for SCC in prior series, placing these rates at or above that range. They describe them as comparable to surgical series.

Frail pts were moved to 44 Gy before it became standard, which may bias toward fewer recurrences being seen (competing deaths) rather than toward better control. SCC CIs are wide (54 Gy lower bound 79.1%), so equivalence for SCC is not shown.

The authors argue follow-up was adequate because recurrences came early (median 10.4 mo BCC, 3.3 mo SCC). They conclude 44 Gy/10 fx is optimal for T1-T2 disease. The data support non-inferior-looking control at small size, not a formal non-inferiority claim.

Single-centre retrospective; schedule assigned by era and frailty, older 44 Gy cohort with shorter follow-up; univariate only, 15 events total. Cosmesis from 14 pts.

Single-centre analysis of a prospectively maintained database, RT delivered 2007-2011. Recurrence was assessed clinically. Univariate then backwards logistic regression, per tumour, with no correction for multiple lesions per pt.

389 pts, 448 BCC/SCC lesions, median age 78 (41-99). 67.9% <2 cm; 9% in immunosuppressed pts. Primary 53.3%, recurrent 29.7%, postoperative 16.7%.

Orthovoltage 100-300 kV, electrons 6-18 MeV with bolus, or 1-2 field photons (IMRT selectively). Most common schedules 50 Gy/20 fx and 40 Gy/10 fx. GTV by clinical mark-up plus a 1-2 cm margin; CT planning for deep tumours.

LC 84.2% at median f/u 18.4 mo; median time to recurrence 11.4 mo. Independent predictors were age, size ≥2 cm, immunosuppression and modality; EQD2 and indication (primary vs recurrent vs postop) were not.

LC sits below the ranges the authors cite (BCC 87%-98%, SCC 56%-97%). The van Hezewijk series used higher-EQD2 schedules (44/10 vs 54/18) with 3y LC 96.1% and 96.9%, but the populations are not comparable.

Logistic regression treats a time-to-event outcome as binary, so pts with 0-mo follow-up count as controlled. The 3-category modality variable cannot separate technique from tumour depth. Recurrence was not split into in-field vs marginal.

The independent risk factors are patient and tumour features, not dose, which points to selection and target coverage rather than prescription as the lever. The modality OR reflects case mix per the authors and should not drive technique choice.

Single-centre retrospective analysis; logistic model ignores censoring, modality effect confounded by indication, and 18.4-mo median f/u undercounts late BCC recurrence.

Prospective single-centre observational cohort following STROBE. Pts were resected between 1990 and 2001, follow-up closed Dec 2005, median f/u 43 mo. Cox models used forward selection, with a 200/415 learning-validation split for internal validation only.

615 assessable white pts with primary cutaneous SCC at any body site, median age 73, 5% immunosuppressed. Excluded: SCC in situ, keratoacanthoma, collision tumours, and recurrent SCC treated elsewhere.

No pt received adjuvant RT. Every resection reached tumour-free margins by 3D-histology, with re-excision as needed, so outcomes reflect surgery alone.

The source states the primary endpoints as time to metastasis and time to local recurrence, each measured from diagnosis of the primary. Seven candidate predictors were chosen a priori.

26 (4%) metastases and 20 (3%) local recurrences. No tumour ≤2.0 mm metastasized. The thinnest tumour that metastasized was 2.8 mm thick.

Clayman and colleagues reported LR in 12% (15 of 130) of primary SCC. Margin-controlled resection here gave 3% (20 of 615). The authors cite an Australian series of 266 pts with nodal disease that also supports tumour thickness over horizontal size.

Follow-up after the early period relied partly on mailed questionnaires to treating physicians. New field-cancerization SCC can mimic local recurrence. University referral may have enriched for poorly differentiated tumours.

Thickness, immunosuppression and desmoplasia outperformed Broders' grade and horizontal size as prognostic factors. The authors propose thickness-based T1-T3 cutoffs (≤2.0, 2.1-6.0, >6.0 mm) with "d" and "i" modifiers. The study does not test whether any treatment changes the high-risk course.

Single-centre prognostic cohort, model selected by forward selection with events per predictor below 5. Validated only internally; no external cohort.

Retrospective single-institution series of 671 lesions treated 1972-2007. Mean follow-up 38.016 mo (range 1-351). Actuarial cure rate by life-table method; chi-squared for dose and size associations.

Basal and squamous cell carcinomas of the skin overlying the nasal cartilages. Histology split of the full cohort not given in the source excerpt. Relapses included 10 lesions already recurrent after prior non-radiological treatment.

CRT in 668 lesions: 55-60 kV, HVD 2-12 mm, 5 Gy/fx twice weekly, total 30-75 Gy (median 55 Gy). Margin 0.5-1 cm, 1.5 cm for morpheaform BCC. Septal cartilage shielded with 1 mm Pb nostril inserts at the alae.

CR 98.80% at 1 mo; 5-yr cure 88.09%, 10-yr 86.51%. Recurrence 38 lesions (13 central, 25 marginal), onset 3-96 mo. No relationship between relapse and dose or size.

Cosmesis good or acceptable in 96.84%; 16 lesions not acceptable. Authors report no complications or sequelae, and flag the 7 newly not-acceptable cases for continued follow-up.

No contemporaneous comparator. The authors cite randomised facial BCC data comparing RT with surgery: cosmesis was similar on nasal skin but control favoured surgery, in tumors under 4 cm treated with mixed RT techniques. Mohs surgery, the usual comparator for nasal BCC today, is not addressed.

Toxicity is clinician-rated cosmesis without a named scale, and a mean follow-up near 3 years is short for late cartilage effects. The null dose-relapse finding is likely confounded by dose being chosen by lesion size.

The data support kV RT as an effective, cartilage-sparing option for nasal skin carcinoma, where tight adherence of skin to cartilage complicates excision. They do not establish superiority over surgery, and the marginal-failure pattern raises the question of whether margins were adequate.

Single-institution retrospective series, 1972-2007, no surgical comparator; the authors' claim of superiority over other modalities rests on cross-literature comparison this design cannot support.

Retrospective single-institution series, 114 pts and 134 lesions treated Nov 2006 to Dec 2011. Analysis per lesion; median follow-up 33 mo.

92 BCC and 42 SCC, all clinically N0. 77.3% definitive, 22.7% adjuvant after excision with positive or close margins.

Ir-192 HDR plesiotherapy, 3 Gy/fx, 3 fx/wk; mean 48.79 Gy (45-54) for BCC and 50.55 Gy (45-57) for SCC, prescribed 3-5 mm below the surface with a 0.5-1 cm margin. Leipzig 2 or 3 cm applicators for flat lesions ≤2 cm (75.4%); customized molds for raised or larger lesions.

Overall 3y/5y DFS 95.12%/93.36%, CR 98%. Recurrent lesions did worse than primary (85.9% vs 95.6% at 5y, p=0.003); applicator and definitive vs adjuvant did not separate DFS.

Acute RTOG G3 40.3%, G4 2.2%; toxicity higher with definitive intent (OR 2.928, p=0.013) and borderline with molds (p=0.067). Late G0-1 95.2%; cosmesis excellent/good 82%.

Authors place results alongside the Kohler Leipzig series (91% complete remission) and Guix's mold series (5y DFS 98%). They cite one randomized surgery vs RT trial as the only head-to-head data, with no numbers given in source.

Molds treated larger lesions, so mold vs Leipzig DFS and toxicity differences cannot be separated from size. Reported recurrence counts do not add up, and the acute toxicity figure differs between abstract and results.

Supports surface HDR as a definitive alternative to excision for small primary NMSC. It does not settle optimal fraction size, and the high acute G3 rate argues for weighing applicator and dose per fraction for larger lesions.

Retrospective single-institution series, no comparator arm; applicator comparison confounded by lesion size and location; DFS per lesion with 33-mo median f/u.

30-question electronic survey sent to ~400 American Brachytherapy Society clinician members. 16 fully completed surveys analyzed; one incomplete survey excluded. Nearly all US respondents, one from Spain.

Radiation oncologists using skin surface brachytherapy for cSCC and BCC. Practice settings spanned academic, hospital-based and private; aggregate experience ranged 8 to 1800 cases.

Hypofractionation preferred; clinical-scenario doses ranged 30 Gy in 5 fractions to 64 Gy in 32 fractions (EQD2 40 Gy-65 Gy). Median max prescription depth 5 mm; shielded applicators most common, custom molds for large or curved areas. Respondents avoided daily schedules when hypofractionating.

Margin on gross disease 3-15mm, median 5mm. Max skin dose 125-150% (median 135%) of prescription; CTV coverage 90-100% (median 95%). No consensus on dosimetric constraints.

Eight respondents described severe acute and late toxicity on the lower extremity, especially pretibial skin. Three referred non-healing in-field ulcers for hyperbaric oxygen.

The cited prior literature (Guix custom-mold HDR, Paravati electronic brachytherapy, van Hezewijk hypofractionated electrons) reports single-series outcomes. This survey adds no outcomes; it documents how widely dose, margin and constraints vary across practices using the technique.

Several key tables carry ambiguous row-value pairing in the source, and the scenario table (Table 4) was not captured. Toxicity is anecdotal recall with no denominators.

The useful output is the spread itself: margins, skin-dose ceilings and the lesion-size threshold for gentler fractionation all vary several-fold. Prospective trials and expert consensus are what the authors call for, and this survey cannot substitute for either.

Practice survey of 16 self-selected respondents; no efficacy or toxicity endpoints measured, so the authors' 'convenient and safe' conclusion is not testable from this design.