Personalized High-Dose-Rate Brachytherapy with Non-Sealed Rhenium-188 in Non-Melanoma Skin Cancer

Objectives: Most non-melanoma skin tumors are treated with conventional methods, being the most common surgery. However, satisfactory surgical treatment can be very challenging for patients with large or multiple lesions. In cases where the tumor is located on the face, hands or genital areas, the results may be suboptimal in terms of aesthetics and/or function. A high dose-rate brachytherapy using non-sealed Rhenium-188 was developed to offer a personalized solution for these cases as well as cases where a surgical approach was not preferred. Here we show a retrospective analysis of 43 patients treated with this technique.Methods: The technique, called dermatological high-dose-rate beta-brachytherapy (DBBR), is a brachytherapy based on a non-sealed beta-emitter embedded in a complex specially-designed acrylic matrix. We use Rhenium-188 as the beta-emitter. This matrix is applied over the tumor, which is protected by a special thin plastic foil avoiding any direct physical contact of the radioisotope with the skin. After the calculated required amount of time, the protective foil with the applied radioactive acrylic matrix is removed. 43 patients (basal/squamous cell carcinomas, BCCs and SCCs) were treated with this technique after histological confirmation of the non-melanoma skin tumor. Patients were then followed up, to evaluate wound healing as well as potential side-effects and recurrences.Results: 29 BCC and 14 SCC patients were treated with DBBR. 36/42 achieved complete clinical remission with only 1 application (24 BCC, 12 SCC) and 6/42 with 2 applications (4 BCC, 2 SCC); 1 BCC patient was lost to follow-up before wound closing. In 4 of the 6 patients (3 BCC, 1 SCC) treated twice the second treatment was planned due to the thickness of the tumor; in the remaining 2 patients (1 BCC, 1 SCC) the second treatment was needed to treat a recurrence at the border of the previously treated area. No side effects were reported. Wound healing was complete in 34-180 days (average 65 days, median 53) for all 42 patients that were followed-up. An average follow-up of 288 days (after one or two treatments) showed no single recurrence (42 patients).Conclusions: DBBR is a very promising alternative for treatment of BCCs and SCCs for all cases in which a surgical approach is not recommended or accepted by the patient

Role of sentinel lymph node biopsy procedure in cervical cancer: a critical point of view

To report our experience about the role of sentinel node biopsy in cervical cancer patients while debating provocatory arguments concerning this procedure. From June 2001 to February 2003, patients affected by stage IB(1) cervical cancer were submitted to the sentinel node biopsy procedure. Patients were submitted to lymphoscintigraphy and, subsequently, to laparoscopy in order to locate the sentinel lymph node. Thirty-seven patients were enrolled in the study. Sentinel node(s) was(were) identified with preoperative lymphoscintigraphy in 89% of the patients. Intraoperative detection rate was 70%. During surgery in 31% of the patients, sentinel node was detected bilaterally; in 15%, two sentinel nodes on the same side of the lymphatic vessels were detected. The sentinel node was located at the level of superficial common iliac vessels (26%), external iliac vessels (69%), and superficial obturator vessels (49%). In 77% of the patients, the histologic specimen sent by the surgeon as unique sentinel node contained two or more nodes. Metastatic sentinel nodes were found in 23% of the patients. There was no case with a positive nonsentinel node in the presence of a negative sentinel node. Sentinel node detection is a feasible procedure in cervical cancer patients. However, a high percentage of patients is found with bilateral and/or more than one sentinel lymph node. Improvements in detection rate and pathological analysis are needed prior to consider the sentinel node biopsy a routine procedure in cervical cancer patients