Brachytherapy effective alternative for skin cancer patients
Provides shorter treatment time, better patient outcomes
By Gremlyn Bradley-Waddell
Skin cancer is the most common form of cancer in the U.S. and the world, and the standard treatment approach is surgical excision.
For those patients who are unable to undergo surgery, however, radiation therapy is an excellent treatment option with high cure rates. Skin brachytherapy — one type of radiation therapy — is a new way of delivering radiation to the skin. The procedure’s shorter treatment time, compared to regular radiation, and its better cosmetic results are a few of the reasons that Anna Likhacheva, M.D., M.P.H., chooses to specialize in delivering this treatment.
“Brachytherapy provides excellent patient outcomes at low cost and with maximum patient convenience,” says the radiation oncologist at Banner MD Anderson Cancer Center in Gilbert, adding that she also likes working with her hands to create the custom molds that are sometimes needed to deliver the radiation to a targeted body part. “I like to think about each patient as a new clinical challenge, and how I can make the best possible outcome happen for that patient.”
Brachytherapy is not a new form of radiation therapy; it has long been used to treat breast, prostate and head and neck cancers, among others, but its use in the treatment of skin cancer reaches back only a couple decades. Although all radiation therapy options are good, she says that brachytherapy's big advantage is that it delivers a dose of radiation from a radioactive source, such as a seed containing Iridium-192, close to the surface of the skin and directly to the site of the cancer.
“That's exactly what you want,” she says of the very precise approach. “You don't want a dose going into deep tissues and unnecessarily irradiating vulnerable structures underneath the skin, and that's what can happen when you use external beam radiation, the most common delivery form of radiation therapy.”
Skin brachytherapy is also a non-invasive procedure, usually requiring a catheter or applicator for the placement of the seed, and it usually takes just a few minutes to complete each treatment. Since less subcutaneous tissue is irradiated, patients experience less scarring, less hypopigmentation (lightening of skin color) and fewer telangiectasias, or dilated blood vessels. In addition, because the procedure delivers radiation to such a precise area, a larger dose can be administered, Likhacheva said. That means fewer treatment sessions, a considerable convenience for the patient.
“We can do 10 treatments instead of the usual 20 or 30 that are needed with external beam radiation,” she says. “So instead of coming in for treatments for four to six weeks, a patient can come for 2 1/2 weeks, every other day, and be done."
She emphasized, the vast majority of the 4 million people in the United States who are diagnosed with skin cancer each year and seek treatment should first be evaluated for surgery, which is the treatment of choice. Alternatives to surgery include topical chemotherapy and radiation, but it is generally accepted that radiation therapy has better outcomes. The percentage of skin cancer patients who opt for brachytherapy hovers in the single digits, but, even one percent of 4 million is a significant number, she said.
Assessing surgical candidates
The overwhelming majority of patients diagnosed with skin cancer will opt for surgery, but the fact is that not everyone is a candidate, and that's often when brachytherapy is utilized. The following scenarios, according to Likhacheva, likely would exclude someone from being a candidate for surgery:
- a history of a bleeding disorder, especially if the patient is older
- an extensive lesion or a large number of lesions
- poor vasculature, or blood vessels
- history of poor healing from surgery
- a cancer that keeps coming back in the same area
- a cancer in parts of the body where surgery could lead to functional impairment , such as nose, ears, fingers, corners of the mouth, eyelids, etc.