Journal of Clinical and Aesthetic Dermatology

Updates on Psoriasis & Cutaneou Oncology

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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S34 P r o c e e D i n G s JCAD jOUrnAl Of ClInICAl And AEsthEtIC dErMAtOlOgy september 2017 • volume 10 • number 9 • supplement target. the accurate and precise placement of the applicator oders excellent results with minimized collateral damage. Brachtherapy may be new to dermatology, but it was already in use as a treatment for, among other things, prostate and breast cancer. over time, high-dose radiation (HDr) was combined with eBx, which signifcantly reduced total radiation exposure (to 30 to 40Gg ) and resulted in fewer treatments for patients. this combination eBx with HDr was used to treat nonmelanoma skin cancers. in a German study that commenced in 1987, 520 patients with skin cancer (Bcc, scc, Kaposi sarcoma, melanomas, skin manifestations of lymphomas, and solid organ tumors) were treated with 3,026 fraction using eBx with HDr. 187 single doses of 5 to 10Gg were used once or twice a week with total doses of about 30 to 40Gg. in 91 percent of cases, complete remission was obtained, and in another six percent, partial remission was reported. recurrence occurred in about eight percent of patients over 10 years. eBx with HDr was also used to treat 136 patients with facial Bcc or scc with a cure rate of 98 percent at fve years and excellent cosmesis. 179 in fact, the local control rate for eBx with HDr is over 90 percent (table 10). a further evolution of ecB is the movement away from radioisotopes. HDr brachytherapy relies on iridium-192, while electronic brachytherapy (eBx) does not. By eliminating the radioisotope, eBx is potentially safer in that there is less collateral damage, even with the same high-dose fractionation; it is potentially more edective (beam is gatter with reduced penumbra), and it may be suitable for use within the clinic because it does not require a leaded vault. in terms of clinical workgow, a radiation oncologist, a radiation therapist, and a physicist are required. the patient enters the room and a portable shield is positioned; the machine is then calibrated and the dosing parameters are programmed. the patient is then treated. the entire visit takes about 15 minutes, and most protocols call for two treatments a week over the course of 8 to 10 weeks, but there is some variation in actual clinical practice. this method allows for the safe, edective use of eBr in a dermatology clinic, a physician's oece, or at a multidisciplinary care center. Data to date on eBx are promising. Bhatnagar presented one- year results from a study of 122 patients with 171 nonmelanoma skin cancers who were treated with HDr-eBx that demonstrated no recurrences at a mean follow up of 10 months (range 1–28 months). 1 97 later, Bhatnagar presented an update of this study where 187 patients with a total of 275 nMsc were treated with eBx. 197 the cancers were mostly Bcc (n=159) and scc (n=109). the surface applicator was placed 10, 20, 35, and 50mm distant with 2mm margin and depth of 3mm (the depth was determined by ct for particularly thick lesions). the dose fractionation was 5Gg x 8 fractions for a total of 40Gg , with treatments administered twice weekly. adverse events were frequent (84% reported dermatitis, 25% pruritus) but were mostly mild. the most common late adverse event was hypopigmentation, which was mild and reported by 12 percent of participants. the vast majority of patients rated cosmesis with eBx as excellent (80% to 96%), and no recurrences were reported over 38 months. the literature describes a multisite, multi- physician dermatology practice that introduced eBr for treating nonmelanoma skin cancer in the practice. after 15 months, the practice had treated 524 nonmelanoma skin cancer patients, and at 12.5 months of follow up, there were four recurrences. cosmesis was excellent, and the practice was able to oder radiation therapy for certain patients as an alternative to MMs. 198 a group of physicians who used HDr-eBx in their practice to treat nMsc have reported treating 1,822 lesions from 2009 to 2014 with recurrence rates below one percent and excellent cosmesis. in this particular practice, lesions were mostly Bcc or scc (57% and 38%, respectively) and smaller than 2cm. 199 t AblE 9. a short summary of united states food and Drug adminstration-approved treatments for feld actinic keratosis trEAtMEnt dOsAgE tOtAl ClEArAnCE MEdIAn ClEArAnCE OnEMyEAr ClEArAnCE COMMEnts 5-fu BiD x 2–6 wk 47.5–84% 75–88% 33–40% Painful, poor appearance D iclofenac B iD x 90 d 1 2–48% 8 3% 1 4–30% reduces ingammation, very long course of treatment imiquimod 5% 2 x/wk for 16 wk 20–45.1% 83.3% 40–73% adherence, poor appearance; gu-like symptoms imiquimod 3.75% Daily x 3 (face/scalp) 50% 85% 46.1% shortest course ingenol mebutate 0.05% Daily x 2 (torso, extremities) 27.8% 69.1% 44% Best results on chest ala-PDt 1–2 courses 70–90% >80% ≥50% Painful 5-fu: 5-guoroacil; BiD: twice daily; d: day(s); wk: week; ala-PDt: aminolevulinic acid-photodynamic therapy

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