Electronic Brachytherapy Treatment (EBT) for Non-Melanomatous Skin Cancer
EBT for skin cancer is a non-invasive office-based alternative to excision or MOHS surgery for the treatment of basal cell and squamous cell skin cancers as well as certain other skin disorders such as keloids and AFX.
Prior to EBT, radiation therapy for skin cancer was typically delivered in a hospital based setting consisting of 20-30 daily treatments. High energy electron beam or mid-range photon beam radiations were utilized. The cure rates for this type of therapy were excellent but the cosmesis, especially for electron beam, was less than satisfactory due to the deeply penetrating nature of these types of high energy radiation therapy. The use of lower energy superficial energy radiation therapy has been used for many years with excellent cosmesis and cure rates but still requires a large fixed site x-ray tube with room wall and ceiling shielding.
The technological advance of EBT is the miniaturization of the low energy x-ray generating tube to a diameter such that it can fit inside a steel tube less than the diameter of a pencil. Stray radiations are therefore eliminated and the therapist remains in the room with the patient throughout the treatment to monitor for patient or applicator motion. The miniaturization of the x-ray tube allows the treatments to be given in any room in a physicians’ office. There is no need for shielding of the room or door and the unit is portable and can be rolled from room to room.
Treatments are given twice a week for 5 weeks and take approximately 2 minutes to complete which allows a rapid throughput of patients.
The flexibility of the treatment device permits the delivery of radiation therapy to any site on the skin surface. Ear, eyelid, lip nose lesions are easily treated with excellent cosmesis and essentially no functional impairment. Lesions up to 4 cm in diameter are candidates for EBT following shave or excisional biopsy. Treatments are painless and the majority of patients experience only a mild to moderate reddening of the skin without desquamation during the course of treatment.
Several articles have been recently published in in peer reviewed journals documenting the cure rate and cosmesis of electronic brachytherapy (EBT) for non-melanomatous skin cancer. These articles documented a local control rate of 98.7%-100% over a 12.5-39 month follow up period. Physician assessed cosmesis was rated excellent to good in 97.6% of patients.