Electronic Brachytherapy e Bx for the Treatment of
Electronic Brachytherapy (e. Bx) for the Treatment of Non-melanoma Skin Cancers Tēⁿ, Si-Chong M. D. Ko-Hiông I-ha k-tāi-ha k 2016/08/25
Background � Non-melanoma skin cancer (NMSC) is the most common malignancy in the US � Affects 3, 000 TW (2 to 3 million US) people each year � High cure rates of Mohs surgery and its inclusion in dermatology training programs promoted its increasing use. � High dose rate (HDR) brachytherapy using surface applicators has shown efficacy in the treatment of NMSC � An electronic brachytherapy (EBT) system permits treatment of NMSC without the use of a radioactive isotope � Xoft Axxent® e. Bx® system: A miniature, electronic, HDR, low energy X-ray tube produces X -rays of 50 ke. V maximum energy
Electronic Brachytherapy (e. Bx) Over 5, 000 patients treated Supported by positive three-year clinical data 1 scalp forehead eyes nose cheeks 1 ears Bhatnagar A. Electronic Brachytherapy for the Treatment of Non-melanoma Skin Cancer: Results at 3 Years. Int J Radiat Oncol Biol Phys 2013; 87: S 65.
One System. Multiple Solutions. Intra-Operative Radiation Therapy BREAST Over 5, 000 patients treated The Xoft Controller is FDA cleared for use anywhere in the body
The Electronic Brachytherapy Source Xoft, Inc. has developed an innovative miniaturized x-ray source for delivering electronic brachytherapy using a non-isotopic source The Source Operates at 50 KV and 300 Micro-amps (15 Watts)
U. S. Market Overview Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC) Cancer Patients SCC Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC) Patients Receiving Radiation Therapy (RT) RT BCC 3. 6 million cases 1 No RT 26, 000 courses of RT² Skin cancer procedures are growing at an estimated 4 -6% per year. • Non-melanoma skin cancer is now considered an epidemic • 3. 5 million NMSC patients are diagnosed annually • Standard of care is Mohs surgery • e. Bx offers a painless, non-surgical, targeted treatment option for those patients that may not be candidates for Mohs surgery 1 2 3 NCCN Guidelines ™ 2. 2011 2007 IMV Radiation Oncology Market Summary Report (surveys based on 2006 data) Rogers HW, Martin A. MD, Ph. D. Incidence Estimate of Nonmelanoma Skin Cancer in the United States, 2006: ARCH DERMATOL/VOL 146 (NO. 3), MAR 2010: 283 -287.
Ability to Treat a Wide Variety of Lesion Sizes • Applicator sizes range from 10 mm to 50 mm – 10 mm, 20 mm, 35 mm and 50 mm • Approximate treatment times – – 10 mm = 1. 67 Gy/min, 3 minute treatment 20 mm = 1. 48 Gy/min, 3. 37 minute treatment 35 mm = 1. 51 Gy/min, 3. 31 minutes treatment 50 mm = 0. 73 Gy/min, 6. 85 minute treatment • Applicator Cone and Source Channel • Stainless steel, easy to clean • Flattening Filter integrated into applicator cone
Surface Applicator Accessories • Plastic end caps cover opening of surface applicator • Single patient use • Clamping system stabilizes applicator during treatment
Effective Treatment Area • • Targeted small treatment areas Built in flattening filter for better dose distribution Fewer visits compared to external beam therapy at hospital No pain, 3 -6 minute treatments, twice a week for 4 weeks
Ideal e. Bx Candidates • High-risk patients with lesions <5 cm that include: – Perineural invasion, Lymphovascular invasion, Diabetic patients – Co-morbidities • Patients who are not surgical candidates for medical reasons – Blood thinning medication, allergic to local anesthesia • Patients who are not interested in having surgery • Patients with challenging anatomic locations – Nasal tip, ears, legs, scalp, eyes lids etc. • Patients with positive or close margins after surgical excision to reduce the risk of recurrence. • Patients with cancer in more functional areas, which require plastic surgery to replace skin and sustain mobility • Extremities • Patients that need or want to get back to normal activities immediately – Swimming, running, exercising etc.
皮膚近接治療 Source Applicator Cooling system Cone Fixer
病人基本資料 姓 名 : 洪陳O珠 病 歷 號: 04107979 Lesion 性 別: 女 年 齡: 81 主 訴: Enlarging nodule over nose for months 診 斷: Skin, usal alar, left, biopsy, basal cell carcinoma 過往病史 Long term use of steroids for rheumatoid : arthritis (20 yrs)
治療計畫 � 治療部位: L’t nose � 治療深度: 5 mm � 治療範圍: 20 mm cone size � 劑量: 5 Gy/fx � 治療次數: 8次(一週 2次) Depth (mm) 0. 0 1. 0 2. 0 3. 0 4. 0 5. 0 6. 0 20 mm Cone 100. 0% 86. 8% 75. 5% 66. 0% 58. 1% 51. 5% 46. 1% Dose (Gy) 9. 71 8. 43 7. 33 6. 41 5. 64 5. 00 4. 48 7. 0 41. 8% 4. 06 8. 0 9. 0 10. 0 11. 0 12. 0 13. 0 14. 0 15. 0 38. 3% 35. 3% 32. 9% 30. 7% 28. 5% 26. 3% 23. 7% 20. 7% 3. 72 3. 43 3. 19 2. 98 2. 77 2. 55 2. 30 2. 01 20 mm Cone Percent Depth Dose 5 mm 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 0. 0 5. 0 10. 0 Depth (mm) 15. 0 20. 0
Case Example 1 Squamous cell carcinoma on right cheek treated with 40 Gy to a 5 mm depth
Case Example 2 Basal cell carcinoma on right nasal ala treated with 40 Gy to a 5 mm depth
Case Example 3 Squamous cell carcinoma on right temple treated with 40 Gy to a 3 mm depth
Case Example 4 Basal cell carcinoma on right upper arm treated with 40 Gy to a 3 mm depth
Case Example 5 Basal cell carcinoma on left cheek treated with 40 Gy to a 3 mm depth
Case Example 6 Basal cell carcinoma on left nasal bridge treated with 40 Gy to a 3 mm depth
Case Example 7 Basal cell carcinoma on right cheek treated with 40 Gy to a 3 mm depth
Case Example 8 Squamous cell carcinoma on left arm treated with 40 Gy to a 5 mm depth
Electronic Brachytherapy for the Treatment of Non-Melanoma Skin Cancer: Results up to 5 Years Ajay Bhatnagar, MD, MBA Cancer Treatment Services Arizona, Aliate of 21 st Century Oncology, Casa Grande, AZ University of Pittsburgh, School of Medicine, Pittsburgh, PA
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