Article information
Abstract
Ionizing radiation causes cell death through DNA damage and has a stronger effect on undifferentiated tumor cells with a high mitotic rate. The use of a fractionated radiotherapy regimen improves both efficacy and tolerance. In addition, greater fractionation, with lower doses per session, minimizes adverse effects. In the majority of tumors treated with radical radiotherapy, the tumor cells do not disappear immediately after treatment, and assessment of the final response to treatment before three months is premature. Radiotherapy is an important treatment modality in selected patients with skin cancer. Modern radiotherapy equipment and techniques achieve excellent rates of tumor control, associated with good cosmetic results, preserved function, and a low rate of complications. The choice of technique is determined by tumor size and site and the thickness. The techniques most widely used at the present time include external beam radiotherapy with linear accelerator sand high-dose-rate brachytherapy.
Key words:
radiotherapy
skin cancer
electrons
high-dose-rate brachytherapy
Resumen
El mecanismo por el cual las radiaciones ionizantes producen muerte celular es el daño al ADN, que afecta más a las células tumorales de mayor actividad mitótica e indiferenciadas. La administración de radioterapia en dosis fraccionadas aumenta la eficacia y la tolerabilidad del tratamiento; esquemas más fraccionados en dosis bajas por sesión minimizan los efectos secundarios. La mayoría de los tumores irradiados en dosis radical no desaparecen de forma rápida al final del tratamiento. Una valoración de la respuesta definitiva antes de los tres meses es prematura. La radioterapia es un tratamiento importante en pacientes seleccionados con cáncer de piel. Se obtienen excelentes tasas de control tumoral, con buen resultado cosmético, preservación funcional e infrecuentes complicaciones con los modernos equipos y las técnicas de radioterapia. La elección de la técnica se determina por el tamaño, el espesor y la localización anatómica del tumor. Las técnicas actualmente más extendidas para el tratamiento del cáncer de piel son la radioterapia externa con electrones de acelerador lineal y la braquiterapia de alta tasa de dosis.
Palabras clave:
radioterapia
cáncer de piel
electrones
braquiterapia de alta tasa
Full text is only aviable in PDF
References
[1.]
C.S.M. Wong, R.C. Strange, J.T. Lear.
Basal cell carcinoma.
BMJ, 327 (2003), pp. 794-798
[2.]
M. Alam, D. Ratner.
Cutaneous squamous-cell carcinoma.
N Engl J Med, 344 (2001), pp. 975-983
[3.]
A.W. Kopf.
Computer analysis of 3531 basal cell carcinoma of the skin.
J Dermatol, 6 (1979), pp. 267
[4.]
H.V. DeBuys, S.B. Levy, J.C. Murray, D.L. Madey, S.R. Pinnell.
Modern approaches to photoprotection.
Dermatol Clin, 18 (2000), pp. 577-590
[5.]
D.S. Preston, R.S. Stern.
Nonmelanoma cancers of the skin.
N Engl J Med, 327 (1992), pp. 1649-1662
[7.]
A.J. Emmett.
Surgical analysis and biological behaviour of 2277 basal cell carcinomas.
Aust N Z J Surg, 60 (1990), pp. 855-863
[8.]
Krekels GAM. Basal cell carcinoma, a disease on the increase: implications for treatment and prevention [thesis]. Maastricht: University of Maastricht; 1998.
[9.]
M.R. Thissen, M.H.A. Neumann, L.J. Schouten.
A systemic review of treatment modalities for primary basal cell carcinoma.
Arch Dermatol, 135 (1999), pp. 1177-1183
[10.]
The, NCCN basal cell, squamous cell skin cancers clinical practice guidelines in oncology.
J Natl Compr Canc Netw, 2 (2004), pp. 6-27
[11.]
L. Ríos-Buceta.
Actitud ante los epiteliomas basocelulares con bordes afectos.
Actas Dermosifiliogr, 98 (2007), pp. 679-687
[12.]
E. Nagore, B. Llombart, A. Compañ, O. Sanmartín, A. Sevila, R. Botella, et al.
Cirugía micrográfica de Mohs del canto interno del ojo. Estudio de casos y controles.
Actas Dermosifiliogr, 93 (2002), pp. 406-412
[13.]
G.L. Clayman, J.J. Lee, F.C. Holsinger, X. Zhou, M. Duvic, A.K. El-Naggar, et al.
Mortality risk from squamous cell skin cancer.
J Clin Oncol, 23 (2005), pp. 759-765
[14.]
R.C. Martin 2nd, M.J. Edwards, T.G. Cawte, C.L. Sewell, K.M. McMasters.
Basosquamous carcinoma: analysis of prognostic factors influencing recurrence.
Cancer, 88 (2000), pp. 1365-1369
[16.]
F.E. Mohs.
Chemosurgery: Microscopically Controlled Surgery for Skin Cancer.
Charles C. Thomas, (1978),
[17.]
H. Von Domarus, P.J. Stevens.
Metastatic basal cell carcinoma: Report of five cases and review of 170 cases in the literature.
J Am Acad Dermatol, 10 (1984), pp. 1043
[18.]
G.W. Binkley, R.R. Rauschkolb.
Basal-cell epithelioma metastasizing to lymph nodes.
Arch Dermatol, 86 (1962), pp. 332
[19.]
F.L. Ampil, J.C. Hardin, S.P. Peskind, F.J. Stucker.
Perineural invasion in skin cancer of the head and neck: a review of nine cases.
J Oral Maxillofac Surg, 53 (1995), pp. 34-38
[20.]
N. Lawrence, W.I. Cotell.
Squamous cell carcinoma of skin with perineural invasion.
J Am Acad Dermatol, 31 (1994), pp. 30-33
[21.]
L.S. Williams, A.A. Mancuso, W.M. Mendenhall.
Perineural spread of cutaneous squamous and basal cell carcinoma: CT and MR detection and its impact on patient management and prognosis.
Int J Radiat Oncol Biol Phys, 49 (2001), pp. 1061-1069
[22.]
C.W. Hanke, R.L. Wolf, S.A. Hochman, J.J. O’Brian.
Chemosurgical reports: perineural spread of basal-cell carcinoma.
J Dermatol Surg Oncol, 9 (1983), pp. 742-747
[23.]
M.W. McCord, W.M. Mendenhall, J.T. Parsons, F.P. Flowers.
Skin cancer of the head and neck with incidental microscopic perineural invasion.
Int J Radiat Oncol Biol Phys, 43 (1999), pp. 591-595
[24.]
T.J. Galloway, C.G. Morris, A.A. Mancuso, R.J. Amdur, W.M. Mendenhall.
Impact of radiographic findings on prognosis for skin carcinoma with clinical perineural invasion.
Cancer, 103 (2005), pp. 1254-1257
[25.]
B.M. Wermuth, L.F. Fajardo.
Metastatic basal cell carcinoma.
A review. Arch Pathol, 90 (1970), pp. 458
[26.]
T.M. Johnson, D.E. Rowe, B.R. Nelson, N.A. Swanson.
Squamous cell carcinoma of the skin (excluding lip and oral mucosa).
J Am Acad Dermatol, 26 (1992), pp. 467-484
[27.]
E. Epstein, N.N. Epstein, K. Bragg, G. Linden.
Metastases from squamous cell carcinoma of the skin.
Arch Dermatol, 97 (1968), pp. 245-249
[28.]
D.H. Kraus, J.F. Carew, L.B. Harrison.
Regional lymph node metastasis from cutaneous squamous cell carcinoma.
Arch Otolaryngol, 124 (1998), pp. 582-587
[29.]
W.H. McBride, H.R. Withers.
Biologic basis of radiation therapy.
Principles and practice of radiation oncology, 5th ed, pp. 76-107
[30.]
M. Algara, A. Biete.
Bases biológicas.
Radioterapia en el tratamiento del cáncer, pp. 19-33
[31.]
J.R. Wong, C.C. Wang.
Radiation therapy in the management of cutaneous malignancies.
Clin Dermatol, 19 (2001), pp. 348-353
[32.]
M.W. McCord, W.M. Mendenhall, J.T. Parsons, R.J. Amdur, S.P. Stringer, N.J. Cassini, et al.
Skin cancer of the head and neck with clinical perineural invasion.
Int J Radiat Oncol Biol Phys, 47 (2000), pp. 89-93
[33.]
M.W. McCord, W.M. Mendenhall, J.T. Parsons, F.P. Flowers.
Skin cancer of the head and neck with incidental microscopic perineural invasion.
Int J Radiat Oncol Biol Phys, 43 (1999), pp. 591-595
[34.]
W.H. Morrison, A.S. Garden, K.K. Ang.
Radiation therapy for nonmelanoma skin carcinomas.
Clin Plast Surg, 24 (1997), pp. 719-729
[35.]
C.A. Perez.
Management of incompletely excised carcinoma of the skin.
Int J Radiat Oncol Biol Phys, 20 (1991), pp. 903-904
[36.]
C.K. Chao, R.M. Gerber, C.A. Perez.
Reirradiation of recurrent skin cancer of the face. A successful salvage modality.
Cancer, 75 (1995), pp. 2351-2355
[37.]
H.R. Atkinson.
Skin carcinoma depth and dose homogeneity in dermatological x-ray therapy.
Aust J Dermatol, 6 (1962), pp. 208
[38.]
M.B. Levene.
Radiotherapeutic management of carcinoma of the eyelid.
Controversy in Ophthalmology, pp. 390
[39.]
W.T. Moss, K.R. Stevens, R. García.
Skin cancer in treatment planning.
Radiation oncology, pp. 449-458
[40.]
I.J. Das, K.R. Kase, J.F. Copeland, T.J. Fitzgerald.
Electron beam modifications for the treatment of superficial malignancies.
Int J Radiat Oncol Biol Phys, 21 (1991), pp. 1627-1634
[41.]
B. Guix, F. Finestres, J. Tello, C. Palma, A. Martínez, J. Guix, et al.
Treatment of skin carcinomas of the face by high-doserate brachytherapy and custom-made surface molds.
Int J Radiat Oncol Biol Phys, 47 (2000), pp. 95-102
[42.]
V.H. Svoboda, J. Kovarik, F. Morris.
High dose-rate microselectron molds in the treatment of skin tumors.
Int J Radiat Oncol Biol Phys, 31 (1995), pp. 967-972
[43.]
A.M. Sabbas, F.G. Kulidzhanov, J. Presser, M.K. Hayes, D. Nori.
HDR brachytherapy with surface applicators: technical considerations and dosimetry.
Technol Cancer Res Treat, 3 (2004), pp. 259-267
[44.]
E. Rio, E. Bardet, C. Ferron, P. Peuvrel, S. Supiot, L. Campion, et al.
Interstitial brachytherapy of periorificial skin carcinomas of the face: a retrospective study of 97 cases.
Int J Radiat Oncol Biol Phys, 63 (2005), pp. 753-757
[45.]
R. Choo, T. Woo, D. Assaad, O. Antonyshyn, E.A. Barnes, D. McKenzie, et al.
What is the microscopic tumor extent beyond clinically delineated gross tumor boundary in nonmelanoma skin cancers?.
Int J Radiat Oncol Biol Phys, 62 (2005), pp. 1096-1099
[46.]
J. Locke, S. Karimpour, G. Young, M.A. Lockett, C.A. Perez.
Radiotherapy for epithelial skin cancer.
Int J Radiat Oncol Biol Phys, 51 (2001), pp. 748-755
[47.]
I. Turesson, G. Notter.
The influence of fraction size in radiotherapy on the late normal tissue reaction: II. Comparison of the effects of daily and twice-a-week fractionation on human skin.
Int J Radiat Oncol Biol Phys, 10 (1984), pp. 599
[48.]
I. Turesson, G. Notter.
The influence of fraction size in radiotherapy on the late normal tissue reaction: I. Comparison of the effects of daily and one-a-week fractionation on human skin.
Int J Radiat Oncol Biol Phys, 10 (1984), pp. 593
[49.]
H.L. Traenkle, D. Mulay.
Further observations on late radiation necrosis following therapy of skin cancer.
Arch Dermatol, 81 (1960), pp. 908
[50.]
Z. Petrovich, R.G. Parker, G. Luxton, H. Kuisk, J. Jepson.
Carcinoma of the lip and selected sites of head and neck skin. A clinical study of 896 patients.
Radiother Oncol, 8 (1987), pp. 11-17
[51.]
A.S. Shiu, S.G. Tung, R.J. Gastorf, K.R. Hogstrom, W.H. Morrison, L.J. Peters.
Dosimetric evaluation of lead and tungsten eye shields in electron beam treatment.
Int J Radiat OncolBiol Phys, 35 (1996), pp. 599-604
[52.]
J.D. Cox, J. Stetz, T.F. Pajak.
Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment Cancer (EORTC).
Int Radiat Oncol Biol Phys, 31 (1995), pp. 1341-1346
[53.]
P. Rubin, G.W. Casarett.
Clinical radiation pathology.
WB Saunders, (1968),
[54.]
H.S. Reinhold, G.H. Buisman.
Radiosensitivity of capillary endothelium.
Br J Radiol., 46 (1973), pp. 54
[55.]
L. Botnick, E.C. Hannon, S. Hellman.
Multisystem stem cell failure after apparent recovery from alkylating agents.
Cancer Res, 38 (1978), pp. 1942
[56.]
S. Hellman, L.E. Botnick.
Stem cell depletion: an explanation of the late effects of cytotoxins.
Int J Radiat Oncol Biol Phys, 2 (1977), pp. 181
[57.]
R.R. Weichselbaum, W. Dahlberg, J.B. Little.
Inherently radioresistant cells exist in some human tumors.
Proc Natl Acad Sci USA, 82 (1985), pp. 4732
[58.]
M.T. Dupree, R.A. Kiteley, K. Weismantle, R. Panos, P.A. Johnstone.
Radiation therapy for Bowen's disease: lessons for lesions of the lower extremity.
J Am Acad Dermatol, 45 (2001), pp. 401-404
[59.]
L.A. Lukas VanderSpek, G.R. Pond, W. Wells, R.W. Tsang.
Radiation therapy for Bowen's disease of the skin.
Int J Radiat Oncol Biol Phys, 63 (2005), pp. 505-510
[60.]
L. Cerroni, H. Kerl.
Keratoacanthoma.
Fitzpatrick's Dermatology in General Medicine, 7th ed, pp. 1049-1053
[61.]
M.H. Schmid-Wendtner, B. Brunner, B. Konz, P. Kaudewitz, C.M. Wendtner, R.U. Peter, et al.
Fractionated radiotherapy of lentigo maligna and lentigo maligna melanoma in 64 patients.
J Am Acad Dermatol, 43 (2000), pp. 477-482
[62.]
G. Delaney, M. Barton, S. Jacob.
Estimation of an optimal radiotherapy utilization rate for melanoma: a review of the evidence.
Cancer, 100 (2004), pp. 1293-1301
[63.]
T.D. Anderson, R.S. Weber, D. Guerry, D. Elder, L. Schuchter, L.A. Loevner, et al.
Desmoplastic neurotropic melanoma of the head and neck: the role of radiation therapy.
Head Neck, 24 (2002), pp. 1068-1071
[64.]
M.T. Ballo, K.K. Ang.
Radiotherapy for cutaneous malignant melanoma: rationale and indications.
Oncology, 18 (2004), pp. 99-107
[65.]
G. Stevens, J.F. Thompson, I. Firth, C.J. O’Brien, W.H. McCarthy, M.J. Quinn.
Locally advanced melanoma: results of postoperative hypofractionated radiation therapy.
Cancer, 88 (2000), pp. 88-94
[66.]
E. Bastiaannet, J.C. Beukema, H.J. Hoekstra.
Radiation therapy following lymph node dissection in melanoma patients: treatment, outcome and complications.
Cancer Treat Rev, 31 (2005), pp. 18-26
[67.]
R.J. Lee, J.F. Gibbs, G.M. Proulx, D.R. Kollmorgen, C. Jia, W.G. Kraybill.
Nodal basin recurrence following lymph node dissection for melanoma: implications for adjuvant radiotherapy.
Int J Radiat Oncol Biol Phys, 46 (2000), pp. 467-474
[68.]
M.T. Ballo, E.A. Strom, G.K. Zagars, A.Y. Bedikian, V.G. Prieto, P.F. Mansfield, et al.
Adjuvant irradiation for axillary metastases from malignant melanoma.
Int J Radiat Oncol Biol Phys, 52 (2002), pp. 964-972
[69.]
M.T. Ballo, G.K. Zagars, J.E. Gershenwald, J.E. Lee, P.F. Mansfield, K.B. Kim, et al.
A critical assessment of adjuvant radiotherapy for inguinal lymph node metastases from melanoma.
Ann Surg Oncol, 11 (2004), pp. 1079-1084
[70.]
M.T. Ballo, K.K. Ang.
Radiation therapy for malignant melanoma.
Surg Clin North Am, 83 (2003), pp. 323-342
[71.]
M.D. Bonnen, M.T. Ballo, J.N. Myers, A.S. Garden, E.M. Diaz Jr, J.E. Gershenwald, et al.
Elective radiotherapy provides regional control for patients with cutaneous melanoma of the head and neck.
Cancer, 100 (2004), pp. 383-389
[72.]
W.M. Mendenhall, C.M. Mendenhall, N.P. Mendenhall.
Merkel cell carcinoma.
Laryngoscope, 114 (2004), pp. 906-910
[73.]
The NCCN Merkel cell carcinoma clinical practice guidelines in oncology.
J Natl Compr Canc Netw, (2004), pp. 80-87
[74.]
S.W. Beenken, M.M. Urist.
Treatment options for Merkel cell carcinoma.
J Natl Compr Canc Netw, 2 (2004), pp. 89-92
[75.]
P.J. Allen, W.B. Bowne, D.P. Jaques, M.F. Brennan, K. Busam, D.G. Coit.
Merkel cell carcinoma: prognosis and treatment of patients from a single institution.
J Clin Oncol, 23 (2005), pp. 2300-2309
[76.]
J.D. Boyer, J.A. Zitelli, D.G. Brodland, G. D’Angelo.
Local control of primary Merkel cell carcinoma: review of 45 cases treated with Mohs micrographic surgery with and without adjuvant radiation.
J Am Acad Dermatol, 47 (2002), pp. 885-892
Copyright © 2009. Academia Española de Dermatología y Venereología and Elsevier España, S.L.
