MPP03 Presentation Time: 4:18 PM

Abstract

Purpose

Periorificial facial cancer (PFC), characterized by cancer originating from the eyelids, nasal vestibule, lips, and ear lobules, exhibits significantly high global incidence rates. Radical surgery have both functional and aesthetic complications. This retrospective analysis explores the effectiveness of high-dose-rate interventional radiotherapy (HDR-IRT, brachytherapy) combined with organ-preserving surgery for managing PFC.

Material and Methods

We conducted a retrospective assessment of patients with PFC and treated with HDR-IRT at our center between 2008 and 2022. Patients underwent a physical examination, tumor biopsy, and head-and-neck CT and/or MRI for locoregional staging. The decision of organ-preserving surgery with HDR-IRT was made by a specialized multidisciplinary tumor board. Organ-preserving surgery ranged from tumor debulking to complete local resection. HDR-IRT catheters were immediately implanted in the operating room, in a parallel arrangement with 8-12 mm spacing. The clinical target volume included the estimated tumor volume and a safety margin (5-15 mm) based on anatomical considerations and nearby critical structures. The prescribed radiation dose was administered twice daily with a minimum six-hour gap between fractions. The median HDR-IRT dose was 40Gy (30-50), the median fraction dose was 4Gy (2.5-5), and the median number of fractions was 10 (8-16). Treatment-related toxicities were assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.

Results

A total of 123 patients were identified, with primary sites as follows: 24 (19.5%) eyelids, 58 (47.2%) nasal vestibule, 25 (20.3%) lips, and 16 (13%) ear lobules. The median age was 76 years (37-99), with 60.2% (74/123) males and 39.2% (49/123) females. Sixty-four percent (64.2%) had primary tumors, and 35.8% had recurrent tumors. Among patients with recurrent tumors, 40 had previous surgery, and four were primarily treated with EBRT. Debulking surgery was performed in 16 patients (13%), and neck dissection in 14 patients (11.4%). Among 107 patients undergoing local resection, eight had close surgical margins, 40 had positive margins, and four had macroscopic residuals. T-status included T1 (53.7%), T2 (28.5%), T3 (10.5%), and T4 (7.3%). Six patients had positive neck lymph nodes. Squamous cell carcinoma constituted 61.8%, basal cell carcinoma 30.9%, and other histologies 7.3%. The median follow-up time was 38 months (4-147). During follow-up, 15 local recurrences (12.2%) were documented, with a median time to recurrence of 13 months (5-71). Local recurrence rates by tumor site were as follows: Nose 10/58 (17.2%), eyelid 3/24 (12.5%), lip 1/25 (4%), and ear lobule 1/16 (6.3%). The 5-year local control (LC) rate was 85.3%, with 10-year and 12-year LC rates of 80.8%. Five-year, 10-year, and 12-year disease-free survival (DFS) rates were 87.8%. Five-year distant metastases-free survival was 94.7%, with 10-year and 12-year rates at 93.1%. Regarding overall survival (OS), the 5-year OS was 88.4%, while 10-year and 12-year OS rates were 66.2%. Acute and chronic treatment-related toxicities were generally mild, with mostly grade 1/2 events. A total of 112 acute toxicity events in 72 patients were recorded, with only four grade-3 events. Chronic treatment-related toxicities affected 40 patients, with a total of 63 events (60 grade 1-2 events vs. 3 grade 3 events).

Conclusions

HDR-IRT combined with organ-preserving surgery appears to be an effective treatment approach for PFC, demonstrating favorable long-term disease control and patient survival rates. Prospective studies are essential to validate and further investigate the role of this treatment in specific subpopulations.