What dose-fractionation would you recommend for a small basal cell carcinoma of the nasal ala in a patient with poor performance status or transportation difficulties?
This is a perfect case for high dose limited fractions. I would use 6mV electrons. The smaller the field, the faster you can go. 3 FX per week M-W-F.
350 cGy to 5250
400 cGy to 4800
500 cGy to 4000
600 cGy to 3600
The final stop point determined by response and reaction.
This patient appears to be an excellent candidate for HDR brachytherapy. An appropriately selected surface applicator (Leipzig or Valencia) may be advantageous compared to electrons by allowing for
- homogeneous dose distribution to a small area
- conformality to an irregular/curved surface
- shallow dos...
The NCCN guidelines for indolent skin cancers (basal cell carcinoma and squamous cell carcinoma) list four examples of fractionation schedules for definitive treatment of early stage tumors < 2 cm: 64 Gy in 32 fractions over 6 weeks, 55 Gy in 20 fractions over 4 weeks, 50 Gy in 15 fractions over 3 w...
I would suggest several caveats to the above answers.
Electron distributions are unpredictable, particularly on curved surfaces and in small fields. The larger margins required would likely be problematic on a nasal ala, and orthovoltage or HDR brachy would be preferred for fields 3 cm or less to av...