1. Ko-Hiông I-ha̍k-tāi-ha̍k
Electronic Brachytherapy (eBx) for the Treatment of Non-melanoma Skin Cancers
Tēⁿ, Si-Chong M.D.
Ko-Hiông I-ha̍k-tāi-ha̍k
2016/08/25

2. 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® eBx® system: A miniature, electronic, HDR, low energy X-ray tube produces X-rays of 50 keV maximum energy

3. Electronic Brachytherapy (eBx)
Over 5,000 patients treated Supported by positive three-year clinical data1
scalp
foreh ead
eyes
nose
cheeks
ears
1 Bhatnagar A. Electronic Brachytherapy for the Treatment of Non-melanoma Skin Cancer: Results at 3 Years. Int J Radiat Oncol Biol Phys 2013;87:S65.

4. 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

5. 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)

6. U.S. Market Overview
Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC) Cancer Patients
SCC
BCC
Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC)
Patients Receiving Radiation Therapy (RT) RT
No RT
26,000 courses of RT²
3.6 million cases1
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
eBx offers a painless, non-surgical, targeted treatment option for those patients that may not be candidates for Mohs surgery
NCCN Guidelines ™
2007 IMV Radiation Oncology Market Summary Report (surveys based on 2006 data)
Rogers HW, Martin A. MD, PhD. Incidence Estimate of Nonmelanoma Skin Cancer in the United States, 2006: ARCH DERMATOL/VOL 146 (NO. 3), MAR 2010:

7. Ability to Treat a Wide Variety of Lesion Sizes
Applicator sizes range from 10mm to 50mm
10mm, 20mm, 35mm and 50mm
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

8. Surface Applicator Accessories
Plastic end caps cover opening of surface applicator
Single patient use
Clamping system stabilizes applicator during treatment

9. 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

10. Ideal eBx Candidates
High-risk patients with lesions <5cm 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.

11. 皮膚近接治療
Source
Applicator
Cooling system
Cone
Fixer

12. 病人基本資料 Enlarging nodule over nose for months
姓名 :
洪陳O珠
病歷號:
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)
Lesion

13. 治療計畫 治療部位:L’t nose 治療深度:5mm 治療範圍:20mm cone size 劑量:5Gy/fx
Depth (mm)
20 mm Cone
Dose (Gy)
0.0
100.0%
9.71
1.0
86.8%
8.43
2.0
75.5%
7.33
3.0
66.0%
6.41
4.0
58.1%
5.64
5.0
51.5%
5.00
6.0
46.1%
4.48
7.0
41.8%
4.06
8.0
38.3%
3.72
9.0
35.3%
3.43
10.0
32.9%
3.19
11.0
30.7%
2.98
12.0
28.5%
2.77
13.0
26.3%
2.55
14.0
23.7%
2.30
15.0
20.7%
2.01
治療部位:L’t nose
治療深度:5mm
治療範圍:20mm cone size
劑量:5Gy/fx
治療次數:8次(一週2次)
5mm

14. 治療過程 治療前 第一週治療中 第二週治療中 第三週治療中 第四週治療中 治療後第一週回診 治療後第五週回診 治療後第十六週回診
治療後第二十八週回診

15. 治療過程 治療前 第一週治療中 第二週治療中 第三週治療中 第四週治療中 治療後第一週回診 治療後第二週回診 治療後第九週回診
治療後第十六週回診

16. 治療過程
治療前
治療後第12週回診
治療後第17週回診
治療後第28週回診

17. Case Example 1
Squamous cell carcinoma on right cheek treated with 40Gy to a 5mm depth

18. Case Example 2
Basal cell carcinoma on right nasal ala treated with 40Gy to a 5mm depth

19. Case Example 3
Squamous cell carcinoma on right temple treated with 40Gy to a 3mm depth

20. Case Example 4
Basal cell carcinoma on right upper arm treated with 40Gy to a 3mm depth

21. Case Example 5
Basal cell carcinoma on left cheek treated with 40Gy to a 3mm depth

22. Basal cell carcinoma on left nasal bridge treated with
Case Example 6
Basal cell carcinoma on left nasal bridge treated with
40Gy to a 3mm depth

23. Basal cell carcinoma on right cheek treated with
Case Example 7
Basal cell carcinoma on right cheek treated with
40Gy to a 3mm depth

24. Case Example 8
Squamous cell carcinoma on left arm treated with 40Gy to a 5mm depth

25. 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 21st Century Oncology, Casa Grande, AZ University of Pittsburgh, School of Medicine, Pittsburgh, PA

26. To-siā 多謝