The unmet supportive care needs and symptom burden in older breast cancer survivors in Singapore

Purpose of the Study: Radiation therapy is a well-recognized modality of treatment for squamous and basal cell cancers of the skin. The purpose of this study was to evaluate the response rate, cosmesis, and safety of electron beam radiation therapy in geriatric patients with non-melanoma skin cancers. Methods: One hundred and two patients with 332 separate epithelial skin cancers were treated definitively with superficial electron beam spray typically utilizing 6 MeV electrons to a depth dose of 90% utilizing topically applied bolus appropriate to the depth and size of the lesion. The ratio of squamous cell carcinomas to basal cell lesions was 1:3 with a small percentage of mixed basal and squamous cell components (~4%). The age range extended from ages 60–99 (average age 78, median age 75). Patients were treated with varying fractionation schedules depending on size and depth of invasion from 400 cGy in 12 fractions to 5000 cGy in 25 fractions. Tumor response was evaluated weekly during treatment, monthly after treatment for 2 visits, and every 4 months thereafter indeterminately. Cosmesis was graded on a 1–4 scale with 1 representing excellent cosmesis and 4 representing poor cosmesis. Patients were evaluated for complete or partial response at each visit. 331 of the lesions were stage T1–T3. One lesion was T4. Results: One hundred and one patients and 331 separate cancers sustained a complete response. A total of 3 patients subsequently failed with recurrent cancer in the treatment site. One of those patients had deep bone invasion (T4) and 2 patients sustained a geographical marginal recurrence. Cosmesis was excellent in 85% depending on initial presentation with respect to size, previous treatment or local tissue damage. Fifteen percent of responses were considered good with no unacceptable cosmetic results. There were no RTOG long term Grade 2 or above complications from treatment. Acute side effects consisted of moist desquamation and/or scabbing which consistently healed within 4–6 weeks or sooner. Conclusions: Electron beam spray radiation results in efficacy and safety comparable to any other form of treatment without the need for surgical intervention. There is no need for discontinuation of anticoagulants and minimal need for bandaging or other post treatment support. The treatment is generally painless, consumes less than 5 min for a treatment, and requires no significant skin or wound care. The only disadvantage is the number of visits required to complete treatment ranging from 10–25 depending on the size and depth of tumor involvement. This form of treatment for epithelial skin cancer represents an excellent noninvasive treatment for geriatric subjects. Surgery, postoperative wound care, suturing, cessation of anticoagulants and antibiotics are essentially unnecessary. X-ray irradiation is unnecessary, and electron beam treatment exposes only the treated area to irradiation.