Xstrahl in Action: Re-excision of BCCs

October 19, 2020

Orthovoltage X-rays, as offered by the Xstrahl 300, provides an excellent alternative to re-excision for incompletely resected or recurrent BCCs

Surgery is the gold standard treatment for basal cell carcinomas (BCCs) but issues arise in the event of positive tumour margins or recurrent disease. Re-excision is generally performed to enhance local control but can result in poor cosmetic outcomes or unacceptable functional impairment.

A Dutch study evaluated the use of orthovoltage radiotherapy as a non-invasive alternative to surgery to reduce the risk of local failure in 66 resected residual or recurrent BCCs of the head and neck.

After a median follow-up of 30.5 months, only five recurrences were reported for a 5-year overall local control rate of 87%.  For incompletely resected lesions that received immediate rather than delayed radiotherapy, the local control rate at five years was 92%, leading the authors to suggest that more recurrences may occur if radiotherapy is postponed, but that this would warrant further investigation.

Any acute toxicities healed without medical intervention within three months and most late toxicities were mild.  As previously reported in the literature, and also experienced in this study, the peri-ocular region developed more toxicity despite orthovoltage being the most suitable therapy due to its shallow penetration.

With no need for a head mask or planning CT scan, 10-minute treatment sessions, and a high local control rate, the authors concluded that orthovoltage radiotherapy is an excellent alternative to surgery for recurrent or incompletely resected BCCs, especially in areas at risk of undesirable functional or cosmetic outcomes.

The Xstrahl 300 machine is the most versatile of the Xstrahl range, providing superficial and orthovoltage X-rays across its 40kV to 300kV range. As there is pinpoint accuracy via a series of applicators, including the possibility of bespoke designs, healthy surrounding skin is not affected.  For patients, this means rapidly delivered, effective and pain-free treatment without surgical scarring.  In addition to treating BCCs and other non-melanoma skin conditions, the Xstrahl 300 is also the machine of choice for various benign and palliative conditions.


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