Electronic brachytherapy has been proposed as a form of radiotherapy for the treatment of non-melanoma skin cancer which includes squamous cell carcinoma and basal cell carcinoma. Squamous cell carcinoma and basal cell carcinoma are the most common types of nonmelanoma skin cancer, affecting between up to three million people per year. Other types (e.g., T-cell lymphoma, Merkel cell tumor, basosquamous carcinoma, Kaposi sarcoma) are much less common. Although these cancers rarely cause mortality, they can impact quality of life, functional status, and physical appearance.
Electronic brachytherapy uses a miniaturized electronic x-ray source rather than a radionuclide-based source. A pliable mold is constructed of silicone or polymethyl-methacrylate and fitted to the tumor surface. This mold allows treatment to be delivered to non-flat surfaces such as the nose or ear. A radioactive source is then inserted into the mold to contact the surface lesion and deliver a uniform radiation dose.
Electronic brachytherapy for the treatment of non-melanoma skin cancer is considered investigational.
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We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
No controlled studies were found in the published literature. In the absence of controlled studies, conclusions cannot be drawn about the efficacy and safety of electronic brachytherapy compared with other treatments for nonmelanoma skin cancer.
American Academy of Dermatology and AAD Association. (2016). Position statement on electronic surface brachytherapy for basal cell carcinoma (BCC) and squamous cell carcinomas (SCC). Retrieved June 27, 2016 from http://www.aad.org/Forms/Policies.
American Academy of Dermatology. (2017). Guidelines of care for the management of cutaneous squamous cell carcinoma. Retrieved March 15, 2019 from https://www.aad.org/practicecenter/quality/clinical-guidelines/nmsc-guidelines.
American Academy of Dermatology. (2018). Guidelines of care for the management of basal cell carcinoma. Retrieved March 15, 2019 from https://www.aad.org/practicecenter/quality/clinical-guidelines/nmsc-guidelines.
Ballester-Sanchez, R., Pons-Llanas, O., Candela-Juan, C., Celado-Alvarez, F.J., de Unamuno-Bustos, B., Llavador-Ros, M., et al. (2015). Efficacy and safety of electronic brachytherapy for superficial and nodular basal cell carcinoma. Journal of Contemporary Brachytherapy, 7 (3), 231-238. (Level 3 evidence)
BlueCross BlueShield Association. Evidence Positioning System. (7:2018). Electronic Brachytherapy for Nonmelanoma Skin Cancer (8.01.62). Retrieved March 15, 2019 from https://www.evidencepositioningsystem. (15 articles and/or guidelines reviewed)
Delishaj, D., Rembielak, A., Manfredi, B., Ursino, S., Pasqualetti, F., Laliscia, C., et al. (2016). Non-melanoma skin cancer treated with high-dose-rate brachytherapy: a review of literature. Journal of Contemporary Brachytherapy, 8 (6), 533-540. (Level 2 evidence)
National Comprehensive Cancer Network. (2018, August). (NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Basal cell skin cancer. Version 1.2019. Retrieved March 15, 2019 from the National Comprehensive Cancer Network.
National Comprehensive Cancer Network. (2018, October). (NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Squamous cell skin cancer. Version 2.2019. Retrieved March 15, 2019 from the National Comprehensive Cancer Network.
U.S. Food and Drug Administration. (2009, February). Centers for Devices and Radiological Health. 510(k) Premarket Notification Database. K08373 (Axxent®). Retrieved August 12, 2015 from http://www.accessdata.fda.gov.
U.S. Food and Drug Administration. (2013, September). Centers for Devices and Radiological Health. 510(k) Premarket Notification Database. K132092 (Esteya™). Retrieved August 12, 2015 from http://www.accessdata.fda.gov.
ORIGINAL EFFECTIVE DATE: 12/12/2015
MOST RECENT REVIEW DATE: 4/11/2019
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