BlueCross BlueShield of Tennessee Medical Policy Manual

Electronic Brachytherapy for Non-Melanoma Skin Cancer

DESCRIPTION

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.

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION  

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.

SOURCES 

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

ID_BA

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

This document has been classified as public information.