Interventional Radiotherapy (Brachytherapy) for the Treatment of Primary Lesions in Nasal Vestibule Malignancies

High-dose rate interventional radiotherapy (HDR-IRT, brachytherapy) is an emerging treatment modality for primary nasal vestibule malignancies. It is usually delivered with a hypofractionated, in some cases also accelerated, schedule (short overall treatment time), which conforms to the target volume, to a potential of target dose delivery according to the biological needs, and to a rapid dose fall-off in adjacent organs at risk. Literature data describe excellent oncological outcomes in nasal vestibule cancer patients who underwent HDR-IRT as the primary treatment for the primary site. The 5-year local control (LC) ranges from 85% to 100%, the regional control (RC) from 87% to 100%, and the overall survival (OS) from 65% to 85%, respectively. Acute side effects during HDR-IRT are moderate to low with overall risk of serious complications, such as cosmetic deformity, chronic pain, or tissue necrosis less than 5%. A multidisciplinary approach is mandatory for appropriate treatment selection with maximum benefit for patients in terms of cure and toxicity and to warrant the quality of the treatment. Basing on the current and emerging data, nose vestibule malignancies appear the most relevant field of application for IRT in the head and neck, and most evidences support HDR IRT as the new standard of care.