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Recommendations of the Spanish brachytherapy group (GEB) of Spanish Society of Radiation Oncology (SEOR) and the Spanish Society of Medical Physics (SEFM) for high-dose rate (HDR) non melanoma skin cancer brachytherapy

  • Clinical Guides in Oncology
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Abstract

Clinical indications of brachytherapy in non-melanoma skin cancers, description of applicators and dosimetry recommendations are described based on the literature review, clinical practice and experience of Spanish Group of Brachytherapy and Spanish Society of Medical Physics reported in the XIV Annual Consensus Meeting on Non Melanoma Skin Cancer Brachytherapy held in Benidorm, Alicante (Spain) on October 21st, 2016. All the recommendations for which consensus was achieved are highlighted in blue. Regular and small surfaces may be treated with Leipzig, Valencia, flap applicators or electronic brachytherapy (EBT). For irregular surfaces, customized molds or interstitial implants should be employed. The dose is prescribed at a maximum depth of 3–4 mm of the clinical target volume/planning target volume (CTV/PTV) in all cases except in flaps or molds in which 5 mm is appropriate. Interstitial brachytherapy should be used for CTV/PTV >5 mm. Different total doses and fraction sizes are used with very similar clinical and toxicity results. Hypofractionation is very useful twice or 3 times a week, being comfortable for patients and practical for Radiotherapy Departments. In interstitial brachytherapy 2 fractions twice a day are applied.

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References

  1. Alam M, Nanda S, Mittal BB, Kim NA, Yoo S. The use of brachytherapy in the treatment of nonmelanoma skin cancer: a review. J Am Acad Dermatol. 2011;65:377–88.

    Article  PubMed  Google Scholar 

  2. Kowalik L, Lyczek J, Sawicki M, Kazalsky D. Individual applicator for brachytherapy for various sites of superficial malignant lesions. J Contemp Brachytherapy. 2013;5:45–9.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Skowronek J. Brachytherapy in the treatment of skin cancer: an overview. Postepy Dermatol Alergol. 2015;5:362–7.

    Article  Google Scholar 

  4. Arenas M, Arguis M, Diez-Presa L, Henriquez I, Murcia-Mejía M, Gascón M, et al. Hypofractionated high-dose-rate plesiotherapy in nonmelanoma skin cancer treatment. Brachytherapy. 2015;14:859–65.

    Article  PubMed  Google Scholar 

  5. Kwan W, Wilson D, Moravan V. Radiotherapy for locally advanced basal cell and squamous cell carcinomas of the skin. Int J Radiat Oncol Biol Phys. 2004;60:406–11.

    Article  PubMed  Google Scholar 

  6. Köhler-Brock A, Prager W, Pohlmann S, Kunzw S. The indications for and results of HDR after loading therapy in diseases of the skin and mucosa with standardized surface applicators (the Leipzig applicator). Strahlenther Onkol. 1999;175(4):170–4.

    Article  PubMed  Google Scholar 

  7. Rose JN, McLaughlin PY, Hanna TP, D’Souza D, Sur R, Falkson CB. Surface mold brachytherapy for nonmelanoma skin cancer: Canadian patterns of practice. Pract Radiat Oncol. 2014;4:398–403.

    Article  PubMed  Google Scholar 

  8. Arenas M, Sabater S, Sintas A, Arguis M, Hernandez V, Arquez M, et al. Individualised 3D scanning and printing for non-melanoma skin cancer brachytherapy: a financial study for its integration into clinical workflow. J Contemp Brachytherapy. 2017;9(3):270–6.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bhatnagar A, Loper A. The initial experience of electronic brachytherapy for the treatment of non-melanoma skin cancer. Radiat Oncol. 2010;5:87.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ballester-Sánchez R, Pons-Llanas O, Candela-Juan C, Celada-Alvárez FJ, de Unamuno-Bustos B, LLavador-Ros M, et al. Efficacy and safety of electronic brachytherapy for superficial and nodular basal cell carcinoma. J Contemp Brachytherapy. 2015;7(3):331–8.

    Google Scholar 

  11. NCCN Clinical Practice Guidelines in Oncology. Squamous Cell Skin Cancer Version 1.2017 NCCN.org.

  12. NCCN Clinical Practice Guidelines in Oncology. Basal Cell Skin Cancer Version 1.2017 NCCN.org.

  13. TNM staging American Joint Committee on Cancer. 7th ed. In: Sobin LH, Gospodarowicz MK, Wittekind Ch, editors. TNM Classification of Malignant Tumors, 7th ed. Oxford: Wiley-Blackwell, 2009. 310 p. ISBN 978-1-4443-3241-4.

  14. Pons-Llanas O, Ballester-Sánchez R, Celada-Álvarez FJ, Candela Juan C, García-Martinez T, Llavador-Ros M, et al. Clinical implementation of a new electronic brachytherapy system for skin brachytherapy. J Contemp Brachytherapy. 2014;6:417–23.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ouhib Z, Kasper M, Calatayud JP, Rodríguez S, et al. Aspects of dosimetry and clinical practice of skin brachytherapy: the American Brachytherapy Society working group report. Brachytherapy. 2015;14(6):840–58.

    Article  PubMed  Google Scholar 

  16. Fulkerson RK, Micka JA, DeWerd LA. Dosimetric characterization and output verification for conical brachytherapy surface applicators. Part I. Electronic brachytherapy source. Med Phys. 2014;41(2):022103.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Fulkerson RK, Micka JA, DeWerd LA. Dosimetric characterization and output verification for conical brachytherapy surface applicators. Part II. High dose rate 192Ir sources. Dosimetric characterization and output verification for conical brachytherapy surface applicators. Part II. Med Phys. 2014;41(2):022104.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Perez-Calatayud J, Granero D, Ballester F, Puchades V, et al. A dosimetric study of Leipzig applicators. Int J Radiat Oncol Biol Phys. 2005;62(2):579–84.

    Article  PubMed  Google Scholar 

  19. Granero D, Pérez-Calatayud J, Gimeno J, Ballester F, et al. Design and evaluation of a HDR skin applicator with flattening filter. Med Phys. 2008;35(2):495–503.

    Article  CAS  PubMed  Google Scholar 

  20. Granero D, Pérez-Calatayud J, Ballester F, Ouib Z. Radiation leakage study for the Valencia applicators. Med Phys. 2013;29:60–4.

    Article  CAS  Google Scholar 

  21. Granero D, Candela-Juan C, Ballester F, Ouib Z, et al. Commissioning and quality assurance procedures for the HDR Valencia skin applicators. J Contemp Brachytherapy. 2016;8(5):441–7.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ibañez-Rosello B, Bautista-Ballesteros JA, Candela-Juan C, Villaescusa JI, et al. Evaluation of the shielding in a treatment room with an electronic brachytherapy unit. J Radiol Prot. 2017;37(2):N5–12 (epub ahead of print).

    Article  PubMed  Google Scholar 

  23. Brenner DJ, Leu CS, Beatty JF, Shefer RE. Clinical relative biological effectiveness of low-energy X-rays emitted by miniature X-ray devices. Phys Med Biol. 1999;44(2):323–33.

    Article  CAS  PubMed  Google Scholar 

  24. García-Martinez T, Chan J-P, Perez-Calatayud J, Ballester F. Dosimetric characteristics of a new unit for electronic skin brachytherapy. J Contemp Brachytherapy. 2014;6:45–53.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Rivard MJ, Davis SD, De Werd LA, Rusch TW, Axelrod S. Calculated and measured brachytherapy dosimetry parameters in water for the Xoft Axxent X-ray source: an electronic brachytherapy source. Med Phys. 2006;33:4020–32.

    Article  PubMed  Google Scholar 

  26. Lam SCP, Xu Y, Ingram G, et al. Dosimetric characteristics of INTRABEAM® flat and surface applicators. Transl Cancer Res. 2014;3:106–11.

    CAS  Google Scholar 

  27. Schneider F, Clausen S, Thölking T, Wenz F, Abo-Madyan Y. A novel approach for superficial intraoperative radiotherapy (IORT) using a 50 kV X-ray source: a technical and case report. J Appl Clin Med Phys. 2014;5:4502.

    Google Scholar 

  28. Bhatnagar A. Nonmelanoma skin cancer treated with electronic brachytherapy: results at 1 year. Brachytherapy. 2013;12:134–40.

    Article  PubMed  Google Scholar 

  29. Bhatnagar A, Patel R, Werschler WP, Ceilley RI, Strimling R. High-dose rate electronic brachytherapy: a nonsurgical treatment alternative for nonmelanoma skin cancer. J Clin Aesthet Dermatol. 2016;9(11):16–2.

    PubMed  PubMed Central  Google Scholar 

  30. Jankarashvili N, Topeshashvili M. Treatment of skin cancer with intrabeam. 9th ZEISS INTRABEAM User Meeting. 2015.

  31. Granero D, Vijande J, Ballester F, Rodríguez S, et al. Prescription depth in surface skin brachytherapy. Brachytherapy. 2017;16(3):S1.

    Article  Google Scholar 

  32. Granero D, Candela-Juan C, Vijande J, Ballester F, et al. Technical note: dosimetry of Leipzig and Valencia applicators without the plastic cap. Med Phys. 2016;43(5):2087.

    Article  CAS  PubMed  Google Scholar 

  33. Candela-Juan C, Niatsetski Y, Ouhib Z, Ballester F, et al. Commissioning and periodic tests of the Esteya® electronic brachytherapy system. J Contemp Brachytherapy. 2015;7(2):189–95.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Rodriguez-Villalba S, Perez-calatayud MJ, Bautista JA, Carmona V, et al. Novel simple templates for reproducible positioning of skin applicators in brachytherapy. J Contemp Brachytherapy. 2016;8(4):1–5.

    Google Scholar 

  35. Lliso F, Granero D, Perez-Calatayud J, Carmona V, Pujades MC, Ballester F. Dosimetric evaluation of internal shielding in a high dose rate skin applicator. J Contemp Brachytherapy. 2011;3(1):32–5.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Granero D, Pérez-Calatayud J, Vijande J, Ballester F, Rivard MJ. Limitations of the TG-43 formalism for skin high-dose-rate brachytherapy dose calculations. Med Phys. 2014;41(2):021703.

    Article  PubMed  Google Scholar 

  37. Candela-Juan C, Granero D, Vijande J, Ballester F, Rivard MJ, et al. Dosimetric perturbations of a lead shield for surface and interstitial high-dose-rate brachytherapy. J Radiol Prot. 2014;34(2):297–311.

    Article  PubMed  Google Scholar 

  38. Safigholi H, Song WY, Meigooni AS. Optimum radiation source for radiation therapy of skin cancer. J Appl Clin Med Phys. 2015;16(5):5407.

    Article  Google Scholar 

  39. Delishaj D, Rembielak A, Manfredi B, Ursino S, Pasqualetti F, Laliscia C, et al. Non-melanoma skin cancer treated with high-dose-rate brachytherapy: a review of literature. J Contemp Brachytherapy. 2016;8(6):533–40.

    Article  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Radiation Oncology Department, Hospital Clínica Benidorm, Av. Alfonso Puchades 8, 30501, Benidorm, Alicante, Spain

    S. Rodríguez, J. Richart & M. Santos

  2. Radiation Oncology Department, Hospital Universitari Sant Joan de Reus, Tarragona, Spain

    M. Arenas

  3. Radiation Oncology Department, Institut Català d’Oncologia, Hospitalet de Llobregat, Catalonia, Spain

    C. Gutierrez

  4. Radiation Oncology Department, Hospital La Fe-IRIMED, Valencia, Spain

    J. Perez-Calatayud & F. Celada

  5. Radiation Oncology Department, ICMHO, Hospital Clínic I Universitari, Barcelona, Spain

    A. Rovirosa

Authors
  1. S. Rodríguez
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  2. M. Arenas
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  3. C. Gutierrez
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  4. J. Richart
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  5. J. Perez-Calatayud
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  6. F. Celada
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  7. M. Santos
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Corresponding author

Correspondence to S. Rodríguez.

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Appendix

Appendix

Addendum 1

  • Hospital Universitario Quirónsalud Madrid

  • Fundación Instituto Valenciano de Oncología (FIVO). Valencia

  • Hospital Universitario Ramón y Cajal. Madrid

  • Complejo Hospitalario de Navarra. Pamplona

  • Hospital Universitario Marqués de Valdecilla. Santander

  • Hospital Universitario Infanta Cristina. Badajoz

  • Fundación Rioja Salud. Logroño

  • Hospital Universitario Sant Joan de Reus. Tarragona.

  • Institut Català d’Oncologia (ICO). Barcelona

  • Hospital Universitario HM San Chinarro. Madrid

  • Hospital Universitario La Paz. Madrid

  • Hospital de Cruces. Vizcaya

  • Hospital Universitario La Fe. Valencia

  • Hospital Clínico Universitario de Valladolid. Valladolid

  • Hospital Regional de Málaga (Carlos Haya). Málaga

  • Hospital Clínica Benidorm. Benidorm. Alicante

  • Hospital Universitario Virgen de la Victoria. Málaga

  • Hospital la Ribera. Alzira. Valencia

  • Hospital Universitario de Gran Canaria Dr. Negrín. Las Palmas de Gran Canaria

  • Centro Oncológico de Galicia. La Coruña

  • Hospital de la Esperanza. Barcelona

  • Hospital do Mixoeiro. Vigo

  • Hospital 12 de octubre. Madrid

  • Instituto IMOR. Barcelona

Addendum 2

AREA H: “Mask areas” of face (central face, eyelids, eyebrows, periorbital, nose, lips [cutaneous and vermillion], chin, mandibule, preauricular and postauricular skin/sulci, temple, ear), genitalia, hands, and feet.

AREA M: cheeks, forehead, scalp, neck, and pretibial.

AREA L: trunk and extremities (excluding pretibial, hands, feet, nail units, and ankles).

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Rodríguez, S., Arenas, M., Gutierrez, C. et al. Recommendations of the Spanish brachytherapy group (GEB) of Spanish Society of Radiation Oncology (SEOR) and the Spanish Society of Medical Physics (SEFM) for high-dose rate (HDR) non melanoma skin cancer brachytherapy. Clin Transl Oncol 20, 431–442 (2018). https://doi.org/10.1007/s12094-017-1733-z

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  • DOI: https://doi.org/10.1007/s12094-017-1733-z

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