Skin surface brachytherapy: A survey of contemporary practice patterns

Abstract

Purpose The aim of this study was to define current patterns of care among radiation oncologists who utilize skin surface brachytherapy for the treatment of cutaneous squamous cell carcinoma (cSCC) and basal cell carcinoma (BCC) in academic and community settings. Methods and materials A 30 question electronic survey was administered to clinician members of the American Brachytherapy Society. The respondents were asked to provide details regarding their clinical practice and their approach to skin surface brachytherapy. Results A total of 16 surveys were returned. Among the respondents, aggregate experience varied from 8 to 1800 cases. Most preferred brachytherapy over external beam radiation because of shorter treatment course, conformality of treatment for irregular or curved targets, and shallow dose deposition. Sixty percent of respondents routinely estimated lesion depth via ultrasound prior to initiating treatment. Treatment margin on gross disease varied widely (range 3–15mm, median 5mm). Hypofractionation was the preferred dose schedule. Prescribed doses ranged from 30 Gy in 5 fractions to 64 Gy in 32 fractions (EQD2 40 Gy-65 Gy). There was a tendency to increase the number of fractions for larger targets, although some used the same fractionation regardless of anatomic location or lesion size. There was no consensus on dosimetric constraints, and some respondents reported cases of severe toxicity, particularly when treating the pretibial skin. Conclusions This patterns of care study suggests that skin brachytherapy can be a convenient and safe tool for treatment of BCC and cSCC. Prospective trials and the development of expert consensus guidelines would be beneficial for optimizing skin surface brachytherapy and reducing practice variation.

Efficacy of hypofractionated radiotherapy in patients with non‐melanoma skin cancer: Results of a systematic review

“…The recent advent of electronic brachytherapy, in addition to the long‐standing use of radionuclide brachytherapy, has made the delivery of brachytherapy safer and broadened its popularity as a modality to non‐surgically treat patients with NMSC, especially in the US. In a recent US‐based survey sent to clinicians utilizing brachytherapy (any type) to treat NMSC, the delivery of hypofractionation was the preferred approach with many clinicians comfortable prescribing up to 7 Gy fractions in select clinical scenarios . In two recent studies, the local control rates with cutaneous brachytherapy were both 99% respectively …”

Updates on the Management of Non-Melanoma Skin Cancer (NMSC)

“…There are several techniques of radiotherapy, each having advantages and disadvantages. A recent survey study completed by 16 members of American Brachytherapy Society indicated that the majority of them prefer brachytherapy over external beam radiation therapy given the shorter treatment course, conformity of treatment for irregular or curved targets and shallow dose deposition [ 176 ]. Many of them routinely use ultrasound to estimate the depth and lateral extension of the lesion before initiating treatment, which has shown to be helpful for more accurate treatment planning [ 176 , 177 ].…”

“…A recent survey study completed by 16 members of American Brachytherapy Society indicated that the majority of them prefer brachytherapy over external beam radiation therapy given the shorter treatment course, conformity of treatment for irregular or curved targets and shallow dose deposition [ 176 ]. Many of them routinely use ultrasound to estimate the depth and lateral extension of the lesion before initiating treatment, which has shown to be helpful for more accurate treatment planning [ 176 , 177 ]. The advantage of superficial radiotherapy (SRT) is that the maximum dose is at skin’s surface, and there is less penetration through eye shields, thus making it easier to use around the eye [ 178 ].…”

Development and clinical implementation of semi‐automated treatment planning including 3D printable applicator holders in complex skin brachytherapy

“…There are no available studies that assess the frequency of errors or the setup accuracy in fractionated treatment regimens, but the proposed methodology can potentially simplify the procedure and may reduce setup variations and errors. Reducing practice variations is crucial to advance the field of skin HDR‐BT.…”