GEC-ESTRO ACROP recommendations in skin brachytherapy

Guinot, José Luis; Rembielak, Agata; Pérez‐Calatayud, José; Rodríguez-Villalba, Silvia; Skowronek, Janusz; Tagliaferri, Luca; Guix, B.; González-Pérez, Víctor; Valentini, Vincenzo; Kovács, György; Estro, Gec

doi:10.1016/j.radonc.2018.01.013

Cited by 132 publications

(155 citation statements)

References 82 publications

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“…Surface high‐dose‐rate electronic brachytherapy (eBT) has become an effective treatment option for the nonmelanoma skin cancer, achieving excellent control rates and good cosmetic results . A surface eBT system consists mainly of two components: an x‐ray tube, which accelerates electrons in the energy range between 50 and 70 kVp and a surface applicator (between 10 and 50 mm diameters) positioned directly in contact with the skin.…”

Section: Introductionmentioning

confidence: 99%

On the use of the absorbed depth‐dose measurements in the beam calibration of a surface electronic high‐dose‐rate brachytherapy unit, a Monte Carlo‐based study

Valdes-Cortez¹,

Niatsetski²,

Ballester³

et al. 2019

Medical Physics

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Purpose To evaluate the use of the absorbed depth‐dose as a surrogate of the half‐value layer in the calibration of a high‐dose‐rate electronic brachytherapy (eBT) equipment. The effect of the manufacturing tolerances and the absorbed depth‐dose measurement uncertainties in the calibration process are also addressed. Methods The eBT system Esteya® (Elekta Brachytherapy, Veenendaal, The Netherlands) has been chosen as a proof‐of‐concept to illustrate the feasibility of the proposed method, using its 10 mm diameter applicator. Two calibration protocols recommended by the AAPM (TG‐61) and the IAEA (TRS‐398) for low‐energy photon beams were evaluated. The required Monte Carlo (MC) simulations were carried out using PENELOPE2014. Several MC simulations were performed modifying the flattening filter thickness and the x‐ray tube potential, generating one absorbed depth‐dose curve and a complete set of parameters required in the beam calibration (i.e., HVL, backscatter factor (Bw), and mass energy‐absorption coefficient ratios (µen/ρ)water,air), for each configuration. Fits between each parameter and some absorbed dose‐ratios calculated from the absorbed depth‐dose curves were established. The effect of the manufacturing tolerances and the absorbed dose‐ratio uncertainties over the calibration process were evaluated by propagating their values over the fitting function, comparing the overall calibration uncertainties against reference values. We proposed four scenarios of uncertainty (from 0% to 10%) in the dose‐ratio determination to evaluate its effect in the calibration process. Results The manufacturing tolerance of the flattening filter (±0.035 mm) produces a change of 1.4% in the calculated HVL and a negligible effect over the Bw, (µen/ρ)water,air, and the overall calibration uncertainty. A potential variation of 14% of the electron energies due to manufacturing tolerances in the x‐ray tube (69.5 ± ~10 keV) generates a variation of 10% in the HVL. However, this change has a negligible effect over the Bw and (µen/ρ)water,air, adding 0.1% to the overall calibration uncertainty. The fitting functions reproduce the data with an uncertainty (k = 2) below 1%, 0.5%, and 0.4% for the HVL, Bw, and (µen/ρ)water,air, respectively. The four studied absorbed dose‐ratio uncertainty scenarios add, in the worst‐case scenario, 0.2% to the overall uncertainty of the calibration process. Conclusions This work shows the feasibility of using the absorbed depth‐dose curve in the calibration of an eBT system with minimal loss of precision.

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Section: Introductionmentioning

confidence: 99%

On the use of the absorbed depth‐dose measurements in the beam calibration of a surface electronic high‐dose‐rate brachytherapy unit, a Monte Carlo‐based study

Valdes-Cortez¹,

Niatsetski²,

Ballester³

et al. 2019

Medical Physics

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“…It is worth to mention that BT plays an important role in treating elderly patients, particularly unfit, frail, or sarcopenic, in which a conservative therapeutic approach may be the best choice [15]. Analyzing the international scenario in terms of cultural background, it becomes clear that there is an adequate attention and consideration towards BT, supported by the presence of dedicated guidelines, with regard to several anatomical sites issued by the main European [16,17,18,19,20,21,22,23,24,25] and American societies [26,27,28]. For this reason, it is sensible to correlate the cultural diffusion of the role and importance of BT at a national level, with its actual diffusion in the clinical practice [29,30,31,32,33,34,35,36,37,38].…”

Section: Airo Interventional Radiotherapy Study Group "State Of the Amentioning

confidence: 99%

Can brachytherapy be properly considered in the clinical practice? Trilogy project: The vision of the AIRO (Italian Association of Radiotherapy and Clinical Oncology) Interventional Radiotherapy study group

Tagliaferri¹,

Vavassori²,

Lancellotta³

et al. 2020

jcb

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Purpose: Brachytherapy (BT, interventional radiotherapy-IRT) is a kind of radiation therapy, in which the radioactive source is placed nearby or even inside the cancer itself. Even though this kind of radiation therapy appears effective and valuable, BT has been facing a slow but progressive decline over the past decades in Europe, particularly in Italy. Aims of this study were to identify the practical and theoretical reasons why BT is facing a slow decline in Italy, and to define a vision of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) and a strategy about this emerged issues. Material and methods: A programmatic path divided into three steps like a trilogy was launched by AIRO Interventional Radiotherapy study group. The study group performed an initial data collection to highlight both the clinical and the educational topics and problems through specific surveys. After having analyzed the results of the surveys and shared a vision about the emerged issues, a specific strategy was adopted. Results: Four relevant domains were identified and for each ones, a strategy has been discussed and defined. This manuscript shows in detail the individual actions defined (accomplished or in progress). Conclusions: The AIRO vision implies that specific strategic interventions must be carried out in the field of national guidelines, education, research, and communication with patients and colleagues of other specialties in an interdisciplinary setting.

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“…High‐dose‐rate brachytherapy (HDR‐BT) has been shown to result in excellent outcomes with good cosmetic effects . Using HDR‐BT to prevent keloid formation or the treatment of chronic psoriasis are prominent examples for the treatment of nonmalignant diseases and are particularly useful for the treatment of complex and irregular surfaces . Compared to alternative treatment modalities such as electron external beam radiation therapy or surgery, the use of skin HDR‐BT has advantages for large complex, curvy, or rounded topologies …”

Section: Introductionmentioning

confidence: 99%

“…1,2 Using HDR-BT to prevent keloid formation or the treatment of chronic psoriasis are prominent examples for the treatment of nonmalignant diseases and are particularly useful for the treatment of complex and irregular surfaces. 3,4 Compared to alternative treatment modalities such as electron external beam radiation therapy or surgery, the use of skin HDR-BT has advantages for large complex, curvy, or rounded topologies. 5 Depending on the topology and the size of the lesion, HDR-BT utilizes different applicators that define the trajectory and distance of the radiation source to the clinical targets [or clinical target areas (CTA)].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Purpose High‐dose‐rate brachytherapy (HDR‐BT) is a treatment option for malignant skin diseases compared to external beam radiation therapy, HDR‐BT provides improved target coverage, better organ sparing, and has comparable treatment times. This is especially true for large clinical targets with complex topologies. To standardize and improve the quality and efficacy of the treatments, a novel streamlined treatment approach in complex skin HDR‐BT was developed and implemented. This approach consists of auto generated treatment plans and a 3D printable applicator holder (3D‐AH). Materials and methods The in‐house developed planning system automatically segments computed tomography simulation images (a), optimizes a treatment plan (b), and generates a model of the 3D‐AH (c). The 3D‐AH is used as an immobilization device for the flexible Freiburg flap applicator used to deliver treatment. The developed, automated planning is compared against the standard clinical plan generation process for a flat 10 × 10 cm2 field, curved fields with radii of 4, 6, and 8 cm, and a representative clinical case. The quality of the 3D print is verified via an additional CT of the flap applicator latched into the holder, followed by an automated rigid registration with the original planning CT. Finally, the methodology is implemented and tested clinically under an IRB approval. Results All automatically generated plans were reviewed and accepted for clinical use. For the clinical workflow, the coverage achieved at a prescription depth for the flat 4, 6, and 8 cm applicator was (100.0 ± 4.9)%, (100.0 ± 4.9)%, (96.0 ± 0.3)%, and (98.4 ± 0.3)%, respectively. For auto planning, the coverage was (99.9 ± 0.3)%, (100.0 ± 0.2)%, (100.0 ± 0.3)%, and (100.1 ± 0.2)%. For the clinical test case, the D90 for the clinical workflow and auto planning was found to be 93.5% and 100.29% of the prescribed dose, respectively. Processing of the patient's CT to generate trajectories and positions as well as the 3D model of the applicator took <5 min. Conclusion This workflow automates time intensive catheter digitizing and treatment planning. Compared to printing full applicators, the use of 3D‐AH reduces the complexity of the 3D prints, the amount of the material to be used, the time of 3D printing, and amount of quality assurance required. The proposed methodology improves the overall treatment plan quality in complex HDR‐BT and impact patient treatment outcomes potentially.

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GEC-ESTRO ACROP recommendations in skin brachytherapy

Abstract: Skin cancer incidence is rising worldwide. BT offers an effective non-invasive or minimally invasive and relative short treatment that particularly appeals to elder and frail population.

Cited by 132 publications

References 82 publications

On the use of the absorbed depth‐dose measurements in the beam calibration of a surface electronic high‐dose‐rate brachytherapy unit, a Monte Carlo‐based study

On the use of the absorbed depth‐dose measurements in the beam calibration of a surface electronic high‐dose‐rate brachytherapy unit, a Monte Carlo‐based study

Can brachytherapy be properly considered in the clinical practice? Trilogy project: The vision of the AIRO (Italian Association of Radiotherapy and Clinical Oncology) Interventional Radiotherapy study group

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

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