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H&N and Skin (Hns) Gec-Estro Working Group Critical Review of Recommendations Regarding Prescription Depth, Bolus Thickness and Maximum Dose in Skin Superficial Brachytherapy With Flaps and Customized Moulds Publisher Pubmed



Gonzalezperez V1 ; Rembielak A2, 3 ; Guinot JL4 ; Jaberi R5 ; Lancellotta V6 ; Walter R7 ; Zuchora A8 ; Budrukkar A9 ; Kovacs G10 ; Jurgenliemkschulz I11 ; Siebert FA12 ; Tagliaferri L6
Authors
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Authors Affiliations
  1. 1. Department of Medical Physics, Fundacion Instituto Valenciano de Oncologia (F.I.V.O.), Beltran Baguena 8, Valencia, 46009, Spain
  2. 2. Department of Clinical Oncology, The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, Manchester, M20 4BX, United Kingdom
  3. 3. Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, M13 9PL Oxford Road, Manchester, United Kingdom
  4. 4. Department of Radiation Oncology, Fundacion Instituto Valenciano de Oncologia (F.I.V.O.), Beltran Baguena 8, Valencia, 46009, Spain
  5. 5. Radiation Oncology Research Centre (RORC), Cancer Institute, Tehran University of Medical Sciences, Keshavarz Blvd, Qods Street, Tehran, 1417863181, Iran
  6. 6. UOC Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, 00168, Italy
  7. 7. Department of Medical Physics, Universitatsklinikum Augsburg, Stenglinstr 2, Augsburg, 86156, Germany
  8. 8. Department of Medical Physics and Clinical Engineering, University Hospital Galway, Newcastle Road, Galway, H91 YR71, Ireland
  9. 9. Department of Radiation Oncology, Tata Memorial Hospital Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, 400012, India
  10. 10. Universita Cattolica del Sacro Cuore, Gemelli – Interacts, Rome, Italy
  11. 11. Department of Radiation Oncology, University Medical Centre Utrecht, Lundlaan, Utrecht, 3584, Netherlands
  12. 12. Clinic of Radiotherapy, University Hospital of Schleswig-Holstein, Arnold-Heller-Straße 3, Haus L, Kiel, 24105, Germany

Source: Radiotherapy and Oncology Published:2022


Abstract

The aim of this publication is the assessment of the existing guidelines for non-melanoma skin cancer (NMSC) superficial brachytherapy (BT) and make a critical review based on the existing literature about the maximum dose prescription depth, bolus thickness and maximum skin surface dose (Dmax) of the published clinical practice. A systematic review of NMSC superficial BT published articles was carried out by the GEC-ESTRO Head & Neck and Skin (HNS) Working Group (WG). 10 members and 2 external reviewers compared the published clinical procedures with the recommendations in the current guidelines and examined the grade of evidence. Our review verified that there is a large variation among centres with regards to clinical practice in superficial BT and identified studies where published parameters such as maximum dose prescription depth, bolus thickness and Dmax exceed the constraints recommended in the guidelines, while showing excellent results in terms of local control, toxicity and cosmesis. This review confirmed that current recommendations on skin superficial BT do not include published experience on tumours treated with superficial BT that require dose prescription depth beyond the recommended 5 mm under the skin surface and that the existing literature does not provide sufficient evidence to relate dosimetry of superficial BT to patient reported outcome measures. The GEC-ESTRO HNS WG considers acceptable to prescribe superficial BT dose at a depth above 5 mm beyond the skin surface, and modify the bolus thickness to optimize the treatment plan and adjust the acceptable maximum dose on the skin surface, all pending clinical situation. © 2022 Elsevier B.V.
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