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Clinical implementation of a new electronic brachytherapy system for skin brachytherapy.

Pons-Llanas O, Ballester-Sánchez R, Celada-Álvarez FJ, Candela-Juan C, García-Martínez T, Llavador-Ros M, Botella-Estrada R, Barker CA, Ballesta A, Tormo-Micó A, Rodríguez S, Perez-Calatayud J - J Contemp Brachytherapy (2014)

Bottom Line: The justification for the hypofractionated regimen is described and compared with others protocols in the literature.We emphasize that these are guidelines, and clinical judgment and experience must always prevail in the care of patients, as with any medical treatment.We conclude that clinical implementation of the Esteya brachytherapy system is simple for patients and providers, and should allow for precise and safe treatment of nonmelanoma skin cancers.

View Article: PubMed Central - PubMed

Affiliation: Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia, Spain.

ABSTRACT
Although surgery is usually the first-line treatment for nonmelanoma skin cancers, radiotherapy (RT) may be indicated in selected cases. Radiation therapy as primary therapy can result in excellent control rates, cosmetics, and quality of life. Brachytherapy is a radiation treatment modality that offers the most conformal option to patients. A new modality for skin brachytherapy is electronic brachytherapy. This involves the placement of a high dose rate X-ray source directly in a skin applicator close to the skin surface, and therefore combines the benefits of brachytherapy with those of low energy X-ray radiotherapy. The Esteya electronic brachytherapy system is specifically designed for skin surface brachytherapy procedures. The purpose of this manuscript is to describe the clinical implementation of the new Esteya electronic brachytherapy system, which may provide guidance for users of this system. The information covered includes patient selection, treatment planning (depth evaluation and margin determination), patient marking, and setup. The justification for the hypofractionated regimen is described and compared with others protocols in the literature. Quality assurance (QA) aspects including daily testing are also included. We emphasize that these are guidelines, and clinical judgment and experience must always prevail in the care of patients, as with any medical treatment. We conclude that clinical implementation of the Esteya brachytherapy system is simple for patients and providers, and should allow for precise and safe treatment of nonmelanoma skin cancers.

No MeSH data available.


Related in: MedlinePlus

Esteya applicators of differing collimator diameters and the corresponding templates La Fe used to mark the outer diameter of each applicator
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Figure 0002: Esteya applicators of differing collimator diameters and the corresponding templates La Fe used to mark the outer diameter of each applicator

Mentions: the applicator is then placed in full contact with the patient's skin surface (Fig. 1D). As previously stated, there is a different template for each applicator size. Figure 2 shows the templates named La Fe (Elekta AB, Stockholm, Sweden), as well as the different applicators available. Because the applicator is centered on the lesion using the mark made with the help of the template, the CTV to PTV margin is generally the width of the line, i.e. the width of the groove of the template, which is 1-1.5 mm. The reproducibility of the positioning of the applicator is smaller or equal to this line mark width. In order to avoid that the Esteya applicator comes in direct contact with the lesion, a plastic wrap is placed between the applicator exit window and the patient skin.


Clinical implementation of a new electronic brachytherapy system for skin brachytherapy.

Pons-Llanas O, Ballester-Sánchez R, Celada-Álvarez FJ, Candela-Juan C, García-Martínez T, Llavador-Ros M, Botella-Estrada R, Barker CA, Ballesta A, Tormo-Micó A, Rodríguez S, Perez-Calatayud J - J Contemp Brachytherapy (2014)

Esteya applicators of differing collimator diameters and the corresponding templates La Fe used to mark the outer diameter of each applicator
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4300364&req=5

Figure 0002: Esteya applicators of differing collimator diameters and the corresponding templates La Fe used to mark the outer diameter of each applicator
Mentions: the applicator is then placed in full contact with the patient's skin surface (Fig. 1D). As previously stated, there is a different template for each applicator size. Figure 2 shows the templates named La Fe (Elekta AB, Stockholm, Sweden), as well as the different applicators available. Because the applicator is centered on the lesion using the mark made with the help of the template, the CTV to PTV margin is generally the width of the line, i.e. the width of the groove of the template, which is 1-1.5 mm. The reproducibility of the positioning of the applicator is smaller or equal to this line mark width. In order to avoid that the Esteya applicator comes in direct contact with the lesion, a plastic wrap is placed between the applicator exit window and the patient skin.

Bottom Line: The justification for the hypofractionated regimen is described and compared with others protocols in the literature.We emphasize that these are guidelines, and clinical judgment and experience must always prevail in the care of patients, as with any medical treatment.We conclude that clinical implementation of the Esteya brachytherapy system is simple for patients and providers, and should allow for precise and safe treatment of nonmelanoma skin cancers.

View Article: PubMed Central - PubMed

Affiliation: Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia, Spain.

ABSTRACT
Although surgery is usually the first-line treatment for nonmelanoma skin cancers, radiotherapy (RT) may be indicated in selected cases. Radiation therapy as primary therapy can result in excellent control rates, cosmetics, and quality of life. Brachytherapy is a radiation treatment modality that offers the most conformal option to patients. A new modality for skin brachytherapy is electronic brachytherapy. This involves the placement of a high dose rate X-ray source directly in a skin applicator close to the skin surface, and therefore combines the benefits of brachytherapy with those of low energy X-ray radiotherapy. The Esteya electronic brachytherapy system is specifically designed for skin surface brachytherapy procedures. The purpose of this manuscript is to describe the clinical implementation of the new Esteya electronic brachytherapy system, which may provide guidance for users of this system. The information covered includes patient selection, treatment planning (depth evaluation and margin determination), patient marking, and setup. The justification for the hypofractionated regimen is described and compared with others protocols in the literature. Quality assurance (QA) aspects including daily testing are also included. We emphasize that these are guidelines, and clinical judgment and experience must always prevail in the care of patients, as with any medical treatment. We conclude that clinical implementation of the Esteya brachytherapy system is simple for patients and providers, and should allow for precise and safe treatment of nonmelanoma skin cancers.

No MeSH data available.


Related in: MedlinePlus