title: Non-melanoma skin cancer treated with HDR Valencia applicator: clinical outcomes.
abstract: OBJECTIVE
  Radiotherapy (RT) has played a significant role in treating non melanoma skin cancer (NMSC). High-dose-rate brachytherapy (HDR-BT) approaches have a paramount relevance due to their adaptability, patient protection, and variable dose fractionation schedules. Several innovative applicators have been introduced to the brachytherapy community. The Valencia applicator is a new superficial device that improves the dose distribution compared with the Leipzig applicator. The purpose of this work is to assess the tumor control, cosmesis, and toxicity in patients with NMSC treated with the Valencia applicator and a new regimen of hypofractionation.
  
  
  METHODS
  From January 2008 to March 2010, 32 patients with 45 NMSC lesions were treated with the Valencia applicator in the Hospital La Fe. The gross tumor volume was visually assessed, but the tumor depth was evaluated using ultrasound imaging. All lesions for the selected cases were limited to 4 mm depth. The prescription dose was 42 Gy in 6 or 7 fractions (biologically effective dose [BED] ≈ 70 Gy), delivered twice a week.
  
  
  RESULTS
  Ninety-eight percent of the lesions were locally controlled at 47 months from treatment. Ninety-three percent of patients were out at least 36 months from treatment. The treatment was well tolerated in all cases. The highest skin toxicity was grade 1 RTOG/EORTC, having resolved with topical treatment at 4 weeks in all but one case which required 2 months. There were no grade 2 or higher late adverse events.
  
  
  CONCLUSIONS
  In patients with superficial basal cell carcinoma lesions less than 25 mm in maximum diameter, HDRBT treatment with the Valencia applicator using a hypofractionated regimen provides excellent results, for both cosmetic and local control at a minimum of 3 years follow-up. Moreover, the shorter hypofractionated regimen facilitates compliance, which is very relevant for the elderly patients in our series. Valencia applicators offer a simple, safe, quick, and attractive nonsurgical treatment option.
authors.affiliation: Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Tormo
authors.affiliation: Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Celada
authors.affiliation: Radiotherapy Department, Benidorm Hospital, Alicante, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Rodriguez
authors.affiliation: Dermatology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Botella
authors.affiliation: Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ballesta
authors.affiliation: Radiation Oncology, Lynn Regional Cancer Center, Boca Raton, Florida, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Kasper
authors.affiliation: Radiation Oncology, Lynn Regional Cancer Center, Boca Raton, Florida, USA.
authors.forename: Zoubir
authors.initials: Z
authors.lastname: Ouhib
authors.affiliation: Radiotherapy Department, Benidorm Hospital, Alicante, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Santos
authors.affiliation: Radiotherapy Department, Benidorm Hospital, Alicante, Spain ; Physics Section, Department of Radiation Oncology, La Fe University Hospital, Valencia, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Perez-Calatayud
keywords: HDR; Valencia applicators; skin brachytherapy; skin cancer
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