title: Clinical implementation of a new electronic brachytherapy system for skin brachytherapy.
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.
authors.affiliation: Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Olga
authors.initials: O
authors.lastname: Pons-Llanas
authors.affiliation: Dermatology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Ballester-Sánchez
authors.affiliation: Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Celada-Álvarez
authors.affiliation: Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Cristian
authors.initials: C
authors.lastname: Candela-Juan
authors.affiliation: Radiation Physics Department, La Ribera University Hospital, Valencia, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: García-Martínez
authors.affiliation: Pathology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Margarita
authors.initials: M
authors.lastname: Llavador-Ros
authors.affiliation: Dermatology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Botella-Estrada
authors.affiliation: Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, USA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Barker
authors.affiliation: Radiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Ballesta
authors.affiliation: Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Tormo-Micó
authors.affiliation: Radiotherapy Department, Benidorm Hospital, Alicante, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Rodríguez
authors.affiliation: Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia, Spain ; Radiotherapy Department, Benidorm Hospital, Alicante, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Perez-Calatayud
keywords: Esteya; basal cell carcinoma; electronic brachytherapy; fractionation; patient setup; skin cancer
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