title: Skin surface brachytherapy: A survey of contemporary practice patterns.
abstract: The aim of this study was to define current patterns of care among radiation oncologists who use skin surface brachytherapy for the treatment of cutaneous squamous cell carcinoma (cSCC) and basal cell carcinoma (BCC) in academic and community settings.
  
  
  
  A 30-question electronic survey was administered to clinician members of the American Brachytherapy Society. The respondents were asked to provide details regarding their clinical practice and their approach to skin surface brachytherapy.
  
  
  
  A total of 16 surveys were returned. Among the respondents, aggregate experience varied from 8 to 1800 cases. Most preferred brachytherapy over external beam radiation because of shorter treatment course, conformality of treatment for irregular or curved targets, and shallow dose deposition. Of the total, 60% of respondents routinely estimated lesion depth via ultrasound before initiating treatment. Treatment margin on gross disease varied widely (range, 3-15 mm; median, 5 mm). Hypofractionation was the preferred dose schedule. Prescribed doses ranged from 30 Gy in five fractions to 64 Gy in 32 fractions (EQD2, 40 Gy-65 Gy). There was a tendency to increase the number of fractions for larger targets, although some used the same fractionation regardless of anatomic location or lesion size. There was no consensus on dosimetric constraints, and some respondents reported cases of severe toxicity, particularly when treating the pretibial skin.
  
  
  
  This pattern of care study suggests that skin brachytherapy can be a convenient and safe tool for treatment of BCC and cSCC. Prospective trials and the development of expert consensus guidelines would be beneficial for optimizing skin surface brachytherapy and reducing practice variation.
authors.affiliation: Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ. Electronic address: anna.likh@gmail.com.
authors.forename: Anna O
authors.initials: AO
authors.lastname: Likhacheva
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA.
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Devlin
authors.affiliation: Department of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ.
authors.forename: Shervin M
authors.initials: SM
authors.lastname: Shirvani
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Barker
authors.affiliation: Department of Radiation Oncology, Ronald Reagan UCLA Medical Center UCLA Medical Center, Los Angeles, CA.
authors.forename: Phillip
authors.initials: P
authors.lastname: Beron
authors.affiliation: Department of Radiation Oncology, 21st Century Oncology, Phoenix, AZ.
authors.forename: Ajay
authors.initials: A
authors.lastname: Bhatnagar
authors.affiliation: Department of Radiation Oncology, Aegis Oncology, Tustin, CA.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Doggett
authors.affiliation: Department of Radiation Oncology, Florida Cancer Affiliates, Trinity, FL.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Hochman
authors.affiliation: Department of Radiation Oncology, University of Arizona Cancer Center, Tucson, AZ.
authors.forename: Charles
authors.initials: C
authors.lastname: Hsu
authors.affiliation: Department of Radiation Oncology, Boca Raton Regional Hospital, Boca Raton, FL.
authors.forename: Michael
authors.initials: M
authors.lastname: Kasper
authors.affiliation: Department of Radiation Oncology, Cancer Healthcare Associated, Miami, FL.
authors.forename: Martin
authors.initials: M
authors.lastname: Keisch
authors.affiliation: Department of Radiation Oncology, The University of Arizona Cancer Center at Dignity Health St. Joseph's Hospital, Phoenix, AZ.
authors.forename: Subhakar
authors.initials: S
authors.lastname: Mutyala
authors.affiliation: Department of Radiation Oncology, Bon Secours Health System, Norfolk, VA.
authors.forename: Bradley
authors.initials: B
authors.lastname: Prestidge
authors.affiliation: Radiotherapy Department, Hospital Clínica Benidorm, Benidorm, Alicante, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Rodriguez Villalba
authors.affiliation: Department of Radiation Oncology, 21st Century Oncology, Phoenix, AZ.
authors.forename: Vershalee
authors.initials: V
authors.lastname: Shukla
authors.affiliation: Department of Radiation Oncology, Memorial Regional Hospital, Hollywood, FL.
authors.forename: Srinath
authors.initials: S
authors.lastname: Sundararaman
authors.affiliation: Department of Radiation Oncology, Ronald Reagan UCLA Medical Center UCLA Medical Center, Los Angeles, CA.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Kamrava
mesh_terms: D001918:Brachytherapy / Q000295:instrumentation / Q000379:methods*; D002280:Basal Cell Carcinoma / Q000532:radiotherapy*; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D000072378:Radiation Oncologists; D012878:Skin Neoplasms / Q000532:radiotherapy*; D011795:Surveys and Questionnaires
keywords: Basal cell carcinoma; Electronic brachytherapy; High dose rate; Ir-192; Leipzig applicator; Nonmelanoma skin cancer; Squamous cell, carcinoma; Valencia applicator; brachytherapy