Department of Medical Physics, Fundación Instituto Valenciano de Oncología (F.I.V.O.), Beltran Baguena 8, 46009 Valencia, Spain.
Department of Clinical Oncology, The Christie NHS Foundation Trust, 550 Wilmslow Road, Manchester, M20 4BX Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, M13 9PL Oxford Road, Manchester, United Kingdom.
Radiother Oncol. 2022 Oct;175:122-132. doi: 10.1016/j.radonc.2022.08.022. Epub 2022 Aug 27.
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 (D) 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 D 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.
本出版物的目的是评估现有的非黑色素瘤皮肤癌（NMSC）浅层放射治疗（BT）指南，并根据现有文献对已发表的临床实践中的最大剂量处方深度、敷贴厚度和最大皮肤表面剂量（D）进行批判性回顾。GEC-ESTRO 头颈部和皮肤（HNS）工作组（WG）对 NMSC 浅层 BT 发表的文章进行了系统回顾。10 名成员和 2 名外部审查员将已发表的临床程序与当前指南中的建议进行了比较，并检查了证据等级。我们的审查证实，在浅层 BT 的临床实践方面，各中心之间存在很大差异，并确定了一些研究，其中发表的参数，如最大剂量处方深度、敷贴厚度和 D，超过了指南中推荐的限制，但在局部控制、毒性和美容方面显示出优异的结果。这项审查证实，目前关于皮肤浅层 BT 的建议并没有包括在皮肤表面以下 5 毫米的深度处需要处方剂量的肿瘤的发表经验，而且现有文献没有提供足够的证据将浅层 BT 的剂量与患者报告的结果测量联系起来。GEC-ESTRO HNS WG 认为可以接受在皮肤表面以下 5 毫米以上的深度处开具浅层 BT 剂量，并修改敷贴厚度以优化治疗计划，并调整皮肤表面上可接受的最大剂量，所有这些都取决于临床情况。
