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.