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Purpose: High-dose-rate electronic brachytherapy (eBx) is a non-surgical treatment option for non-melanoma skin cancer (NMSC) patients. This study assessed long-term effectiveness and safety of eBx for the treatment of NMSC. Material and methods: A chart review was conducted to identify subjects who had five or more years since their last eBx treatment fraction. Subjects meeting these criteria were contacted to determine their interest in participating in a long-term follow-up study. Those who agreed, underwent a follow-up visit where consent was obtained, and their lesions were clinically assessed for recurrence and long-term skin toxicities. History and demographic data were retrospectively collected, and treatment method was verified. Results: 183 subjects with 185 lesions were enrolled into this study at four dermatology centers in two practices in California. Three subjects in the analysis were less than 5 years from the last treatment to follow-up visit. All lesions were stage 1 basal cell carcinoma, squamous cell carcinoma, or squamous cell carcinoma in situ. Recurrence rate for the 183 subjects was 1.1%. Long-term skin toxicities were reported in 70.0% of the subjects. Hypopigmentation grade 1 was observed in 65.9% of the lesions, telangiectasia grade 1 was seen in 22.2%, scarring grade 1 in two subjects (1.1%), hyperpigmentation grade 1 in two subjects (1.1%), and induration grade 2 in one patient (0.5%). The induration grade 2 was located on the upper back and did not limit instrumental activities of daily living (ADLs). Conclusions: Electronic brachytherapy for the treatment of non-melanoma skin cancer is safe and effective, showing excellent long-term 98.9% local control through a median follow-up of 7.6 years (n = 183), with minimal long-term toxicities. [ABSTRACT FROM AUTHOR]

With a high volume, high acuity brachytherapy service, focusing primarily on patients undergoing therapy for gynecological cancers, the Brachytherapy RNs and physicians identified an opportunity to expand services, as well as increase patient safety and well-being with the integration of the Anesthesia team. The purpose of this project was to provide deep procedural and/or general anesthesia to new patient populations previously not eligible for brachytherapy services due to patient acuity and/or inability to provide specific brachytherapy service within OR setting. To ensure patient safety and regulatory compliance, a multi-disciplinary work group, composed of Radiation Oncology staff RNs and leaders, MDs, Physicists and Anesthesiology leadership worked closely together and identified the following critical steps and interventions: (1) Determination of resources (budget, time, people) and timeline; (2) Physical environment: Creation of dedicated post-anesthesia care space: (3) Create standard workflows for pre-anesthesia assessment and education by Anesthesiologist, Radiation Oncologist and RN, intra-procedure care and roles, and post-procedure care and roles; (4) Implement EMR documentation system: RNs had previously documented delivery of care, including moderate sedation, on paper flowsheets; Radiation Oncologists, Physicists and RNs generally use the EMR associated with the linear accelerators. This department uses ARIA (documentation and planning system of Varian) which then moves to EPIC via a one-way feed every 24 hours. Expanding services gave us the opportunity to move into our systemwide EMR - EPIC; Collaborative work with IS team to develop and implement EPIC OpTime (procedural module) in Radiation Oncology, aligned with other procedural areas throughout healthcare system; (5) Development of Competencies, Patient Education and Policies and Procedures in alignment with other perioperative and procedural areas: (6) Ensure regulatory compliance with all state and federally mandated requirements for anesthesia care (be sure to includes Regulatory Services from beginning of project and team planning for CDPH visit). Project management timelines and updates crucial to ongoing team engagement. Metrics: patient safety (airway management, reversal), staff engagement and satisfaction, and patient satisfaction - perception of comfort and wellbeing during brachytherapy. Look forward to reporting on launch by ONS Congress 2022! Radiation Oncology RNs are leading the way as part of an overall strategic department goal to clinical documentation within EPIC. Our department will be able to offer brachytherapy services to high acuity patients who previously could not safely have moderate sedation, positively impacting their outcomes [ABSTRACT FROM AUTHOR]