On the surface of excellence: Core competencies for successful skin and superficial brachytherapy

PURPOSE: Brachytherapy (BT) is an increasingly used modality for delivering highly conformal, surface-weighted radiation to cancers involving the skin with excellent cosmetic outcomes. Its applications span nonmelanoma skin cancers and cutaneous manifestations of hematologic and other malignancies, and are useful in the definitive or palliative settings. Currently, there is no standardized framework for training radiation oncologists in delivering cutaneous BT. This review outlines current evidence and principles to guide patient selection, proper setup, planning, and treatment delivery in accordance with the recent ABS/GEC-ESTRO Consensus Statement on Objectives for BT training. METHODS AND MATERIALS: A narrative review was conducted, synthesizing consensus guidelines, key clinical series, historical planning systems, and contemporary recommendations from experts and professional societies. RESULTS: Both electronic and radionuclide-based high-dose-rate BT offer flexible, conformal treatment options for diverse anatomical sites with respective advantages and limitations. Optimal application depends on risk stratification, evaluating locoregional involvement and pathologic features. High-quality delivery requires precise imaging and target delineation, matching anatomic complexity with the appropriate applicator selection and placement, appropriate planning, and rigorous quality assurance. Fractionation schedules range from conventional to ultra-hypofractionated, with prescription depth and applicator type guiding dose. CONCLUSIONS: The clinical and technical evidence summarized within establishes a practical framework for the core competencies necessary to perform high-quality skin brachytherapy.