{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T07:44:38Z","timestamp":1792568678938,"version":"4.5.0"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Radiat Environ Biophys"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Non-melanoma skin cancers (NMSCs), primarily basal cell carcinoma and squamous cell carcinoma, are the most common malignancies worldwide and frequently arise on the scalp, where complex curvature and anatomical constraints make treatment planning challenging. While surgery remains the standard approach, radiotherapy, particularly high-dose-rate interventional radiotherapy (HDR-IRT, modern brachytherapy), has become an important alternative for patients who are not ideal surgical candidates. Previous dosimetric analyses have demonstrated that\n                    <jats:sup>192<\/jats:sup>\n                    I HDR-IRT provides superior target coverage and dose conformity compared with external beam techniques such as volumetric modulated arc therapy (VMAT) and electron beam therapy (EBT). However, the reproducibility of these findings across centres and radioactive sources, including\n                    <jats:sup>60<\/jats:sup>\n                    Co, has not been systematically validated. This study aimed to independently validate prior dosimetric results by independently replanning the same cohort of 25 patients with scalp NMSC using\n                    <jats:sup>60<\/jats:sup>\n                    Co HDR-IRT. The objective was to assess whether the dosimetric advantages of HDR-IRT remain consistent when different operators, institutions, and isotopes are employed, and to compare\n                    <jats:sup>60<\/jats:sup>\n                    Co HDR-IRT with VMAT and EBT under identical clinical conditions. A retrospective dosimetric comparison was conducted using the original CT datasets from 25 patients previously analyzed with\n                    <jats:sup>192<\/jats:sup>\n                    Ir HDR-IRT. At an independent institution, new plans were generated for\n                    <jats:sup>60<\/jats:sup>\n                    Co HDR-IRT, VMAT, and EBT using the same contours, applicator geometry, prescription doses, and V\n                    <jats:sub>95%<\/jats:sub>\n                    constraints. HDR-IRT plans were constructed in Oncentra Brachy v4.6 based on TG-43 formalism; VMAT and EBT plans were generated in Eclipse TPS v16.1 using 6 MV photons and 6\u00a0MeV electrons, respectively. Dosimetric parameters (V\n                    <jats:sub>90%<\/jats:sub>\n                    , V\n                    <jats:sub>95%<\/jats:sub>\n                    , V\n                    <jats:sub>100%<\/jats:sub>\n                    , D\n                    <jats:sub>90%<\/jats:sub>\n                    , D\n                    <jats:sub>mean<\/jats:sub>\n                    , D\n                    <jats:sub>max<\/jats:sub>\n                    ) and brain D2cc values were extracted from DVHs. Statistical comparisons were performed with the Mann\u2013Whitney U test (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05). All techniques provided comparable V\n                    <jats:sub>90%<\/jats:sub>\n                    (&gt;\u200999%) and V\n                    <jats:sub>95%<\/jats:sub>\n                    values, ensuring consistent baseline coverage. However, HDR-IRT using Co-60 demonstrated significantly higher V\n                    <jats:sub>100%<\/jats:sub>\n                    , D\n                    <jats:sub>90%<\/jats:sub>\n                    , and D\n                    <jats:sub>mean<\/jats:sub>\n                    values than VMAT and EBT across all prescription groups (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05). This reflects the proximity of the source to the target and the steep dose gradient inherent to brachytherapy. VMAT produced the most homogeneous dose distributions but at the expense of slightly reduced high-dose coverage. EBT performed adequately for small, flat lesions but showed pronounced limitations in large or curved anatomies, with increased variability and occasional hotspots in the brain. Brain D\n                    <jats:sub>2cc<\/jats:sub>\n                    doses remained comparable across modalities (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&gt;\u20090.05), confirming adequate protection of critical structures. This external validation confirms that HDR-IRT retains its dosimetric superiority over VMAT and EBT even when replanned by different operators, at a different institution, and using an alternative isotope (\n                    <jats:sup>60<\/jats:sup>\n                    Co instead of\n                    <jats:sup>192<\/jats:sup>\n                    Ir). The findings demonstrate that HDR-IRT is a robust and reproduciblemodality for scalp NMSC, capable of achieving excellent target coverage and rapid dose fall-off without compromising organ-at-risk sparing. These results strengthen the evidence supporting HDR-IRT as a reliable option for treating superficial scalp cancers across diverse clinical settings.\n                  <\/jats:p>","DOI":"10.1007\/s00411-026-01258-z","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T08:58:22Z","timestamp":1791536302000},"page":"1069-1076","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Updated dosimetric comparison of HDR interventional radiotherapy including 60Co sources versus VMAT and electron beam therapy for NMSC"],"prefix":"10.1007","volume":"65","author":[{"given":"Sidra","family":"Sajjad","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Shahban","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1666-012X","authenticated-orcid":false,"given":"Enrico","family":"Rosa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Fionda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Humera","family":"Mehmood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Basim","family":"Kakakhel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Tagliaferri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"De Spirito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Placidi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"1258_CR1","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1016\/j.jaad.2010.03.027","volume":"65","author":"M Alam","year":"2011","unstructured":"Alam M, Nanda S, Nanda S, Mittal BB, Kim NA, Yoo S (2011) The use of brachytherapy in the treatment of nonmelanoma skin cancer: A review. J Am Acad Dermatol 65:377\u2013388. https:\/\/doi.org\/10.1016\/j.jaad.2010.03.027","journal-title":"J Am Acad Dermatol"},{"key":"1258_CR2","doi-asserted-by":"publisher","first-page":"7021","DOI":"10.3390\/curroncol29100552","volume":"29","author":"S Bisello","year":"2022","unstructured":"Bisello S, Cilla S, Benini A, Cardano R, Nguyen NP, Deodato F, Macchia G, Buwenge M, Cammelli S, Morganti AG (2022) Dose-Volume Constraints fOr oRganS At risk In Radiotherapy (CORSAIR): An All-in-One. Multicenter-Multidisciplinary Practical Summary Curr Oncol 29:7021\u20137050. https:\/\/doi.org\/10.3390\/curroncol29100552","journal-title":"Multicenter-Multidisciplinary Practical Summary Curr Oncol"},{"key":"1258_CR3","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","volume":"74","author":"F Bray","year":"2024","unstructured":"Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, Jemal A (2024) Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 74:229\u2013263. https:\/\/doi.org\/10.3322\/caac.21834","journal-title":"CA Cancer J Clin"},{"key":"1258_CR4","doi-asserted-by":"publisher","first-page":"195","DOI":"10.5114\/jcb.2021.105288","volume":"13","author":"IM Buzurovic","year":"2021","unstructured":"Buzurovic IM, O\u2019Farrell DA, Harris TC, Friesen S, King MT, Cormack RA, Devlin PM (2021) Selection criteria for high-dose-rate surface brachytherapy and electron beam therapy in cutaneous oncology. J Contemp Brachytherapy 13:195\u2013204. https:\/\/doi.org\/10.5114\/jcb.2021.105288","journal-title":"J Contemp Brachytherapy"},{"key":"1258_CR5","doi-asserted-by":"publisher","first-page":"437","DOI":"10.5114\/jcb.2015.55746","volume":"6","author":"D Delishaj","year":"2015","unstructured":"Delishaj D, Laliscia C, Manfredi B, Ursino S, Pasqualetti F, Lombardo E, Perrone F, Morganti R, Paiar F, Fabrini MG (2015) Non-melanoma skin cancer treated with high-dose-rate brachytherapy and Valencia applicator in elderly patients: a retrospective case series. J Contemp Brachytherapy 6:437\u2013444. https:\/\/doi.org\/10.5114\/jcb.2015.55746","journal-title":"J Contemp Brachytherapy"},{"key":"1258_CR6","doi-asserted-by":"publisher","first-page":"533","DOI":"10.5114\/jcb.2016.64112","volume":"8","author":"D Delishaj","year":"2016","unstructured":"Delishaj D, Rembielak A, Manfredi B, Ursino S, Pasqualetti F, Laliscia C, Orlandi F, Morganti R, Fabrini MG, Paiar F (2016) Non-melanoma skin cancer treated with high-dose-rate brachytherapy: a review of literature. J Contemp Brachytherapy 8:533\u2013540. https:\/\/doi.org\/10.5114\/jcb.2016.64112","journal-title":"J Contemp Brachytherapy"},{"key":"1258_CR7","doi-asserted-by":"publisher","DOI":"10.17265\/1548-6648\/2013.01.008","author":"JK Emmanuel","year":"2013","unstructured":"Emmanuel JK, Adu (2013) Tumours of the Scalp: A Review of Ten Cases. J US-China Med Sci. https:\/\/doi.org\/10.17265\/1548-6648\/2013.01.008. 10:","journal-title":"J US-China Med Sci"},{"key":"1258_CR9","doi-asserted-by":"publisher","first-page":"220","DOI":"10.5114\/jcb.2023.127837","volume":"15","author":"B Fionda","year":"2023","unstructured":"Fionda B, Placidi E, Rosa E, Lancellotta V, Stimato G, De Angeli M, Ciardo FG, Cornacchione P, Siebert FA, Tagliaferri L, Indovina L (2023) Multilayer intensity modulated contact interventional radiotherapy (brachytherapy): Stretching the therapeutic window in skin cancer. J Contemp Brachytherapy 15:220\u2013223. https:\/\/doi.org\/10.5114\/jcb.2023.127837","journal-title":"J Contemp Brachytherapy"},{"key":"1258_CR8","doi-asserted-by":"publisher","first-page":"306","DOI":"10.5114\/jcb.2024.143223","volume":"16","author":"B Fionda","year":"2024","unstructured":"Fionda B, Placidi E, Lancellotta V, Rosa E, De Angeli M, Wojcieszek P, Siebert FA, De Spirito M, Gambacorta MA, Tagliaferri L (2024) COMIRI \u2013 COMplexity Index of interventional Radiotherapy (brachytherapy) Implants: assessment of procedures based on type, equipment, and team. J Contemp Brachytherapy 16:306\u2013309. https:\/\/doi.org\/10.5114\/jcb.2024.143223","journal-title":"J Contemp Brachytherapy"},{"key":"1258_CR10","doi-asserted-by":"publisher","first-page":"643","DOI":"10.14336\/AD.2017.0503","volume":"8","author":"S Garcovich","year":"2017","unstructured":"Garcovich S, Colloca G, Sollena P, Bellieni A, Balducci L, Cho WC, Bernabei R, Peris K (2017) Skin Cancer Epidemics in the Elderly as An Emerging Issue in Geriatric Oncology. Aging Dis 8:643. https:\/\/doi.org\/10.14336\/AD.2017.0503","journal-title":"Aging Dis"},{"key":"1258_CR11","doi-asserted-by":"publisher","first-page":"833","DOI":"10.1118\/1.597396","volume":"21","author":"D Jones","year":"1994","unstructured":"Jones D (1994) ICRU Report 50\u2014Prescribing, Recording and Reporting Photon Beam Therapy. Med Phys 21:833\u2013834. https:\/\/doi.org\/10.1118\/1.597396","journal-title":"Med Phys"},{"key":"1258_CR12","doi-asserted-by":"publisher","first-page":"1069","DOI":"10.1111\/j.1365-2133.2012.10830.x","volume":"166","author":"A Lomas","year":"2012","unstructured":"Lomas A, Leonardi-Bee J, Bath\u2010Hextall F (2012) A systematic review of worldwide incidence of nonmelanoma skin cancer. Br J Dermatol 166:1069\u20131080. https:\/\/doi.org\/10.1111\/j.1365-2133.2012.10830.x","journal-title":"Br J Dermatol"},{"key":"1258_CR13","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1118\/1.597458","volume":"22","author":"R Nath","year":"1995","unstructured":"Nath R, Anderson LL, Luxton G, Weaver KA, Williamson JF, Meigooni AS (1995) Dosimetry of interstitial brachytherapy sources: Recommendations of the AAPM Radiation Therapy Committee Task Group 43. Med Phys 22:209\u2013234. https:\/\/doi.org\/10.1118\/1.597458","journal-title":"Med Phys"},{"key":"1258_CR15","doi-asserted-by":"publisher","first-page":"448","DOI":"10.5114\/jcb.2023.134173","volume":"15","author":"E Placidi","year":"2023","unstructured":"Placidi E, Fionda B, Rosa E, Lancellotta V, Napolitano A, De Angeli M, Pastore F, Gambacorta MA, Indovina L, Tagliaferri L, De Spirito M (2023) Dosimetric impact of applying a model-based dose calculation algorithm for skin cancer brachytherapy (interventional radiotherapy). J Contemp Brachytherapy 15:448\u2013452. https:\/\/doi.org\/10.5114\/jcb.2023.134173","journal-title":"J Contemp Brachytherapy"},{"key":"1258_CR14","doi-asserted-by":"publisher","first-page":"10669","DOI":"10.3390\/app142210669","volume":"14","author":"E Placidi","year":"2024","unstructured":"Placidi E, Fionda B, Rosa E, Lancellotta V, Napolitano A, De Angeli M, Ciasca G, Pastore F, Gambacorta MA, Tagliaferri L, De Spirito M (2024) Retrospective Dosimetric Comparison of HDR Interventional Radiotherapy (Brachytherapy) Versus Planning with VMAT and Electron Beam Therapy for Non-Melanoma Skin Cancer Treatment. Appl Sci 14:10669. https:\/\/doi.org\/10.3390\/app142210669","journal-title":"Appl Sci"},{"key":"1258_CR16","doi-asserted-by":"publisher","first-page":"730","DOI":"10.1111\/ddg.13546","volume":"16","author":"CM Prodinger","year":"2018","unstructured":"Prodinger CM, Koller J, Laimer M (2018) Scalp tumors. JDDG J Dtsch Dermatol Ges 16:730\u2013753. https:\/\/doi.org\/10.1111\/ddg.13546","journal-title":"JDDG J Dtsch Dermatol Ges"},{"key":"1258_CR17","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1111\/dsu.12024","volume":"39","author":"HW Rogers","year":"2013","unstructured":"Rogers HW, Coldiron BM (2013) Analysis of Skin Cancer Treatment and Costs in the United States Medicare Population, 1996\u20132008. Dermatol Surg 39:35\u201342. https:\/\/doi.org\/10.1111\/dsu.12024","journal-title":"Dermatol Surg"},{"key":"1258_CR18","doi-asserted-by":"publisher","first-page":"105767","DOI":"10.1016\/j.ejmp.2026.105767","volume":"145","author":"E Rosa","year":"2026","unstructured":"Rosa E, Raponi S, Fionda B, Napolitano A, Lancellotta V, Vaccaro M, De Angeli M, Pastore F, Bannoni L, Dragonetti P, Tagliaferri L, De Spirito M, Placidi E (2026) Impact of applicator curvature in contact interventional radiotherapy (brachytherapy) for skin cancer: exploring the Nautilus Effect. Phys Med 145:105767. https:\/\/doi.org\/10.1016\/j.ejmp.2026.105767","journal-title":"Phys Med"},{"key":"1258_CR19","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1120\/jacmp.v16i5.5407","volume":"16","author":"H Safigholi","year":"2015","unstructured":"Safigholi H, Song WY, Meigooni AS (2015) Optimum radiation source for radiation therapy of skin cancer. J Appl Clin Med Phys 16:219\u2013227. https:\/\/doi.org\/10.1120\/jacmp.v16i5.5407","journal-title":"J Appl Clin Med Phys"},{"key":"1258_CR20","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1159\/000521067","volume":"14","author":"L Spelman","year":"2022","unstructured":"Spelman L, Christie D, Kaminski A, Baker C, Supranowicz M, Sinclair R (2022) Radiotherapy, Utilizing Volumetric Modulated Arc Therapy, for Extensive Skin Field Cancerization: A Retrospective Case Series Assessing Efficacy, Safety, and Cosmetic Outcomes at 12 Months After Treatment. Case Rep Dermatol 14:31\u201338. https:\/\/doi.org\/10.1159\/000521067","journal-title":"Case Rep Dermatol"},{"key":"1258_CR21","doi-asserted-by":"publisher","first-page":"100616","DOI":"10.1016\/j.adro.2020.10.028","volume":"6","author":"JM Taylor","year":"2021","unstructured":"Taylor JM, Dasgeb B, Dasgeb B, Liem S, Ali A, Harrison A, Finkelstein M, Cha J, Anne R, Greenbaum S, Sherwin W, Shi W (2021) High-Dose-Rate Brachytherapy for the Treatment of Basal and Squamous Cell Carcinomas on Sensitive Areas of the Face: A Report of Clinical Outcomes and Acute and Subacute Toxicities. Adv Radiat Oncol 6:100616. https:\/\/doi.org\/10.1016\/j.adro.2020.10.028","journal-title":"Adv Radiat Oncol"},{"key":"1258_CR22","doi-asserted-by":"publisher","first-page":"1767","DOI":"10.1088\/0031-9155\/50\/8\/010","volume":"50","author":"W Ulmer","year":"2005","unstructured":"Ulmer W, Pyyry J, Kaissl W (2005) A 3D photon superposition\/convolution algorithm and its foundation on results of Monte Carlo calculations*. Phys Med Biol 50:1767\u20131790. https:\/\/doi.org\/10.1088\/0031-9155\/50\/8\/010","journal-title":"Phys Med Biol"},{"key":"1258_CR23","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1002\/hed.2880140305","volume":"14","author":"AI Zablow","year":"1992","unstructured":"Zablow AI, Eanelli TR, Sanfilippo LJ (1992) Electron beam therapy for skin cancer of the head and neck. Head Neck 14:188\u2013195. https:\/\/doi.org\/10.1002\/hed.2880140305","journal-title":"Head Neck"},{"key":"1258_CR24","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.radonc.2017.08.011","volume":"125","author":"NG Zaorsky","year":"2017","unstructured":"Zaorsky NG, Lee CT, Zhang E, Keith SW, Galloway TJ (2017) Hypofractionated radiation therapy for basal and squamous cell skin cancer: A meta-analysis. Radiother Oncol 125:13\u201320. https:\/\/doi.org\/10.1016\/j.radonc.2017.08.011","journal-title":"Radiother Oncol"}],"container-title":["Radiation and Environmental Biophysics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00411-026-01258-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00411-026-01258-z","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00411-026-01258-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T07:32:34Z","timestamp":1792567954000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00411-026-01258-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,9]]},"references-count":24,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["1258"],"URL":"https:\/\/doi.org\/10.1007\/s00411-026-01258-z","relation":{},"ISSN":["0301-634X","1432-2099"],"issn-type":[{"value":"0301-634X","type":"print"},{"value":"1432-2099","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,9]]},"assertion":[{"value":"13 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 October 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}