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Recurrent Bowen's disease of scalp treated with high dose rate surface mold brachytherapy: a case report and review of the literature.

Gandhi AK, Laviraj MA, Kashyap L, Purkait S, Sharma DN, Julka PK, Rath GK - J Contemp Brachytherapy (2014)

Bottom Line: Patient had failed topical therapy with 5% 5-florouracil, 0.1% tacrolimus and was intolerant to topical imiquimod.Alopecia in the adjacent area has resolved and the skin pigmentation has begun.Patient is satisfied with both the disease control and the cosmetic outcome of the procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences.

ABSTRACT
Our case is a 46-year-old female presenting to us with Bowen's disease of scalp since 5 years. Patient had failed topical therapy with 5% 5-florouracil, 0.1% tacrolimus and was intolerant to topical imiquimod. At presentation, she had 15 cm × 10 cm erythematous, hyperpigmented, crusted plaque with irregular border in the superior and lateral aspect of left side of scalp with extension in to forehead. Patient was treated with computed tomography based customized surface mold high dose rate brachytherapy with Iridium-192 to a dose of 35 Gy in 10 fractions (twice daily, 6 hours apart) over 5 days. Patient tolerated the treatment well and showed regression of the lesion with mild dermatitis at the end of treatment. Though dermatitis increased at 2 weeks, at 4 weeks post treatment there was near complete resolution of the lesion with adjacent alopecia. At 8 weeks after completion of the treatment, there was complete resolution of the lesion and patient was asymptomatic. Alopecia in the adjacent area has resolved and the skin pigmentation has begun. Patient is satisfied with both the disease control and the cosmetic outcome of the procedure. Our case report demonstrates successful application of surface mold high dose rate brachytherapy in the treatment of recurrent Bowen's disease of the scalp. Brachytherapy can play an important role in the management of recurrent malignant and premalignant diseases of the complex treatment sites like scalp and it's non-hesitant use should be encouraged in appropriately selected patients at the earliest.

No MeSH data available.


Related in: MedlinePlus

A) Shows customized mold with plastic brachytherapy catheters in situ. B) Planning CT scan acquired with customized mold. Orange arrow shows the brachytherapy catheters with lead wire and green arrows show the lead wire around the lesion placed to delineate the treatment area. C) Isodose lines (green color shows 80% and red color shows 100% isodose lines) for the treatment. D) Shows patient being treated on remote after loading HDR brachytherapy unit
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Figure 0003: A) Shows customized mold with plastic brachytherapy catheters in situ. B) Planning CT scan acquired with customized mold. Orange arrow shows the brachytherapy catheters with lead wire and green arrows show the lead wire around the lesion placed to delineate the treatment area. C) Isodose lines (green color shows 80% and red color shows 100% isodose lines) for the treatment. D) Shows patient being treated on remote after loading HDR brachytherapy unit

Mentions: A customized thermoplastic immobilization cast of the head was made. Flexible plastic brachytherapy catheters (12 catheters at a distance of 1 cm from each other) inserted between layers of wax was pasted in close contact with the thermoplastic cast (Fig. 3A). Computed tomography scan (3 mm thickness) was acquired and a lead wire was also placed around the circumference of the lesion (before the assembled cast was applied) for proper delineation of the treatment area. The planning CT scan was transferred to Oncentra treatment planning system (Nucletron, an Elekta company, Elekta AB, Stockholm, Sweden). Clinical target volume (CTV) was delineated based on the markers and clinical findings. Organs at risk including brain parenchyma, bones of skull, eyes, lens, optic nerves, optic chiasm, and brainstem was also delineated on serial CT slices (Fig. 3B). Catheters were reconstructed with axial and multi-planar views. Dwell positions were created with spacing of 5 mm and normalization was done using catheter points. Graphical optimization was done to ensure 95% coverage of the CTV (Fig. 3C). A dose of 35 Gy was prescribed in 10 fractions (2 fractions per day, 6 hours apart). Lesion coverage factor [11] was 0.951 (TVRI [volume of target covered by the reference isodose line]/TV [target volume]). Target volume measured 33.59 cm3. Brain parenchyma received a mean dose of 0.39 Gy/fraction and dose to whole brain was 0.07 Gy/fraction of treatment. Rest of the dosimetric data has been summarized in Table 1. Treatment was administered using an Iridium-192 source (Microselectron HDR, Nucletron, an Elekta company, Elekta AB, Stockholm, Sweden) (Fig. 3D). Treatment time was 10 minutes per fraction including treatment set up time. Patient tolerated the treatment well without any interruption. Figure 2B shows the clinical picture at completion of the treatment. At 2 weeks after completion of the treatment (Fig. 2C), healthy granulation tissue with partial resolution of the lesion was appreciable along with alopecia in the adjacent area. Figure 2D shows complete resolution of the lesion at 8 weeks of treatment. Alopecia was resolved in the adjacent area and there is no evidence of radiation dermatitis or ulceration.


Recurrent Bowen's disease of scalp treated with high dose rate surface mold brachytherapy: a case report and review of the literature.

Gandhi AK, Laviraj MA, Kashyap L, Purkait S, Sharma DN, Julka PK, Rath GK - J Contemp Brachytherapy (2014)

A) Shows customized mold with plastic brachytherapy catheters in situ. B) Planning CT scan acquired with customized mold. Orange arrow shows the brachytherapy catheters with lead wire and green arrows show the lead wire around the lesion placed to delineate the treatment area. C) Isodose lines (green color shows 80% and red color shows 100% isodose lines) for the treatment. D) Shows patient being treated on remote after loading HDR brachytherapy unit
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4300359&req=5

Figure 0003: A) Shows customized mold with plastic brachytherapy catheters in situ. B) Planning CT scan acquired with customized mold. Orange arrow shows the brachytherapy catheters with lead wire and green arrows show the lead wire around the lesion placed to delineate the treatment area. C) Isodose lines (green color shows 80% and red color shows 100% isodose lines) for the treatment. D) Shows patient being treated on remote after loading HDR brachytherapy unit
Mentions: A customized thermoplastic immobilization cast of the head was made. Flexible plastic brachytherapy catheters (12 catheters at a distance of 1 cm from each other) inserted between layers of wax was pasted in close contact with the thermoplastic cast (Fig. 3A). Computed tomography scan (3 mm thickness) was acquired and a lead wire was also placed around the circumference of the lesion (before the assembled cast was applied) for proper delineation of the treatment area. The planning CT scan was transferred to Oncentra treatment planning system (Nucletron, an Elekta company, Elekta AB, Stockholm, Sweden). Clinical target volume (CTV) was delineated based on the markers and clinical findings. Organs at risk including brain parenchyma, bones of skull, eyes, lens, optic nerves, optic chiasm, and brainstem was also delineated on serial CT slices (Fig. 3B). Catheters were reconstructed with axial and multi-planar views. Dwell positions were created with spacing of 5 mm and normalization was done using catheter points. Graphical optimization was done to ensure 95% coverage of the CTV (Fig. 3C). A dose of 35 Gy was prescribed in 10 fractions (2 fractions per day, 6 hours apart). Lesion coverage factor [11] was 0.951 (TVRI [volume of target covered by the reference isodose line]/TV [target volume]). Target volume measured 33.59 cm3. Brain parenchyma received a mean dose of 0.39 Gy/fraction and dose to whole brain was 0.07 Gy/fraction of treatment. Rest of the dosimetric data has been summarized in Table 1. Treatment was administered using an Iridium-192 source (Microselectron HDR, Nucletron, an Elekta company, Elekta AB, Stockholm, Sweden) (Fig. 3D). Treatment time was 10 minutes per fraction including treatment set up time. Patient tolerated the treatment well without any interruption. Figure 2B shows the clinical picture at completion of the treatment. At 2 weeks after completion of the treatment (Fig. 2C), healthy granulation tissue with partial resolution of the lesion was appreciable along with alopecia in the adjacent area. Figure 2D shows complete resolution of the lesion at 8 weeks of treatment. Alopecia was resolved in the adjacent area and there is no evidence of radiation dermatitis or ulceration.

Bottom Line: Patient had failed topical therapy with 5% 5-florouracil, 0.1% tacrolimus and was intolerant to topical imiquimod.Alopecia in the adjacent area has resolved and the skin pigmentation has begun.Patient is satisfied with both the disease control and the cosmetic outcome of the procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences.

ABSTRACT
Our case is a 46-year-old female presenting to us with Bowen's disease of scalp since 5 years. Patient had failed topical therapy with 5% 5-florouracil, 0.1% tacrolimus and was intolerant to topical imiquimod. At presentation, she had 15 cm × 10 cm erythematous, hyperpigmented, crusted plaque with irregular border in the superior and lateral aspect of left side of scalp with extension in to forehead. Patient was treated with computed tomography based customized surface mold high dose rate brachytherapy with Iridium-192 to a dose of 35 Gy in 10 fractions (twice daily, 6 hours apart) over 5 days. Patient tolerated the treatment well and showed regression of the lesion with mild dermatitis at the end of treatment. Though dermatitis increased at 2 weeks, at 4 weeks post treatment there was near complete resolution of the lesion with adjacent alopecia. At 8 weeks after completion of the treatment, there was complete resolution of the lesion and patient was asymptomatic. Alopecia in the adjacent area has resolved and the skin pigmentation has begun. Patient is satisfied with both the disease control and the cosmetic outcome of the procedure. Our case report demonstrates successful application of surface mold high dose rate brachytherapy in the treatment of recurrent Bowen's disease of the scalp. Brachytherapy can play an important role in the management of recurrent malignant and premalignant diseases of the complex treatment sites like scalp and it's non-hesitant use should be encouraged in appropriately selected patients at the earliest.

No MeSH data available.


Related in: MedlinePlus