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High-dose-rate intraluminal brachytherapy for paraneoplastic autoimmune multiorgan syndrome

View Article: PubMed Central - PubMed

ABSTRACT

Paraneoplastic autoimmune multiorgan syndrome (PAMS), also known as paraneoplasic pemphigus, involves the skin, internal organs and mucosa. PAMS-associated mortality may occur as a result of autoantibody formation against internal tumors and their infiltration into organs other than the skin lesions that characterize PAMS. The most common symptoms of PAMS include pain associated with continuous oral ulceration and resistance to pharmacological treatment. The present study reports the case of a 42-year-old female patient who was admitted with an 8-month history of erosive skin lesions within the trunk region, oral mucosa and vaginal mucosa. The patient was diagnosed with PAMS based on computed tomography scans and histological analyses of the lesions. The lymphoid hyperplasia in the retroperitoneum and lesions in the vaginal mucosa and trunk area were improved following pharmacological treatment and resection of the lymph node showing hyperplasia. However, the oral lesion was treated with intraluminal brachytherapy due to its resistance to long-term pharmacological treatment. The majority of the lesions were improved following treatment, in the absence of any severe side effects. In addition, neither worsening nor progression of the oral lesion was observed during the 4-year follow-up period.

No MeSH data available.


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Brachytherapy for the treatment of the oral lesion. (A) The mold for the lower jaw consisted of three 6F catheter holes with 1-cm intervals to permit the insertion of the catheter for brachytherapy. (B) The mold for the lower jaw was designed to have a 2-mm lead plate to minimize radiation exposure to the gingiva and teeth, which were located adjacent to the tongue lesion. (C) Treatment was performed by inserting a Lumencath® catheter (6F 150 cm) for brachytherapy.
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f4-etm-0-0-3458: Brachytherapy for the treatment of the oral lesion. (A) The mold for the lower jaw consisted of three 6F catheter holes with 1-cm intervals to permit the insertion of the catheter for brachytherapy. (B) The mold for the lower jaw was designed to have a 2-mm lead plate to minimize radiation exposure to the gingiva and teeth, which were located adjacent to the tongue lesion. (C) Treatment was performed by inserting a Lumencath® catheter (6F 150 cm) for brachytherapy.

Mentions: Oral lesions were limited to the anterior half of the tongue, and no ulcerous lesions were observed in the buccal mucosa or gingiva (Fig. 3). Intraluminal brachytherapy was performed (date, 7/1/2010) to treat locally-located lesions, prevent damage to the gingiva and enhance the radiation dose effect. The device for oral brachytherapy was designed using acrylic resin and consisted of separate molds for the upper and lower jaws. The mold for the lower jaw consisted of three 6F catheter holes with 1-cm intervals to insert the catheter for brachytherapy (Fig. 4A). The mold for the lower jaw constituted 2-mm lead plates to minimize the radiation exposure to the gingiva and teeth during the therapy, which were located adjacent to the tongue lesion. A 2-mm lead plate was also inserted into the mold for the upper jaw during each therapy to reduce the radiation exposure to the palate (Fig. 4B). The radiation dose for each therapy was limited to ≤15 cGy. Treatment was performed using a Lumencath® catheter (6F 150 cm; Elekta Instrument AB Stockholm, Stockholm, Sweden) for brachytherapy. Radiation treatment consisted of 2 Gy per session and two sessions per week, using an Iridium-192 high-dose-rate brachytherapy system (microSelectron HDR afterloader; Elekta Instrument AB Stockholm) (Fig. 4C). The patient was exposed to a total of 40 Gy radiation during 20 therapy sessions.


High-dose-rate intraluminal brachytherapy for paraneoplastic autoimmune multiorgan syndrome
Brachytherapy for the treatment of the oral lesion. (A) The mold for the lower jaw consisted of three 6F catheter holes with 1-cm intervals to permit the insertion of the catheter for brachytherapy. (B) The mold for the lower jaw was designed to have a 2-mm lead plate to minimize radiation exposure to the gingiva and teeth, which were located adjacent to the tongue lesion. (C) Treatment was performed by inserting a Lumencath® catheter (6F 150 cm) for brachytherapy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998192&req=5

f4-etm-0-0-3458: Brachytherapy for the treatment of the oral lesion. (A) The mold for the lower jaw consisted of three 6F catheter holes with 1-cm intervals to permit the insertion of the catheter for brachytherapy. (B) The mold for the lower jaw was designed to have a 2-mm lead plate to minimize radiation exposure to the gingiva and teeth, which were located adjacent to the tongue lesion. (C) Treatment was performed by inserting a Lumencath® catheter (6F 150 cm) for brachytherapy.
Mentions: Oral lesions were limited to the anterior half of the tongue, and no ulcerous lesions were observed in the buccal mucosa or gingiva (Fig. 3). Intraluminal brachytherapy was performed (date, 7/1/2010) to treat locally-located lesions, prevent damage to the gingiva and enhance the radiation dose effect. The device for oral brachytherapy was designed using acrylic resin and consisted of separate molds for the upper and lower jaws. The mold for the lower jaw consisted of three 6F catheter holes with 1-cm intervals to insert the catheter for brachytherapy (Fig. 4A). The mold for the lower jaw constituted 2-mm lead plates to minimize the radiation exposure to the gingiva and teeth during the therapy, which were located adjacent to the tongue lesion. A 2-mm lead plate was also inserted into the mold for the upper jaw during each therapy to reduce the radiation exposure to the palate (Fig. 4B). The radiation dose for each therapy was limited to ≤15 cGy. Treatment was performed using a Lumencath® catheter (6F 150 cm; Elekta Instrument AB Stockholm, Stockholm, Sweden) for brachytherapy. Radiation treatment consisted of 2 Gy per session and two sessions per week, using an Iridium-192 high-dose-rate brachytherapy system (microSelectron HDR afterloader; Elekta Instrument AB Stockholm) (Fig. 4C). The patient was exposed to a total of 40 Gy radiation during 20 therapy sessions.

View Article: PubMed Central - PubMed

ABSTRACT

Paraneoplastic autoimmune multiorgan syndrome (PAMS), also known as paraneoplasic pemphigus, involves the skin, internal organs and mucosa. PAMS-associated mortality may occur as a result of autoantibody formation against internal tumors and their infiltration into organs other than the skin lesions that characterize PAMS. The most common symptoms of PAMS include pain associated with continuous oral ulceration and resistance to pharmacological treatment. The present study reports the case of a 42-year-old female patient who was admitted with an 8-month history of erosive skin lesions within the trunk region, oral mucosa and vaginal mucosa. The patient was diagnosed with PAMS based on computed tomography scans and histological analyses of the lesions. The lymphoid hyperplasia in the retroperitoneum and lesions in the vaginal mucosa and trunk area were improved following pharmacological treatment and resection of the lymph node showing hyperplasia. However, the oral lesion was treated with intraluminal brachytherapy due to its resistance to long-term pharmacological treatment. The majority of the lesions were improved following treatment, in the absence of any severe side effects. In addition, neither worsening nor progression of the oral lesion was observed during the 4-year follow-up period.

No MeSH data available.


Related in: MedlinePlus