An electronic brachytherapy technique for treating squamous cell carcinoma in situ of the digit: a case report

BMC Research Notes

Alice C Watson¹  V Elayne Arterbery² 

[1] Department of Dermatology, University Physician Group-Georgetown, Professional Building, Suite 208, Sterling Heights, MI, 48310, USA;Crittenton Radiation Oncology Center, 1901 Star Batt Drive, Rochester Hills, MI, 48309, USA

关键词: Electronic brachytherapy;    Radiation therapy;    Skin cancer;   

Others  :  1142937
DOI  :  10.1186/1756-0500-6-147

 received in 2012-08-14, accepted in 2013-02-27,  发布年份 2013

【 摘 要 】

Background

Squamous cell carcinoma in situ of the digit presents a complex management problem, which is usually treated with surgery or radiation or topical agents. The outcome of the surgical treatment can be an undesirable cosmetic result and loss of function. We report a unique Electronic Brachytherapy technique to treat the digit, which uses a 50 Kv miniaturized X-ray source with specialized applicators.

Case presentation

A 62-year-old African-American male was presented with a 12-month history of gradual darkening of the dorsal-distal middle left finger. Examination revealed a hyper pigmented scaly patch on the proximal to lateral nail fold of the L 3rd finger, nail dystrophy, and vertical split in the lateral section of the nail. The patient underwent evaluation of the lesion by Plastic Surgery with the removal of the lateral nail and a nail bed biopsy. Pathology revealed squamous cell carcinoma in situ with a possible focal positive, deep margin. The patient deliberated over surgical opinions, and eventually decided on radiation. A high dose rate Electronic Brachytherapy system using the XOFT Accent controller delivered dose of 4000 cGy in eight fractions, twice weekly, with at least 48 hours between fractions and treatment prescribed to a depth of 0 to 2 mm. The Xoft unit has specialized skin applicators that permit superficial treatment. Parameters assessed included the efficacy, cosmetic results feasibility, and acute safety of the Electronic Brachytherapy technique.

Conclusions

The patient exhibited moderate redness, hyperpigmentation erythema, desquamation, and Grade 1 to 2 edema acutely (following radiation), which resolved within 1 month of the treatment. Electronic brachytherapy treatment delivery took about 6 minutes, and the total procedure time was about 15 minutes. At the median follow-up of one year, the area revealed excellent cosmesis, and there was no infection or fat necrosis, desquamation, no cancer recurrence, and no evidence of fibrosis at the last follow-up. This suggests that Electronic Brachytherapy was a viable treatment option for this particular patient.

【 授权许可】

   
2013 Arterbery and Watson; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Rogers HW, Weinstock MA, Harris AR, Hinckley MR, Feldman SR, Fleischer AB, Coldiron BM: Incidence Estimate of Non-melanoma Skin Cancer in the United States. Arch Derm 2006, 142:729-735.
• [2]Ahmed I, Jones B, Holmes C, O' Callaghan C, Ilchyshyn A: Comparison of cryotherapy with curettage in the treatment of Bowen's disease: a prospective study. Br J Dermatol 2000, 143(4):759-766.
• [3]Tantikun N: Treatment of Bowen's disease of the digit with carbon dioxide laser. J Am Acad Dermatol 2000, 43(6):1080-1083.
• [4]Palungwachira P, Ogawa H: Treatment of multiple lesions of Bowen's disease and squamous cell carcinoma with topical imiquimod. J Dermatol 2005, 32(12):1005-1009.
• [5]Patel GK, Goodwin R, Chawla M, et al.: Imiquimod 5% cream monotherapy for cutaneous squamous cell carcinoma in situ (Bowen’s disease): a randomized, double-blind, placebo-controlled trial. J Am Acad Dermatol 2006, 54:1025-1032.
• [6]Hansen JP, Drake AL, Walling HW: Bowen's Disease: a four-year retrospective review of epidemiology and treatment at a university center. Derm Surg 2008, 34(7):878-883.
• [7]Leibovitch I, Huilgol SC, Selva D, Franzco AAA, Richards S, Paver R: Cutaneous squamous carcinoma in situ (Bowen’s disease): Treatment with Mohs micrographic surgery. J Am Acad Dermatol 2005, 52:997.
• [8]Herman JM, Pierce L, Sandler HM, Griffith K, Jabbari S, Hiniker S, Johnson T: Radiotherapy using the water bath in the treatment of Bowen's disease of the digit. Radiother Oncol 2008, 88(3):398-402. Epub
• [9]Lee JD, Park KK, Lee MG, Kim EH, Rhim KJ, Lee JT, Yoo HS, Kim YM, Park KB, Kim JR: Radio-nuclide therapy of skin cancers and Bowen's disease using a specially designed skin patch. J Nucl Med 1997, 38(5):697-702.
• [10]Zygogianni A, Kouvaris J, Tolia M, Kyrgias G, Beli I, Kantzou I, Soulimioti G, Kouloulias V: The Potential Role of Radiation Therapy in Bowen's Disease: A Review of the Current Literature. Rev Recent Clin Trials 2011. ISSN: 1876-1038
• [11]Foo CC, Lee JS, Guilanno V, Yan X, Tan SH, Giam YC: Squamous cell carcinoma and Bowen's disease of the skin in Singapore. Annual Acad Med Singapore 2007, 36(3):189-193. 17450264
• [12]Leibovitch I, Huilgol SC, Selva D, Richards S, Paver R: Cutaneous squamous carcinoma in situ (Bowen's disease): treatment with Mohs micrographic surgery. J Am Acad Dermatol 2005, 52(6):997-1002.
• [13]Nakano A, Watanabe D, Akita Y, Kawamura T, Tamada Y, Matsumoto Y: Treatment efficiency of combining photodynamic therapy and ionizing radiation for Bowen's disease. J Eur Acad Dermatol Venereol 2011, 25(4):475-478.
• [14]Gordon KB, Garden JM, Robinson JK: Bowen's disease of the distal digit outcome of treatment with carbon dioxide laser vaporization. Dermatoll Surg 1996, 22(8):723-728.
• [15]Rong Y: Surface applicator calibration and commissioning for skin applicators for electronic brachytherapy. Med Phys 2010, 37(10):5509-5517.
• [16]Shimm DS, Cassady JR: The skin. In Moss' radiation oncology. 7th edition. Edited by Cox JD. St. Louis: Mosby – Year Book Inc; 1994:99-118.