Helmet mold-based surface brachytherapy for homogeneous scalp treatment: a case report

• Published in: Strahlentherapie und Onkologie 2007-04, Vol.183 (4), p.211-214
• Main Authors: Liebmann, André, Pohlmann, Stefan, Heinicke, Frank, Hildebrandt, Guido
• Format: Article
• Language: English
• Subjects: Brachytherapy - methods; Equipment Design; Head Protective Devices; Humans; Leukemia, Lymphocytic, Chronic, B-Cell - pathology; Leukemia, Lymphocytic, Chronic, B-Cell - radiotherapy; Radiation therapy; Scalp; Skin Neoplasms - diagnostic imaging; Skin Neoplasms - radiotherapy; Skin Neoplasms - secondary; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 0179-7158; 1439-099X
• DOI: 10.1007/s00066-007-1648-7

BACKGROUND/CASE REPORT: External-beam radiotherapy of complex-shaped areas is sometimes difficult to realize. In a patient with chronic lymphatic leukemia (CLL) infiltrates of the skin of the whole scalp, conventional external-beam radiotherapy with electrons or photons was not able to treat the target sufficiently. Thus, the authors developed a brachytherapy moulage technique using a customized helmet (polyethylene) with flexible interstitial plastic applicators and irradiated the target very homogeneously with a microselectron (192)Ir HDR (high-dose-rate) source (2.0 Gy daily fractionated; 36.0 Gy total dose related to the reference points in 3 mm focus depth). Technical difficulties, CT-supported three-dimensional conformal treatment planning, and verification with TLD probe measurements are described. The treatment was well tolerated and resulted in complete local remission of the CLL infiltrates within a follow-up of 30 months. The presented treatment of lymphoma infiltrates at the scalp by HDR moulage techniques is exceptional but safe and practicable to achieve local tumor control.