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Title: Subungual squamous cell carcinoma: A case study

Abstract

The purpose of this case study is to describe a dosimetric delivery of radiation to a superficial disease process involving the skin and bone of the distal finger. A 76-year-old male patient presented with a subungual squamous cell carcinoma (SCC) of the left distal index finger with bony involvement. The patient refused conventional surgical treatment but agreed to external beam radiation therapy (EBRT). There is a gap in the current literature describing how to successfully immobilize fingers and which EBRT modality is dosimetrically advantageous in treating them. The construction of a simple immobilization method with the patient in a reproducible position is described. The use of photons and electrons were compared ultimately showing photons to be dosimetrically advantageous. Long-term efficacy of the treatment was not evaluated because of patient noncompliance.

Authors:
Publication Date:
OSTI Identifier:
22685194
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Dosimetry; Journal Volume: 42; Journal Issue: 2; Other Information: Copyright (c) 2017 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
61 RADIATION PROTECTION AND DOSIMETRY; 62 RADIOLOGY AND NUCLEAR MEDICINE; BEAMS; CARCINOMAS; COMPARATIVE EVALUATIONS; DELIVERY; EXTERNAL BEAM RADIATION THERAPY; FINGERS; MALES; PATIENTS; PHOTONS; SKELETON; SKIN; SURGERY

Citation Formats

Neill, Cory J., E-mail: coryjneill@gmail.com. Subungual squamous cell carcinoma: A case study. United States: N. p., 2017. Web. doi:10.1016/J.MEDDOS.2017.02.003.
Neill, Cory J., E-mail: coryjneill@gmail.com. Subungual squamous cell carcinoma: A case study. United States. doi:10.1016/J.MEDDOS.2017.02.003.
Neill, Cory J., E-mail: coryjneill@gmail.com. Sat . "Subungual squamous cell carcinoma: A case study". United States. doi:10.1016/J.MEDDOS.2017.02.003.
@article{osti_22685194,
title = {Subungual squamous cell carcinoma: A case study},
author = {Neill, Cory J., E-mail: coryjneill@gmail.com},
abstractNote = {The purpose of this case study is to describe a dosimetric delivery of radiation to a superficial disease process involving the skin and bone of the distal finger. A 76-year-old male patient presented with a subungual squamous cell carcinoma (SCC) of the left distal index finger with bony involvement. The patient refused conventional surgical treatment but agreed to external beam radiation therapy (EBRT). There is a gap in the current literature describing how to successfully immobilize fingers and which EBRT modality is dosimetrically advantageous in treating them. The construction of a simple immobilization method with the patient in a reproducible position is described. The use of photons and electrons were compared ultimately showing photons to be dosimetrically advantageous. Long-term efficacy of the treatment was not evaluated because of patient noncompliance.},
doi = {10.1016/J.MEDDOS.2017.02.003},
journal = {Medical Dosimetry},
number = 2,
volume = 42,
place = {United States},
year = {Sat Jul 01 00:00:00 EDT 2017},
month = {Sat Jul 01 00:00:00 EDT 2017}
}
  • Purpose: We performed a comparative planning study among High Dose Rate (HDR) brachytherapy, superficial electrons, Volume Modulated Arc Therapy (VMAT), and Helical IMRT (Tomotherapy) for squamous cell carcinoma of the abdominal wall with consideration for the underlining bowel. Methods: A 69-year old female presented with squamous cell carcinoma protruding 8mm beyond the anterior skin surface of the midabdomen was considered for treatment. The patient had a ventral hernia which resulted in the reduction of the abdominal wall thickness and the adjacent small bowel being the dose limiting structure. Four plans were generated using different treatment modalities: a) an enface electronmore » field (eMC, Eclipse v. 11), b) Tomotherapy (HI-Art II v.5.0.5), c) VMAT (Acuros, Eclipse v. 11), and d) HDR using a Freiburg applicator (Oncentra v. 4.3). The following plan objectives were used for all four plans: for the CTV target, V90% ≥90% (61.8Gy2/2).For the small bowel, D0.1cc < 56.2 Gy2/2 was a hard constraint and expressed as a percentage of the prescription for comparison to demonstrate the dose fall-off achieved among the modalities.For HDR, V200% <0.1cc was an additional constraint. Multiple dosimetric parameters, including those listed above, were compared among the four modalities. Results: The HDR plan showed comparable target coverage compared to the Tomotherapy plan and better coverage compared to the electron plan. Small bowel doses (D0.1cc) were lower in HDR plan compared to Tomotherapy, electron, & VMAT plans (88.8%, 89.6%, 90.9%, & 96.6%). Integral dose to the whole body (V5%) was much higher for HDR, VMAT, and Tomotherapy when compared to electron plan by factors of seven, eight, and ten, respectively. After reviewing all treatment modalities, the physician selected HDR owing to better control of the small bowel dose while maintaining adequate target coverage. Conclusion: This case study demonstrated HDR can successfully treat superficial lesions with superior sparing of underlying structures.« less
  • The purpose of this case study is to communicate a technique on treating the re-irradiation of squamous cell carcinoma (SCC) of anal canal with proton fields matched with electron fields to spare prostatic urethra. A 76-year old male presented with a secondary radiation-induced malignancy as a result of prostate brachytherapy seeds irradiation 10 years prior. A rectal examination revealed a bulky tumor at the top of the anal canal involving the left superior-most aspect of the anal canal extending superiorly into the rectum. The inferior extent was palpable approximately 3 cm from the anal verge and the superior extent ofmore » the mass measured greater than 5 cm in the superior-inferior dimension. Chemoradiation was suggested since the patient was opposed to abdominoperineal resection (APR) and colostomy. The use of proton therapy matching with electron fields in the re-irradiation setting could help reduce the complications. A 2 lateral proton beams were designed to treat the bulky tumor volume with 2 electron beams treating the nodal volumes. This complication of treatment fields helped spare the prostatic urethra and reduced the risk of urinary obstruction in the future.« less
  • A case report is cited illustrating the development of carcinoma of the uterine cervix 18 yr after successful radiation treatment of a previous cervical carcinoma. The 23-yr-old patient had a rapidly growing squamouscell carcinoma of highest grade of malignancy in 1943. She was given deep x-ray therapy using 4 ports, 10 x 15 cm, 200 kv, and 20 ma on 20 different days for a total of 6720 r (168 r to each of 2 ports per treatment). Radium in a total dose of 5400 mg-hr was also given. Subsequent repeated examinations showed total disappearance of the tumor, but inmore » 1961 a cervical biopsy showed carcinoma in situ with no evidence of invasive or recurrent carcinoma. Recovery from this presumably primary tumor was complete but another apparently primary tumor developed in the rectum, diagnosed as a moderately differentiated squamous-cell carcinoma. Eight previously reported cases of such an in situ carcinoma developing after radiotherapy are reviewed. Various sequelae of radiation injury of the gastrointestinal and genitourinary tracts are described as a result of pathologic study of the case and their significance discussed. (BBB)« less