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

Abstract

BackgroundSquamous 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 presentationA 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.ConclusionsThe 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.

Does ultrasound measurement improve the accuracy of electronic brachytherapy in the treatment of superficial non-melanomatous skin cancer?

“…The Xoft eBT skin applicators commonly used in practice are available in 4 different sizes (10, 20, 35, and 50 mm). These applicators are placed directly in contact with the lesion, thus the name of contact radiotherapy [ 25 , 26 ]. This technique does not require a radioactive isotope, but uses a similar hypofractionated regimen as other orthovoltage or brachytherapy techniques previously mentioned [ 7 , 20 , 25 , 26 ].…”

“…These applicators are placed directly in contact with the lesion, thus the name of contact radiotherapy [ 25 , 26 ]. This technique does not require a radioactive isotope, but uses a similar hypofractionated regimen as other orthovoltage or brachytherapy techniques previously mentioned [ 7 , 20 , 25 , 26 ]. Excellent local control of 98.7% and cosmesis of 94.2% at a minimum follow-up of 16.1 months have been reported for NMSC treated with eBT [ 10 ].…”

Subungual Squamous Cell Carcinoma of the Thumb Treated by "Function Sparing Approach" Using Contact Radiotherapy (Brachytherapy)

“…[7] In fact, this finger has a primary role in grabbing and carrying out normal daily activities, [8,9] especially in the case of local recurrences, radiation therapy represents a valid alternative to re-excision or amputation both with potentially functional impairment. [10,11] Contact radiotherapy is a radiation treatment where the radioactive source is placed temporarily in contact the tumor site [12,13] and allows to target the dose on the target volume, while sparing the surrounding normal tissues because of a rapid fall-off representing a valid therapeutic option, it has been widely demonstrated in other peculiar anatomical districts. [14,15] This allows us to minimize the side effects of radiotherapy and allows such an approach to be also considered for frail and elderly patients.…”

Skin cancer management—updates on Merkel cell carcinoma

“…Generally skin lesions on the hand and foot are best treated by electron external beam treatment. Electronic brachytherapy can be used, as shown in a case report (12) in which each treatment only required 6 minutes. An excellent cosmetic and functional outcome was achieved at 1 year.…”