Novel application of high-dose rate brachytherapy for severe, recalcitrant palmoplantar pustulosis

Timerman, Dmitriy; Devlin, Peter; Ve, Nambudiri; Na, Wright; Ra, Vleugels; Clark, R. A.; Ts, Kupper; Merola, Joseph F.; Patel, Mrinali

doi:10.1111/ced.12803

Cited by 7 publications

(5 citation statements)

References 7 publications

(8 reference statements)

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“…Similarly, Han et al reported a 25% reduction in BT use in cervical cancer between 1988 and 2009. Despite this decline, new benefits associated with BTusage continue to be explored, including advanced image guidance and novel applications emerging in the past decade (6,7). Often these advancements in BT have arisen from the platform provided by clinical trials (CTs).…”

Section: Introductionmentioning

confidence: 99%

A comprehensive analysis of brachytherapy clinical trials over the past 15 years

et al. 2016

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Section: Introductionmentioning

confidence: 99%

A comprehensive analysis of brachytherapy clinical trials over the past 15 years

et al. 2016

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“…Advantageous over open field, the underlying healthy tissue and bone would be spared, decreasing the risk of radiation‐induced side effects and increasing the specificity of treatment. 6 The utilisation of this type of treatment for psoriasis is extremely limited in the literature and discusses psoriatic nail beds and palmoplantar pustular dermatitis exclusively. Furthermore, each case differs significantly in fractionation and total dose, with a maximum reported total dose of 21.6 Gy.…”

Section: Discussionmentioning

confidence: 99%

Radiation therapy in the adjuvant treatment of hyperkeratotic palmoplantar psoriasis: a case study

Shirley

Andrae

Lay

et al. 2021

J of Medical Radiation Sci

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Psoriasis is an inflammatory autoimmune disease of the skin and nails, causing debilitating pain and having an adverse effect on the patients' life. Typical treatment regimens involve topical and systemic therapies in combination with phototherapy. However, patients with extensive, chronic disease may encounter treatment resistance, with limited or no success of these therapies. Radiation therapy (RT) has been shown to be an effective treatment for benign skin lesions; however, recommended dose, fractionation and long-term follow-up is not well established within the literature making clinical implementation challenging. Furthermore, RT may induce the Koebner Phenomenon, exacerbating the disease. This case study presents a patient with chronic hyperkeratotic palmoplantar psoriasis who was offered RT as a last resort. A total dose of 6Gy was delivered using photons and superficial energies. Significant reduction in extent of disease was seen as a result, with the patient no longer wheelchair-bound and able to mobilise with minimal discomfort. This case is a single example of RT as a successful treatment for chronic palmoplantar psoriasis; however, a larger sample size and clinical trial is needed to ascertain dose and fractionation for optimal long-term control. Implementation of such treatments within departments invites clinicians to further develop RT practices and provide much needed relief to a new cohort of patients with non-malignant conditions.

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“…Absorbed dose simulations in near-surface regions have also confirmed that high-dose-rate (HDR) iridium-192 ( 192 Ir) is an optimal radiation source for skin lesions, especially for the treatment of conditions with bone located directly beneath the skin [3,4]. Besides skin cancers, satisfactory results of the use of 192 Ir HDR-BT with chronic dermatitis, such as palmoplantar pustulosis on feet or ankles, have been presented [5]. The role of HDR-BT in stimulating T-cells, a significant component of the inflammatory infiltrate of psoriatic lesions, in order to increase the immune response has also recently been demonstrated [6].…”

Section: Purposementioning

confidence: 99%

End-to-end test and MOSFET in vivo skin dosimetry for 192Ir high-dose-rate brachytherapy of chronic psoriasis

Tuntipumiamorn

Nakkrasae

Kongkum

et al. 2019

jcb

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PurposeThis study was performed using end-to-end testing and real-time in vivo skin dose measurements, using metal oxide semiconductor field effect transistor (MOSFET) dosimeters on our first chronic psoriasis patient treated with iridium-192 (192Ir) high-dose-rate (HDR) brachytherapy (BT).Material and methodsTreatment delivery was planned with the prescription dose of 1.8 Gy to a 3 mm depth for 12 fractions, using our custom-fabricated surface mold and Varian soft catheters. The optimal technique to provide an adequate and acceptable skin dose as well as its feasibility were evaluated by an end-to-end exercise using a perspex finger phantom. The accuracy and reliability of MOSFET dose measurement was explored with a thermoluminescence dosimetry (TLD) before being used in vivo to monitor skin doses during treatment delivery for each BT fraction.ResultsUsing custom-made surface mold (2.4 mm Med-Tec thermoplastic mask for hand fixation and 5 applicators attached to each finger for dose delivery), the optimal skin dose on the phantom was obtained without the need for additional bolus to increase thickness of applicator. We acquired mean skin doses at different skin depths from various dose-volume parameters of no-bolus and 3 mm-added bolus plans. They were 125% and 110% (1 mm), 120% and 108% (2 mm), and 114% and 106% (3 mm), respectively. There was excellent agreement between MOSFET and TLD for 192Ir HDR-BT within ±3% (mean 2.65%, SD = 2.05%). With no energy correction, MOSFET overestimated the Acuros BV surface doses by up to 7% in the phantom study and in the clinical case.ConclusionsWe demonstrated achievable HDR-BT for our first case of nail bed psoriasis. The end-to-end exercise was an efficient methodology to evaluate new feasibility for this technique. Real-time dose monitoring using MOSFET was an effective and reliable tool to ensure treatment quality and patient safety.

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Novel application of high-dose rate brachytherapy for severe, recalcitrant palmoplantar pustulosis

Cited by 7 publications

References 7 publications

A comprehensive analysis of brachytherapy clinical trials over the past 15 years

A comprehensive analysis of brachytherapy clinical trials over the past 15 years

Radiation therapy in the adjuvant treatment of hyperkeratotic palmoplantar psoriasis: a case study

End-to-end test and MOSFET in vivo skin dosimetry for 192Ir high-dose-rate brachytherapy of chronic psoriasis

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