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

Abstract

A-48-year old man, affected by HIV, working as an electrician, presented a swollen and painful subungual lesion over the distal phalanx of the right thumb with an important limitation to his job. A cutaneous examination of the right thumb revealed an irregular erosive crusted mass formation about 2 cm×1 cm size with erythematous changes and complete destruction of the overlying nail plate. There was no evidence of regional lymphadenopathy; the patient was studied with computed tomography that did not show any distant disease. A conservative onychectomy was performed with removal of the lesion and with histological confirmation of SCC. However, after five months, the patient presented local recurrence over the thumb. Amputation was proposed, but the patient declined due to the negative impacts on his job. Thus, contact radiotherapy (i.e., brachytherapy, BT) was proposed. BT was delivered using a customized homemade surface mold with six plastic tubes arranged around. The total delivered dose was 40 Gy delivered in eight fractions, 5 Gy for daily using Iridium-192 High Dose Rate (HDR) source. Four years later, recently, the patient is free from disease and has a complete functionality of the thumb without any limitations in any movement and in his job. The patient only reported a slight sensitivity reduction.

Can brachytherapy be properly considered in the clinical practice? Trilogy project: The vision of the AIRO (Italian Association of Radiotherapy and Clinical Oncology) Interventional Radiotherapy study group

“…In particular, there is evidence, which has proven that in selected cancers, such as cervical and prostate cancer, BT boost vs. no boost increases overall survival after external beam radiation therapy [8,9,10]. Moreover, there is evidence that the use of intensity modulated or stereotactic radiation therapy as alternatives to BT boost resulted in worse results not only in terms of overall survival, but also with regards to aesthetic results, and function and organ preservation [11,12,13,14].…”