Simple fabrication technique of personalized endocavitary brachytherapy applicator for maxillary alveolar cancer

We report on methods and outcomes of post-operative endocavitary brachytherapy after prior irradiation and salvage surgery in a patient with maxillary alveolar squamous cell carcinoma (SCC).

A 67-year-old male with right maxillary alveolar SCC was referred for brachytherapy after prior definitive chemoradiotherapy and salvage posterior maxillectomy. A personalized endocavitary applicator was fabricated using dental impression plastic tray, vinyl polysiloxane paste, and four flexible catheters to deliver fourteen 3.5 Gy high-dose-rate fractions. High-risk and intermediate-risk clinical target volumes were treated to 3.7 Gy (D₉₀) and 2.4 Gy (D₉₈), with mandibular dose limited to 2.3 Gy (D_2cc) per fraction. These corresponded to total 2 Gy equivalent doses (EQD₂) of 72.8 Gy, 40.5 Gy, and 34 Gy, respectively.

The patient developed grade 2 mucositis and was disease-free for six months. He had biopsy-confirmed local recurrence at 8 months. He refused further treatment and expired within a month.

This simple approach to a personalized endocavitary applicator is feasible and allows for lower costs and less treatment delays, while ensuring patient comfort and convenience.