A case study on postoperative radiation therapy of the big toe

Sweat gland cancers, particularly eccrine sweat gland carcinomas, are rare and challenging to treat due to their aggressive nature and inconspicuous clinical presentation. Aggressive digital papillary adenocarcinoma, a rare subtype, frequently presents with delays in diagnosis, increasing the risk of metastasis and recurrence. Surgical excision remains the standard treatment, but the role of postoperative radiation therapy is not well-established due to the paucity of data. This case study explores the use of radiotherapy in treating a 50-year-old female with digital papillary adenocarcinoma of the great toe. A custom three-dimensional (3D) printed bolus was utilized to improve dose distribution and reproducibility in radiation treatment using Volumetric Modulated Arc Therapy (VMAT). The comparative analysis of VMAT and 3D conformal radiation plans demonstrated superior target coverage, dose homogeneity, and reduced exposure to adjacent healthy tissue with VMAT. The findings contribute valuable insight into the use of 3D-printed bolus and advanced radiotherapy techniques in the management of rare sweat gland cancers, particularly in complex anatomical regions like the toe.