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Related Experiment Videos

First experiences with superfractionated skin irradiations using large afterloading molds

P Fritz1, F W Hensley, C Berns

  • 1Department of Clinical Radiology, University of Heidelberg, Germany.

International Journal of Radiation Oncology, Biology, Physics
|August 1, 1996
PubMed
Summary

Superfractionated brachytherapy using skin molds effectively treats breast cancer skin metastases, even in previously irradiated areas. This method offers an economical and efficient alternative to traditional external beam therapy.

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Medical Physics

Background:

  • Radiotherapy for cutaneous breast cancer metastases often requires large fields and high doses.
  • Conventional treatments can be lengthy and may lead to significant skin toxicity.

Purpose of the Study:

  • To evaluate the efficacy and sequelae of superfractionated irradiation using afterloading molds for cutaneous breast cancer metastases.
  • To assess treatment outcomes on both pre-irradiated and non-irradiated skin.

Main Methods:

  • Development of a flexible, reusable skin mold with 18 parallel catheters for pulsed-dose-rate (PDR) afterloading.
  • Irradiation of 16 patients with thoracic wall metastases using 192Ir source, delivering 40-50 Gy in two PDR split courses.
  • Treatment of 11 previously irradiated fields (50-60 Gy external beam) and 7 newly irradiated fields.

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Main Results:

  • Local control (LC) achieved in 8 of 10 pre-irradiated fields and 6 of 7 newly irradiated fields (overall 82% LC).
  • Acute skin reactions were generally manageable (Grade 2 moist desquamation in 2/10 pre-irradiated fields).
  • Intermediate/late reactions included telangiectasia (7/10 pre-irradiated fields) and one Grade 4 ulcer in a pre-irradiated field.

Conclusions:

  • Superfractionated brachytherapy with skin molds is an effective and economical treatment for skin metastases of breast cancer, even in pre-irradiated skin.
  • Optimized molds provide superior dose homogeneity compared to electron fields on curved surfaces.
  • Skin reactions are comparable to orthovolt irradiation; PDR doses should be limited to 40-45 Gy in pre-irradiated areas and 50 Gy in non-irradiated areas.