Gandhi Ajeet Kumar, Laviraj Macharla Anjaneyulu, Kashyap Lakhan, Purkait Suvendu, Sharma Daya Nand, Julka Pramod Kumar, Rath Goura Kishor
Department of Radiation Oncology, All India Institute of Medical Sciences.
Medical Physics, Department of Radiation Oncology, All India Institute of Medical Sciences.
J Contemp Brachytherapy. 2015 Jan;6(4):389-94. doi: 10.5114/jcb.2014.47704. Epub 2014 Dec 31.
Our case is a 46-year-old female presenting to us with Bowen's disease of scalp since 5 years. Patient had failed topical therapy with 5% 5-florouracil, 0.1% tacrolimus and was intolerant to topical imiquimod. At presentation, she had 15 cm × 10 cm erythematous, hyperpigmented, crusted plaque with irregular border in the superior and lateral aspect of left side of scalp with extension in to forehead. Patient was treated with computed tomography based customized surface mold high dose rate brachytherapy with Iridium-192 to a dose of 35 Gy in 10 fractions (twice daily, 6 hours apart) over 5 days. Patient tolerated the treatment well and showed regression of the lesion with mild dermatitis at the end of treatment. Though dermatitis increased at 2 weeks, at 4 weeks post treatment there was near complete resolution of the lesion with adjacent alopecia. At 8 weeks after completion of the treatment, there was complete resolution of the lesion and patient was asymptomatic. Alopecia in the adjacent area has resolved and the skin pigmentation has begun. Patient is satisfied with both the disease control and the cosmetic outcome of the procedure. Our case report demonstrates successful application of surface mold high dose rate brachytherapy in the treatment of recurrent Bowen's disease of the scalp. Brachytherapy can play an important role in the management of recurrent malignant and premalignant diseases of the complex treatment sites like scalp and it's non-hesitant use should be encouraged in appropriately selected patients at the earliest.
我们的病例是一位46岁女性，5年来一直患有头皮鲍温病。患者使用5%氟尿嘧啶、0.1%他克莫司进行局部治疗均失败，且对局部使用咪喹莫特不耐受。就诊时，她左侧头皮上半部分和外侧有一个15厘米×10厘米的红斑、色素沉着、结痂斑块，边界不规则，延伸至前额。患者接受了基于计算机断层扫描定制的表面模具高剂量率铱-192近距离放射治疗，在5天内分10次给予35 Gy剂量（每天两次，间隔6小时）。患者对治疗耐受性良好，治疗结束时病变消退，伴有轻度皮炎。虽然在2周时皮炎加重，但在治疗后4周，病变几乎完全消退，伴有相邻区域脱发。治疗完成8周后，病变完全消退，患者无症状。相邻区域的脱发已消退，皮肤色素沉着已开始。患者对疾病控制和手术的美容效果都很满意。我们的病例报告证明了表面模具高剂量率近距离放射治疗在复发性头皮鲍温病治疗中的成功应用。近距离放射治疗在头皮等复杂治疗部位复发性恶性和癌前疾病的管理中可以发挥重要作用，应尽早鼓励在适当选择的患者中毫不犹豫地使用。
