Superficial application and perioperative brachytherapy

Certain patients have a lengthy disease course with recurrent small skin metastasis after mastectomy and radiation therapy, but work-ups show no other spread. So far chemotherapy has given a temporary restraining effect on this type of disease. The dissemination mechanism is usually via subcutaneous lymph nodes and the area of dissemination always tends to enlarge.

Indication

As early as possible, preferably before chemotherapy or after the second surgically removed recurrence. The identified metastasis should not be larger than a grain of rice.

Anesthesia is not necessary. The metastasis is carefully palpated and documented, and the safety margin is marked. A special applicator of silicon is bandaged closely to the skin. 25 Grey is given via the PDR technique over 2.5 days and nights. There is then a break of 4 weeks, after which an additional 25 Grey is given as above. 1-2 weeks after the treatment there will be an intensive exudative skin reaction that will require wound care. More than 70% of patients are healed after 3 years.

Larger isolated tumor recurrences after previous radiation can be treated with a similar technique as "tumors of the head and neck". The treatment involves non-radical tumor resection and perioperative brachytherapy of the surgical wound (50-60 Gy for 5-6 days), and possibly covering of the wound with a graft.


Page revised Wednesday, April 6, 2011

Published by Anita Pettersson

Contact

Bengt Johansson, consultant

Phone: +46 19 602 27 91