ABSTRACT
Early-stage squamous cell carcinoma of the larynx is usually treated with local field radiotherapy. Surgery is used for salvage following recurrence. Further recurrences present a more difficult therapeutic problem which requires individualized management. The aims of local control, survival, maintenance of function and minimizing side effects all need to be balanced according to the site and extent of disease. The present case study looks at the management of a 54-year-old man with multiple recurrences from a squamous cell carcinoma of the larynx. It describes a technique of endoluminal brachytherapy using an iridium-192 wire spiralled around the outer part of a tracheostomy tube that achieves good local control while enabling self-insertion and self-cleaning during the procedure. The dose given was 2500 cGy at 5 mm over 25.2 h and was achieved with minimal early or delayed side effects. The patient had no further symptoms relating to the stomal recurrence until his death from metastatic disease 6 months later.
Subject(s)
Brachytherapy , Carcinoma, Squamous Cell/radiotherapy , Iridium Radioisotopes/therapeutic use , Laryngeal Neoplasms/radiotherapy , Neoplasm Recurrence, Local/radiotherapy , Brachytherapy/instrumentation , Carcinoma, Squamous Cell/therapy , Combined Modality Therapy , Humans , Laryngeal Neoplasms/therapy , Male , Middle AgedABSTRACT
In the treatment of carcinoma of the cervix uteri radiotherapy patients in Perth undergo a three course treatment. The treatment involves a course of external beam radiotherapy followed by a caesium--137 implant using the Curietron 2 afterloading device and finally an external beam boost dose with a block shielding the cervix. The aim of this project was to use the boost dose to compensate for the falling gradient in the summed dose profile introduced by the caesium implant. The required boost dose was calculated using sealed source dosimetry software and the measured attenuation coefficient for low melting point alloy was then used to determine the required block profile. The clinical requirement was for a dose of 85Gy to the Manchester system A points from a combination of caesium insertion and external irradiation. Due to the geometry of the caesium implant the pelvic gland regions will receive slightly more than 85Gy. Use of the block gives rise to total doses between 85.0Gy and 89.5Gy across the field at the level of the A points. At positions 25mm above and below the A point level doses between 87.5Gy and 89.0Gy are achieved.
