First Clinical Experience of Tungsten Rubber Electron Adaptive Therapy With Real-time Variable-shape Tungsten Rubber.

BACKGROUND/AIM: We investigated the dosimetric characteristics of electron radiotherapy for auricular keloid using real-time variable-shape tungsten rubber (STR). PATIENTS AND METHODS: For the first evaluation, STR was shaped into a rectangular irradiation field (3.0×5.0 cm2). In the next step, the STR was reshaped to fit the target (3.5×6.5 cm2) for the second evaluation. Percentage depth doses (PDDs) and lateral dose profiles were obtained with 6-MeV electron beams and compared with those of low-melting-point lead (LML). RESULTS: Compared to the LML on electron applicator, PDD differences were within 0.4 mm, while the penumbras as width of 20-80% dose levels were smaller (maximum reductions: 75.8% and 82.9% at first and second evaluations, respectively). The treatment process of shaping the STR, decision on output, and irradiation was completed within 45 min. CONCLUSION: Electron radiotherapy using STR for keloid can be performed with excellent dose distribution in a short time. First clinical experience found the STR is suitable for use in individualized and immediate electron radiotherapy.

A retrospective analysis of surgical resection of large ear keloids.

OBJECTIVE: To investigate surgical methods for the removal of larger ear keloids. METHODS: Two different surgical techniques were used: Method A, tumour excision followed by in situ scar flap repair; and Method B, wedge resection of an auricular lesion followed by primary closure or local flap repair. After the treatment, patients received postoperative, local radiotherapy. Follow-up was for 1-3 years (median 28.9 months). RESULTS: Twenty patients with 35 large ear keloids were reviewed. In Method A, six ears were cured, three ears improved, five ears relapsed after 1 year and one ear recurred within 1 year. In Method B, 17 ears were cured, two ears improved and one ear recurred within 1 year. CONCLUSION: Keloid scars can be effectively treated with a combination of radiotherapy and surgical excision.

Three-dimensional customized bolus for intensity-modulated radiotherapy in a patient with Kimura's disease involving the auricle.

In radiotherapy, a commercial bolus often does not provide a suitable fit over irregular surfaces. To address this issue, we fabricated a customized bolus using 3D printing technology. The aim of our study was to evaluate the application of this 3D-printed bolus in a clinical setting. The patient was a 45-year-old man with recurrent Kimura's disease involving the auricle, receiving radiotherapy in our oncology department. A customized bolus, 5mm in thickness, was fabricated based on reconstruction of computed tomography (CT) images. The bolus was printed on a Dimension 1200 series SST 3D printer. Repeat CT-based simulation indicated an acceptable fit of the 3D-printed bolus to the target region, with a maximum air gap of less than 5mm at the tragus. Most of the surface area of the target region was covered by the 95% isodose line. The plan with the 3D-printed bolus improved target coverage compared to that without a bolus. And the plan with the 3D-printed bolus yielded comparable results to those with the paraffin wax bolus. In conclusion, a customized bolus using a 3D printer was successfully applied to an irregular surface.

Management of ear lobule keloids using 980-nm diode laser.

The objective of the study was to evaluate the 980-nm diode laser in conjunction with corticosteroids in the treatment of ear lobule keloids. Several methods have been described for the treatment of keloid scars, but none of them have been 100% successful. Advances in laser techniques have enabled surgeons to define the most appropriate lasers for use in the treatment of different scar types. The diode laser pulses are delivered interstitially in a single repeated mode in non-overlapping sites using a bare optical fiber, followed by intralesional triamcinolone acetonide injection. The number of sessions varies between two to five for the management of more than 75% of keloid size, with a total success rate of 75% and no recurrence in the follow-up of 12 months. The technique used proved to be effective in the treatment of ear lobule keloids.

A radiobiological analysis of multicenter data for postoperative keloid radiotherapy.

PURPOSE: To identify factors significantly affecting recurrence rates after postoperative external beam radiotherapy (XRT) of keloids, and to delineate any radiation dose response and effects of radiation dose per fraction. METHODS AND MATERIALS: A comprehensive literature review was performed to compile a database of 2,515 resected keloids (36.9% earlobe). Postoperative XRT was 45- to 100-kV X-rays in 27.0% or 120- to 250-kV X-rays in 11.1%, Co-60 in 1.9%, Sr-90 in 4.7%, 1.5- to 9-MeV electrons in 26.5%, and no XRT in 28.8%. In the 1,791 irradiated patients, the median radiation parameters were as follows: total dose, 15 Gy (range, 6-30 Gy); dose per fraction, 5.0 Gy (range, 2-15 Gy); fractions, 3 (range, 1-10); and time, 7 days (range, 0-33 days). RESULTS: Multivariate stepwise logistic regression correlated decreased keloid recurrence with earlobe location (p = 1.98E-10; odds ratio, 0.34), biologically effective dose (p = 1.01E-27), and treatment with electron beam or Co-60 vs. other techniques (p = 0.0014; odds ratio, 0.72). Different radiobiological models calculated values of α/ß = 1.12 to 2.86 (mean, 2.08) and time (repopulation) correction factors for biologically effective dose from 0.98 to 2.13 Gy per day (mean, 1.34) starting 10 days after surgery. Different models (with α/ß = 2.08) predicted that doses needed for 90% and 95% control with 3 fractions of postoperative electron beam were 16.0 to 16.2 Gy and 18.3 to 19.2 Gy, respectively, in less than 10 days for earlobe keloids and 21.5 to 22.2 Gy and 23.4 to 24.8 Gy, respectively, in less than 10 days for other sites. CONCLUSIONS: Postoperative keloid radiotherapy requires moderately high doses and optimal technique to be effective. The relatively low α/ß ratio indicates that radiotherapy with a limited number of fractions and high doses per fraction is the best strategy.

[Postoperative ischemic acute stroke and thrombolytic therapy]. / Thrombolyse postopératoire immédiate dans un contexte d'accident vasculaire sylvien gauche.

Intravenous thrombolytic therapy for ischemic stroke was performed on a 75-year-old patient at recovery from cervicocephalic superficial surgery. The patient recovered totally from ischemic stroke and no neurologic sequelae was observed. Thrombolytic therapy must be performed in an intensive care unit in order to manage some bleeding events which can occur.

[Multimodal treatment strategy for Langerhans cell histiocytosis at head and neck manifestations]. / Interdisziplinäre Therapie der Langerhans-Zell-Histiozytose im Kopf- und Halsbereich.

Langerhans cell histiocytosis (LCH) is a rare disorder with different clinical features. An established standardized treatment does not exist.We present a case report of a patient with localized LCH of the temporal bone and discuss the interdisciplinary treatment strategies. We reviewed the international literature and summarized the current knowledge. Beside a wait and see policy in cases without symptomatic disease, surgery, radiotherapy or chemotherapy, and combinations of these options are used as treatment modalities. While surgery or radiotherapy are preferred in localized (symptomatic) lesions, stage-adapted chemotherapeutic regimens are the treatments of choice in disseminated disease. Treatment selection depends on the individual clinical features.

Otologic manifestations of amyloidosis.

OBJECTIVE: To describe otologic manifestations of amyloidosis. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Case report of a patient with bilateral external auditory meatal stenosis secondary to amyloidosis. RESULTS: The patient is a 60-year-old man who presented with several months' history of bilateral ear blockage and drainage. Physical examination revealed markedly thickened skin in each ear in the area of concha and meatus that was associated with fissuring. The meatus were markedly stenosed. The medial aspect of the external auditory canal and the tympanic membrane were normal. He had partial improvement on medical therapy with topical steroid-containing eardrops and ointment. Past medical history was positive for multiple myeloma. Meatal biopsy was performed. Grossly, the tissue was hypovascular and markedly thickened. Histopathologic examination was consistent with amyloidosis. The patient was continued on topical steroid ointments, frequent ear cleaning, and close follow-up. He was subsequently diagnosed with systemic amyloidosis. A review of the literature was done. Head and neck involvement with amyloidosis is reviewed, with emphasis on otologic manifestations. CONCLUSION: Otologic involvement with amyloidosis is extremely rare. The pathophysiology may be related to the local factors in the external auditory canal.

Prevention of earlobe keloid recurrence with postoperative corticosteroid injections versus radiation therapy: a randomized, prospective study and review of the literature.

BACKGROUND: Simple excision of earlobe keloids can result in recurrence rates approaching 80%. Many modalities have been suggested to reduce the risk of recurrence postoperatively, including intralesional steroids and radiotherapy. OBJECTIVE: In order to determine the most reliable method to prevent keloid recurrence, we have conducted the first randomized, prospective trial comparing corticosteroid injections versus radiation therapy. RESULTS: Thirty-one keloids were treated and followed for a minimum of 12.0 months. Two of 16 keloids (12.5%) recurred after surgery and radiation therapy, while 4 of 12 (33%) recurred after surgery and steroid injections. No alteration of skin pigmentation, wound dehiscence, chronic dermatitis, or neoplastic changes was observed in any patient in either group. Although a statistically significant difference was not observed, radiotherapy appeared to be more effective than steroid injections in preventing keloid recurrence. CONCLUSIONS: Radiotherapy is a simpler treatment modality with better patient compliance, and patients were much more likely to complete treatment than with corticosteroid injections. We believe that radiotherapy can play an important role in the prevention of earlobe keloid recurrences, and that with current techniques, complications can be minimized. Further randomized study with additional patients is needed to compare the effectiveness of corticosteroid injections and radiotherapy in preventing keloid recurrence.

Otoesclerosis sensorial profunda: correlación clínica y de imagen / Severe sensorial hearing loss due cochlear otosclerosis: clinical and imaging correlation

Se correlacionan los hallazgos de Tomografía Computada de alta resolución e IRM sin contraste del hueso temporal con los estudios audiométricos: (audiotería tonal, logoaudiometría, timpanometría y prueba de estimulación eléctrica del promontorio) en cuatro pacientes con el diagnóstico clínico de otoesclerosis coclear, los cuales manifestaban hipoacusia sensorial profunda. Los hallazgos clínicos correlacionados con los hallazgos de imagen, nos permitió valorar el grado de compromiso coclear en estos pacientes (obliteración parcial o total) y determinar la conducta clínica posterior. Los cambios a nivel del hueso conocidos y descritos por Valvassori como lo es el signo de doble contorno, engrosamiento de la ventana oval, y los focos de mayor densidad ósea, fueron observados en casi todos los pacientes en mayor o menor grado. En la IRM sin contraste se observó incremento de la señal a nivel de la vuelta basal en T1 en forma no constante, el signo de doble contorno se observó en tres de cuatro pacientes en las diferentes secuencias (T1 y T2)

Treatment of keloids with excision and postoperative X-ray irradiation.

During a 9-year period 47 patients with 62 keloids, treated with excision and postoperative superficial X-ray irradiation, were included in a retrospective study. The follow-up time was 6 months to 9 years. 88% experienced a good or excellent result. Single or fractioned dose and time interval between excision and radiation did not influence the result. Hyperpigmentation was noted as a side effect in 16 of 47 patients. More favorable results were obtained in the treatment of small keloids and of keloids located in the head-neck area compared to those on the trunk and the extremities.

Parotid carcinoma and posterior fossa schwannoma following irradiation. Report of a patient treated in infancy for benign ear disease.

A 23-year-old man had received irradiation for a benign ear problem at the age of 1 year. Twenty year later, a malignant left parotid carcinoma and a right jugular foramen schwannoma developed. Earlier reports in the literature suggest that radiation can induce tumors in the head and neck. The localization of both tumors and the histological features of the parotid tumor suggest that they were radiation-induced.