Iridium-192 brachytherapy for hemorrhagic angiosarcoma of the scalp: a case report

Jpn J Clin Oncol. 2003 Apr;33(4):198-201. doi: 10.1093/jjco/hyg032.

Abstract

A 60-year-old woman presented with multicentric skin tumors of the head. The histologically proven hemangioendothelioma was bleeding as a result of disseminated coagulopathy. In addition to immunotherapy, 6 MeV electron beam radiotherapy was used for the purpose of hemostasis with a single portal, 20 x 20 cm in size, covering the whole scalp from the top of the head. The radiotherapy was discontinued after 39 Gy/13 fractions/20 days because of the progress in size of a peripheral tumor and the stability of coagulopathy. After another electron boost delivery by two portals focused to exophytic parietal and temporal tumors of 20 Gy/10 fractions, high dose rate brachytherapy with a surface mold technique was performed, 3 Gy/fraction, four fractions/week, for a total of 36 Gy. It induced partial regression of the tumor and complete recovery of platelet counts from 2.5 x 10(4) to 18.2 x 10(4). The tumor disappeared in 3 months. No late side effects occurred, except for permanent alopecia. The patient developed a cervical lymph node metastasis 1 year after and marginal recurrence 2 years after the initial treatment. Both recurrent tumors were successfully treated by 4 MV external photons of 60 Gy/20 fractions/46 days and electron beam irradiation of 60 Gy/20 fractions/29 days, respectively. She has remained disease free for 3 years after the initial presentation.

Publication types

  • Case Reports

MeSH terms

  • Brachytherapy*
  • Dose Fractionation, Radiation
  • Female
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / radiotherapy*
  • Hemangiosarcoma / pathology
  • Hemangiosarcoma / radiotherapy*
  • Hemorrhage / pathology
  • Hemorrhage / radiotherapy*
  • Humans
  • Iridium Radioisotopes / therapeutic use*
  • Middle Aged
  • Radiotherapy Dosage
  • Scalp*
  • Skin Neoplasms / pathology
  • Skin Neoplasms / radiotherapy*

Substances

  • Iridium Radioisotopes