title: Iridium-192 brachytherapy for hemorrhagic angiosarcoma of the scalp: a case report.
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.
authors.affiliation: Department of Radiology, Iwate Medical University, Morioka, Japan. rnakamur@iwate-med.ac.jp
authors.forename: Ryuji
authors.initials: R
authors.lastname: Nakamura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Harada
authors.forename: Toya
authors.initials: T
authors.lastname: Obara
authors.forename: Shigeru
authors.initials: S
authors.lastname: Ehara
authors.forename: Aki
authors.initials: A
authors.lastname: Yoshida
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Akasaka
authors.forename: Masanori
authors.initials: M
authors.lastname: Shozushima
mesh_terms: D001918:Brachytherapy; D019583:Dose Fractionation, Radiation; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D006394:Hemangiosarcoma / Q000473:pathology / Q000532:radiotherapy*; D006470:Hemorrhage / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use*; D008875:Middle Aged; D011879:Radiotherapy Dosage; D012535:Scalp; D012878:Skin Neoplasms / Q000473:pathology / Q000532:radiotherapy*
chemical_list: D007496:Iridium Radioisotopes