title: Helmet mold-based surface brachytherapy for homogeneous scalp treatment: a case report.
abstract: BACKGROUND/CASE REPORT: External-beam radiotherapy of complex-shaped areas is sometimes difficult to realize. In a patient with chronic lymphatic leukemia (CLL) infiltrates of the skin of the whole scalp, conventional external-beam radiotherapy with electrons or photons was not able to treat the target sufficiently. Thus, the authors developed a brachytherapy moulage technique using a customized helmet (polyethylene) with flexible interstitial plastic applicators and irradiated the target very homogeneously with a microselectron (192)Ir HDR (high-dose-rate) source (2.0 Gy daily fractionated; 36.0 Gy total dose related to the reference points in 3 mm focus depth). Technical difficulties, CT-supported three-dimensional conformal treatment planning, and verification with TLD probe measurements are described. The treatment was well tolerated and resulted in complete local remission of the CLL infiltrates within a follow-up of 30 months.
  
  
  CONCLUSIONS
  The presented treatment of lymphoma infiltrates at the scalp by HDR moulage techniques is exceptional but safe and practicable to achieve local tumor control.
authors.affiliation: Department of Radiotherapy and Radiooncology, University Hospital Leipzig AöR, Leipzig, Germany.
authors.forename: André
authors.initials: A
authors.lastname: Liebmann
authors.forename: Stefan
authors.initials: S
authors.lastname: Pohlmann
authors.forename: Frank
authors.initials: F
authors.lastname: Heinicke
authors.forename: Guido
authors.initials: G
authors.lastname: Hildebrandt
mesh_terms: D001918:Brachytherapy / Q000379:methods*; D004867:Equipment Design; D006260:Head Protective Devices; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000473:pathology / Q000532:radiotherapy; D012535:Scalp; D012878:Skin Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000556:secondary*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome