title: Helical tomotherapy of the complete scalp and the ipsilateral lymph nodes in a case of scalp angiosarcoma.
abstract: Scalp angiosarcoma represents a therapeutic challenge to all disciplines. This case report demonstrates the potential usefulness of helical tomotherapy (HT) as a new radiotherapeutic treatment option. A 71-year-old woman presented with a superficial angiosarcoma of the scalp, forehead, and left pre- and postauricular areas, with several nodular ulcerating and bleeding lesions. Irradiation of the gross tumor was performed with a total dose of 70 Gy in 2-Gy fractions and of the left cervical lymph nodes with 56 Gy in 1.6-Gy fractions. Good target coverage was achieved without compromising organs at risk, notably the brain. Treatment was very fast (661 seconds per fraction) and was administered with minimal acute toxicity (National Cancer Institute Common Toxicity Criteria: grade 2 erythema and grade 2 dysphagia). During treatment, tumor nodules dissolved into hyperkeratosis. We conclude that with HT, irradiation of the scalp and cervical lymph nodes can be conducted with minimal acute toxicity and without junction problems.
authors.affiliation: Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. sonja.katayama@med.uni-heidelberg.de.
authors.forename: Sonja
authors.initials: S
authors.lastname: Katayama
authors.forename: Markus
authors.initials: M
authors.lastname: Hantschke
authors.forename: Steffen
authors.initials: S
authors.lastname: Lissner
authors.forename: Katja
authors.initials: K
authors.lastname: Lindel
authors.forename: Dieter
authors.initials: D
authors.lastname: Oetzel
authors.forename: Klaus
authors.initials: K
authors.lastname: Herfarth
authors.forename: Juergen
authors.initials: J
authors.lastname: Debus
authors.forename: Florian
authors.initials: F
authors.lastname: Sterzing
mesh_terms: D000368:Aged; D019583:Dose Fractionation, Radiation; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D006394:Hemangiosarcoma / Q000532:radiotherapy* / Q000556:secondary; D006801:Humans; D008198:Lymph Nodes; D008207:Lymphatic Metastasis; D009333:Neck; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D012535:Scalp; D012878:Skin Neoplasms / Q000473:pathology / Q000532:radiotherapy*