Water bolus in photon-beam therapy of irregular skin lesions of extremities: a case report
Authors: Catarina Novalio Oliveira, Diana Ferreira Braga, Nelson Miranda Ferreira, Claudia Matias Silva, Ines Henriques de Carvalho Pino, Filomena Trindade Santos
Background: Mycosis fungoides (MF) represents the most common cutaneous T-cell lymphoma and approximately 4% of non-Hodgkin lymphomas. Treatment of skin lesions includes external beam radiation therapy which often provides adequate local control and symptom relief. Case presentation: A 39-year-old male with the diagnosis of MF presents with infiltrative and pruriginous plaques comprising the plantar, interdigital, lateral and posterior surfaces of the foot. A protocol using a water tank was used to provide uniform coverage to an irregular target volume. By creating a tissue-equivalent and homogenous bolus material a total dose of 8Gy in 2 fractions of photon-beam therapy was prescribed. After one month of treatment there was a partial response with minimal toxicity, achieving complete response in most lesions after six months. Conclusion: Photon-beam therapy for irregular surfaces such as extremities is a valid alternative to conventional electron-beam radiation by attaining uniform coverage while minimizing hotspots. Treatment utilizing a water tank is well-tolerated and has good clinical outcomes even in the presence of extensive skin lesions.
Keywords: Case report, radiation therapy, mycosis fungoides, irregular surface, water tank, tissue compensation.
Authors
Catarina Novalio Oliveira
Department of Radiation Oncology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto 1099-023, Lisbon, Portugal
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Diana Ferreira Braga
Department of Radiation Oncology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto 1099-023, Lisbon, Portugal
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Nelson Miranda Ferreira
Department of Radiation Oncology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto 1099-023, Lisbon, Portugal
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Claudia Matias Silva
Department of Radiation Oncology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto 1099-023, Lisbon, Portugal
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Ines Henriques de Carvalho Pino
Department of Radiation Oncology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto 1099-023, Lisbon, Portugal
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Filomena Trindade Santos
Department of Radiation Oncology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto 1099-023, Lisbon, Portugal.
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Correspondence to:
Catarina Novalio Oliveira, Department of Radiation Oncology, Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Rua Professor Lima Basto 1099-023, Lisbon, Portugal catoliveira@ipolisboa.min.saude.pt
Publication history:
Received 17 Apr 2023
Revised 27 Jun 2023
Accepted 25 Aug 2023
Published online 18 Dec 2023
Published in print 22 Mar 2024
Oliveira CN, Braga DF, Ferreira NM, Silva CM, Pino IHdC, Santos FT. Water bolus in photon-beam therapy of irregular skin lesions of extremities: a case report. EJMCR. 2023; 7(8): 158-160. doi:
10.24911/ejmcr/173-1668678100
Oliveira CN, Braga DF, Ferreira NM, Silva CM, Pino IHdC, Santos FT. Water bolus in photon-beam therapy of irregular skin lesions of extremities: a case report. https://www.ejmcr.com/?mno=130723 [Access: April 29, 2024]. doi:
10.24911/ejmcr/173-1668678100
Oliveira CN, Braga DF, Ferreira NM, Silva CM, Pino IHdC, Santos FT. Water bolus in photon-beam therapy of irregular skin lesions of extremities: a case report. EJMCR. 2023; 7(8): 158-160. doi:
10.24911/ejmcr/173-1668678100
Oliveira CN, Braga DF, Ferreira NM, Silva CM, Pino IHdC, Santos FT. Water bolus in photon-beam therapy of irregular skin lesions of extremities: a case report. EJMCR. (2023), [cited April 29, 2024]; 7(8): 158-160. doi:
10.24911/ejmcr/173-1668678100
Oliveira, C. N., Braga, . D. F., Ferreira, . N. M., Silva, . C. M., Pino, . I. H. d. C. & Santos, . F. T. (2023) Water bolus in photon-beam therapy of irregular skin lesions of extremities: a case report. EJMCR, 7 (8), 158-160. doi:
10.24911/ejmcr/173-1668678100
Oliveira, Catarina Novalio, Diana Ferreira Braga, Nelson Miranda Ferreira, Claudia Matias Silva, Ines Henriques de Carvalho Pino, and Filomena Trindade Santos. 2023. Water bolus in photon-beam therapy of irregular skin lesions of extremities: a case report. European Journal of Medical Case Reports, 7 (8), 158-160. doi:
10.24911/ejmcr/173-1668678100
Oliveira, Catarina Novalio, Diana Ferreira Braga, Nelson Miranda Ferreira, Claudia Matias Silva, Ines Henriques de Carvalho Pino, and Filomena Trindade Santos. "Water bolus in photon-beam therapy of irregular skin lesions of extremities: a case report." European Journal of Medical Case Reports 7 (2023), 158-160. doi:
10.24911/ejmcr/173-1668678100
Oliveira, Catarina Novalio, Diana Ferreira Braga, Nelson Miranda Ferreira, Claudia Matias Silva, Ines Henriques de Carvalho Pino, and Filomena Trindade Santos. "Water bolus in photon-beam therapy of irregular skin lesions of extremities: a case report." European Journal of Medical Case Reports 7.8 (2023), 158-160. Print. doi:
10.24911/ejmcr/173-1668678100
Oliveira, C. N., Braga, . D. F., Ferreira, . N. M., Silva, . C. M., Pino, . I. H. d. C. & Santos, . F. T. (2023) Water bolus in photon-beam therapy of irregular skin lesions of extremities: a case report. European Journal of Medical Case Reports, 7 (8), 158-160. doi:
10.24911/ejmcr/173-1668678100