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Japanese Journal of Clinical Oncology 33:198-201 (2003)
© 2003 Foundation for Promotion of Cancer Research

Iridium-192 Brachytherapy for Hemorrhagic Angiosarcoma of the Scalp: a Case Report

Ryuji Nakamura1, Satoshi Harada1, Toya Obara1, Shigeru Ehara1, Aki Yoshida2, Toshiyuki Akasaka2 and Masanori Shozushima3,+

Departments of 1 Radiology, 2 Dermatology and 3 Dental Radiology, Iwate Medical University, Morioka, Japan

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 104 to 18.2 x 104. 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.

+ For reprints and all correspondence: Ryuji Nakamura, Department of Radiology, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505 Japan. E-mail: rnakamur{at}iwate-med.ac.jp


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