The Using of Surface mould brachytherapy as palliative treatment of breast cancer; Chiang Mai University Hospital (CMUH) experience

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CASE REPORT The Using of Surface mould
brachytherapy as palliative treatment of breast
cancer Chiang Mai University Hospital (CMUH)
experience
Ekkasit Tharavichitkul, MD The division of
therapeutic radiology and oncology, Faculty of
Medicine, Chiang Mai University, Chiang Mai,
Thailand
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Patient history

• 38 years old women presented with bulging mass at
  right chest wall. In the year of 2008, she
  presented with Breast cancer (stage T2N2M0).
• Modified radical mastectomy was done and
  pathological report revealed invasive ductal
  carcinoma with axillary lymph node involvement
  (10/10).
• Estrogen and Progesterone receptors were positive
  (1).
• Bone scintigraphy and Liver ultrasound were
  negative.

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• After resection, she received 6 cycles of FAC
  regimen. She was planned to receive
  post-mastectomy irradiation after the last cycle
  of chemotherapy.
• At simulation date, we found right chest wall
  mass and biopsy showed invasive ductal carcinoma.

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• She received 5 cycles of chemotherapy
  (Paclitaxel) and got stable of disease. She was
  sent to radiotherapy department again for
  palliation radiation therapy.

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Physical examination

• Huge right breast mass 1515 cm in diameter with
  necrotic ulcer on top and foul smelling. Many
  regimens of chemotherapy were used but
  unfortunately, no response occurred. She suffered
  from the foul smelling of the tumor on her right
  breast.
• So Palliative RT was performed to this patient.

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Pre-treatment status
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Methods

• Individual surface mould with catheter was
  invented
• Aquaplast mask was performed with patient chest
  wall curve
• Plastic catheters were sutured with aquaplast
  template parallely

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Image

• The CT simulation was carried out with 5 mm slice
  thickness. The dose of 1.5 Gy per fraction two
  times per day in total dose of 30 Gy will be
  calculated.

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CT-based planning
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CT-based planning
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After BT

• Three weeks later, EBRT with tangential field
  technique in total dose of 50 Gy was prescribed.

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Follow-up after BT at simulation
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After treatment

• After EBRT completed, she was sent back to
  receive chemotherapy. After treatment, the chest
  wall mass disappeared without foul smell.
  Unfortunately, her disease progressed elsewhere.

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One month after RT
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Situation

• RIP at 22 Feb 2010
• (8 months after treatment)

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Conclusion

• In summary, Surface mould brachytherapy can be
  use as palliative treatment. It can help to
  improve the quality of life and relief symptoms
  of locally advanced disease.
• However, careful selection should be kept in mind
  for high benefit of modality.

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Thank you very much!!!!
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Dose comparison
Parameters/Dose 300 cGyx 10 Fx 150cGyx20 Fx
Total treatment time Of BT 5 days 10-12 days
EQD2 (10) 32.5 Gy 28.75 Gy
EQD2 (3) 35 Gy 26 Gy
EQD2(10) 50 Gy 82.5 Gy 78.75 Gy
EQD2(3) 50 Gy 85 Gy 76 Gy