eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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vol. 12
Case report

Combined interstitial and surface high-dose-rate brachytherapy treatment of squamous cell carcinoma of the hand

Daniel W. Kim
Ivan M. Buzurovic
Brandon V. Mahal
William Hwang
Oluwadamilola T. Oladeru
Desmond A. O’Farrell
Thomas C. Harris
Danielle N. Margalit
Miranda Lam
Phillip M. Devlin

J Contemp Brachytherapy 2020; 12, 1: 48–52
Online publish date: 2020/01/20
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We present a case report of treatment using interstitial and surface high-dose-rate (HDR) brachytherapy for cutaneous squamous cell carcinoma (SCC) involving the interspace of the third and fourth digits. The patient refused two-ray amputation and the lesion was not amenable for external beam radiation therapy (EBRT). This is the first report detailing combined interstitial and surface HDR brachytherapy for a hand SCC.

Material and methods
The patient received 4050 cGy in 9 fractions, twice daily using 6 interstitial catheters and 8 Freiburg flap catheters. The clinical target was defined by MRI and ultrasound as a dorsal mass to the interspace between the heads of the third and fourth metacarpals measuring approximately 7 mm transverse × 5 mm volar-dorsal × 16 mm proximal-distal.

The treatment resulted in radiographic and clinical tumor control. The patient retained functional use of her hand. However, there were both acute and late treatment-related side effects. Acutely, inpatient admission for pain control with a nerve block was needed. Long-term toxicity was notable for grade 2 skin necrosis treated with hyperbaric oxygen.

The first interstitial and surface HDR brachytherapy for cutaneous squamous cell carcinoma of a finger interspace for hand function preservation is presented. The initial experience revealed that brachytherapy was tolerated but with notable acute and late side effects. Treatment did result in tumor shrinkage with organ preservation and function of two rays. A larger cohort of patients will be required for additional conclusions related to long-term clinical benefits in patients who refuse ray amputation.


interstitial brachytherapy, surface brachytherapy, cutaneous squamous cell carcinoma

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