Palliative brachytherapy to axilla and hypopharynx in elderly patient with hypopharyngeal squamous cell carcinoma - case report

Abstract

Brachytherapy (BT) is an important local treatment of tumor and it can be applied to different anatomical sites either in a curative or palliative setting. BT can deliver large dose of radiation to the tumor while sparing the surrounding normal tissue which translates into a better therapeutic ratio compared to external beam radiotherapy. However, the evidence for the use of brachytherapy in the palliative setting is lacking in the literature. In this case report, we describe the brachytherapy technique and outcome of a patient with squamous cell carcinoma of the hypopharynx who underwent palliative brachytherapy to the hypopharynx and metastatic tumor at the right axilla.

Keywords: axilla; brachytherapy; elderly; hypopharynx; squamous cell carcinoma.

Figure 1

12 × 7 cm foul smelling fungating lesion at the right axilla

Figure 2AB

Axial slice of CT showing extensive right axilla lesion involving the chest wall and right arm

Figure 3

15 applicators were used to cover the marked tumour area sufficiently

Figure 4

Final isodose plan after optimization

Figure 5

One-week post treatment, the axillary fungating mass had flattened and there was no more spontaneous bleeding

Figure 6

The axillary tumour site showed telangiactesia at the periphery and slough covered cavity with no significant pain or active bleeding

Figure 7A

The isodoses were normalized and adjusted graphically as to have the 100% isodose covering 1 cm depth laterally from the from the centre of the applicator; B. Due to the geographical position of the tumor, 0.5 cm safety margin superiorly and 1.5 cm inferiorly of the gross tumor volume (GTV) was assigned