PMC8382068_01
12 x 7 cm foul smelling fungating lesion at the right axilla
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There was a 12 x 7 cm foul smelling fungating lesion at the right axilla that bled spontaneously with movement (Fig. 1).
Axial slice of CT showing extensive right axilla lesion involving the chest wall and right arm
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A repeat CT neck-thorax-abdomen-pelvis (NTAP) did not show any other metastatic disease; however, the local disease at the right axilla was extensive, involving the chest wall and right arm (Fig. 2A and 2B).
15 applicators were used to cover the marked tumour area sufficiently
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In total, 15 BT applicators were used to cover the marked tumour area sufficiently (Fig. 3).
Final isodose plan after optimization
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After achieving a good dose distribution (D90 of PTV receiving 7.23 Gy per fraction) with further manual graphical optimisation of the isodoses, the final plan was exported to the high dose rate (HDR) Nucletron remote after loader system (Fig. 4).
One-week post treatment, the axillary fungating mass had flattened and there was no more spontaneous bleeding
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The axillary fungating mass had flattened and there was no more spontaneous bleeding (Fig. 5).
The axillary tumour site showed telangiactesia at the periphery and slough covered cavity with no significant pain or active bleeding
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Clinically, the axillary tumour site showed telangiactesia at the periphery and slough covered cavity with no significant pain or active bleeding (Fig. 6).
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
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Interestingly, the right axillary region did not show any clinical sign of local recurrence (Fig. 7A and B). TPS. Then, the isodoses were normalized and adjusted graphically to have the 100% isodose covering 1 cm depth laterally from the centre of the applicator (Fig. 7A). Due to the geographical position of the tumor, 0.5 cm safety margin superiorly and 1.5 cm inferiorly of the GTV (Fig. 7B) was assigned.