PMC10335800_01
(A) Clinical presentation of the acrometastasis; (B) MR exam of the left hand; (C) set-up procedure; (D) contouring process on the CT-simulation; (E) 95% dose coverage with the two treatment coplanar arcs highlighted; (F) hand status one month after SBRT.
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Tomography (CT) couch with her left hand above her head and between a two-sheet stereotactic mask within the frameless extension for ExacTrac  system (Brainlab , Munich, Germany) at the couch top, the hand replacing the skull (Figure 1). The simulation CT scan was acquired with 1.5mm thickness slices and merged with the previous diagnostic MRI for precise delineation of the gross tumor volume (GTV). This was 1 mm-expanded to create a clinical target volume (CTV) covering any possible subclinical spread, especially in the fifth metacarpal bone.
Treatment setup verification by the ExacTrac system.
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The treatment was delivered under both the ExacTrac- and cone beam CT-guidance in five consecutive days in September 2022 (Figure 2).
Timeline of events.
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The brain MRI re-evaluation is awaited in due course (Figure 3).