PMC5440184_01
Before treatment: multiple lesions in the face and scalp are noted, consistent with extensive BCC.
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figure1
In November 2015, she was referred to our institution for the consideration of radiation therapy to an extensive recurrent BCC of the left forehead and both temple areas extending into the hairline (Figure 1).
Patient was simulated and treated with a 1 cm custom made helmet bolus. Red isodose line is the Rx dose of 50 Gy for the first plan. Blue line, 25 Gy (50% of Rx dose) is shown, demonstrating excellent coverage with depiction of low dose to regions of the brain.
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figure2
The clinical target volume (CTV) included the skin surface to the depth of the cranium over the extent of the patient's scalp (Figure 2).
Showing beam arrangement: Top Beam A, A1, Middle Beam B, B1, Bottom Beam C (left) and C (right) all beams.
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figure3
Details of each arc are described in Table 1 and shown in Figure 3.
Dose volume histogram (DVH) of the composite plan showing 96 % of the CTV (Red) covered by 60 Gy. V30 of the brain (orange) is less than 20%. The remaining lines represent the dose to the optic nerves (green) with a maximum < 25 Gy, respectively, left lens (cyan) 11 Gy and right lens (magenta) 16 Gy (late formation of cataracts could be expected). The maximum doses to the optic chiasm (dark blue) and brainstem (brown) were less than 16 Gy.
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figure4
The dose volume histogram (DVH) (Figure 4), demonstrated excellent coverage and a homogeneous dose within the target with acceptable dosage of the organs at risk.
Top row: Mid treatment course: complete clinical response with mild dermatitis seen in patches. Grade-I pruritus was recorded clinically. Middle row: evaluation at second follow-up at six months shows complete response and resolution of the erythema. Bottom row: most recent follow-up at 1 year after treatment completion showing complete response and resolution of alopecia.
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figure5
No late toxicities were reported (Figure 5).