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• W4386987337 abstract "Purpose There has been increased use of surface mould brachytherapy (SMBT) for treating superficial skin lesions located over curved surface and at locations where a sharp dose fall-off is required. We describe our clinical workflow, dosimetry and initial clinical outcome of treating extramammary Paget's disease (EMPD) using SMBT with 3D printed custom applicator. Materials and Methods CT images acquired with and without a thin metal wire were used for delineating target extent to aid contouring gross disease and designing 1cm thick applicator, respectively, in MIM treatment planning system (MIM Software Inc., Cleveland, OH, USA). CTV was delineated on CT images aided by clinical exam and a uniform lateral margin of 7mm was applied to define target. The standard triangle language (STL) files for the applicator and target were generated and further processed in Autodesk Inventor 2021, Autodesk MeshMixer 2017, and Autodesk MeshEnabler 2021 (Autodesk, Inc. San Rafael, California, USA) to design the applicator. Customized catheter positioning regarding spacing and depth from the skin surface (5-7mm, depending upon the patient anatomy) were designed to cover the target volume and minimize dose to organs at risk (OAR). Applicators were then 3D printed using the Accura ClearVue, a USP class VI transparent resin. Plastic catheters were inserted in the applicator and QA test completed to ensure a safe radiation source delivery before using them to acquire planning CT images. Treatment plans were generated with a uniform prescription (Rx) of 42.5Gy in 10 daily fractions prescribed at the target surface with the aim of Target D90%>35Gy and maximum surface dose (defined by D0.3cc) <130% of Rx. We present initial experience, local control, toxicity and cosmesis results for first five EMPD patients treated with our customized SMBT workflow. Results Median patient age was 77yrs (range 66-94), and 3 were female 2 male. All patients presented with characteristic expanding erythematous plaques with typical histopathology and supportive immunohistochemical and clinical findings for EMPD. Median follow-up was 13.3 months (range 1.5-33.4). Mean Target D90 was 34.5 Gy (range 31.7-36), mean Target D0.1cc 53.1 Gy (range 46.2-58.4), mean Target D0.3cc 51.3 Gy (range 45.3-56.4), and mean Target D0.5cc 50.3 Gy (range 44.9-55.4). Treatment was well tolerated, with complete response in 5/5 patients and marginal relapse in 1 patient (Figure 1) which was outside of the treatment field at 13.6 months post-treatment. Acute dermatitis grade 3 was noted in 4 patients with resolution at mean of 49.2 days (range 44-54) and late toxicity hypopigmentation (grade 1; 3 patients) and telangiectasia (grade 1; 1 patient) was noted in a subset of patients treated. Conclusions SMBT was successfully planned and delivered for EMPD using 3D printed custom applicators. Excellent target coverage was achieved while minimizing dose to OAR, and toxicity and cosmesis rates were good to excellent. There has been increased use of surface mould brachytherapy (SMBT) for treating superficial skin lesions located over curved surface and at locations where a sharp dose fall-off is required. We describe our clinical workflow, dosimetry and initial clinical outcome of treating extramammary Paget's disease (EMPD) using SMBT with 3D printed custom applicator. CT images acquired with and without a thin metal wire were used for delineating target extent to aid contouring gross disease and designing 1cm thick applicator, respectively, in MIM treatment planning system (MIM Software Inc., Cleveland, OH, USA). CTV was delineated on CT images aided by clinical exam and a uniform lateral margin of 7mm was applied to define target. The standard triangle language (STL) files for the applicator and target were generated and further processed in Autodesk Inventor 2021, Autodesk MeshMixer 2017, and Autodesk MeshEnabler 2021 (Autodesk, Inc. San Rafael, California, USA) to design the applicator. Customized catheter positioning regarding spacing and depth from the skin surface (5-7mm, depending upon the patient anatomy) were designed to cover the target volume and minimize dose to organs at risk (OAR). Applicators were then 3D printed using the Accura ClearVue, a USP class VI transparent resin. Plastic catheters were inserted in the applicator and QA test completed to ensure a safe radiation source delivery before using them to acquire planning CT images. Treatment plans were generated with a uniform prescription (Rx) of 42.5Gy in 10 daily fractions prescribed at the target surface with the aim of Target D90%>35Gy and maximum surface dose (defined by D0.3cc) <130% of Rx. We present initial experience, local control, toxicity and cosmesis results for first five EMPD patients treated with our customized SMBT workflow. Median patient age was 77yrs (range 66-94), and 3 were female 2 male. All patients presented with characteristic expanding erythematous plaques with typical histopathology and supportive immunohistochemical and clinical findings for EMPD. Median follow-up was 13.3 months (range 1.5-33.4). Mean Target D90 was 34.5 Gy (range 31.7-36), mean Target D0.1cc 53.1 Gy (range 46.2-58.4), mean Target D0.3cc 51.3 Gy (range 45.3-56.4), and mean Target D0.5cc 50.3 Gy (range 44.9-55.4). Treatment was well tolerated, with complete response in 5/5 patients and marginal relapse in 1 patient (Figure 1) which was outside of the treatment field at 13.6 months post-treatment. Acute dermatitis grade 3 was noted in 4 patients with resolution at mean of 49.2 days (range 44-54) and late toxicity hypopigmentation (grade 1; 3 patients) and telangiectasia (grade 1; 1 patient) was noted in a subset of patients treated. SMBT was successfully planned and delivered for EMPD using 3D printed custom applicators. Excellent target coverage was achieved while minimizing dose to OAR, and toxicity and cosmesis rates were good to excellent." @default.
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• W4386987337 date "2023-09-01" @default.
• W4386987337 modified "2023-10-18" @default.
• W4386987337 title "PO118" @default.
• W4386987337 doi "https://doi.org/10.1016/j.brachy.2023.06.219" @default.
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