TURKISH JOURNAL OF ONCOLOGY 2019 , Vol 34 , Num 4
Subungual Squamous Cell Carcinoma of the Thumb Treated by "Function Sparing Approach" Using Contact Radiotherapy (Brachytherapy)
Luca TAGLIAFERRI1,Valentina LANCELLOTTA1,Bruno FIONDA1,Giulia PANZA2,Patrizia CORNACCHIONE1,Giuseppe COLLOCA1,Luigi AZARIO3,Gian Carlo MATTIUCCI2,Maria Antonietta GAMBACORTA2,Vincenzo VALENTINI2
1U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario ?A. Gemelli? IRCCS, Rome-Italy
2U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Istituto di Radiologia, Fondazione Policlinico Universitario ?A. Gemelli? IRCCS, Università Cattolica del Sacro Cuore, Rome-Italy
3U.O.C. Fisica Sanitaria, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Istituto di Fisica, Fondazione Policlinico Universitario ?A. Gemelli? IRCCS, Università cattolica del Sacro Cuore, Rome-Italy DOI : 10.5505/tjo.2019.2002 A-48-year old man, affected by HIV, working as an electrician, presented a swollen and painful subungual lesion over the distal phalanx of the right thumb with an important limitation to his job. A cutaneous examination of the right thumb revealed an irregular erosive crusted mass formation about 2 cm×1 cm size with erythematous changes and complete destruction of the overlying nail plate. There was no evidence of regional lymphadenopathy; the patient was studied with computed tomography that did not show any distant disease. A conservative onychectomy was performed with removal of the lesion and with histological confirmation of SCC. However, after five months, the patient presented local recurrence over the thumb. Amputation was proposed, but the patient declined due to the negative impacts on his job. Thus, contact radiotherapy (i.e., brachytherapy, BT) was proposed. BT was delivered using a customized homemade surface mold with six plastic tubes arranged around. The total delivered dose was 40 Gy delivered in eight fractions, 5 Gy for daily using Iridium-192 High Dose Rate (HDR) source. Four years later, recently, the patient is free from disease and has a complete functionality of the thumb without any limitations in any movement and in his job. The patient only reported a slight sensitivity reduction. Keywords : Brachytherapy; contact radiotherapy; interventional radiotherapy; thumb carcinoma