29 Skin Cancer

Skin Cancer

8

THE GEC ESTROHANDBOOKOF BRACHYTHERAPY | Part II Clinical Practice Version 1 - 30/04/2017

Fig. 31.7: Large flap wax-made for scalp contact brachytherapy with nine parallel plastic tubes. A second mask is added and tied, to keep the wax at place.

Fig. 31.9: Wax moulds for nose and curved areas. Isodose curves for a nasal mould with five plastic tubes.HDR 3Gy three times a week x 16 fractions. Results at two years.

Fig. 31.8: Custom-made polymethyl methacrylate surface moulds with six plastic tubes. (from Guix et al. 2000, with permission [49])

they are located in the middle axis of the flap with 5 mm from the skin. The HAM flap applicator has an array of catheters spaced 10 mm apart and at 5 mm from the skin. Thermoplastic masks aid to fix the position for the daily exact placement in contact with the skin (Fig. 6). Large areas such the scalp can be treated with different systems using thin wax layers, silicon or similar materials to fix the parallel plastic tubes to the head [21, 22, 23] (Fig. 7).

8.1.3 Customized Moulds Individual off prints can be taken from different anatomical areas to construct surface-moulds containing plastic tubes for, PDR or HDR afterloading: these moulds allow contact brachytherapy of several anatomical tumour sites, including irregular shaped areas such as the external ear or nose (Fig. 31.8 and 31.9).