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cavity, 250µm in diameter and 4mm deep, is filled with
the scintillating material, terbium doped gadolinium
oxysulphide (Gd
2
O
2
S:Tb, GOS) and sealed with epoxy. The
scintillation material fluoresces on exposure to ionising
radiation and the resultant emitted fluorescent light
penetrates the PMMA optical fibre core and propagates
along the fibre to a Hamamatsu Multi-Pixel Photon
Counting Module (MPPC C11208) for monitoring of the
optical signal.
Results
The sensor was further evaluated for its response to
different levels of radiation to determine its suitability for
brachytherapy applications. The sensor is exposed to a full
cartridge, i.e. 15 seeds, corresponding to an activity of
5.35mCi and to a second full cartridge corresponding to an
activity of 4.45mCi. Alongside the optical fibre sensor, the
charge was also collected within a Standard Imaging HDR
1000 Well Chamber and a reading displayed on the
Standard Imaging Max 4000 Electrometer. Fig 2 shows the
average photon counts equate to 750 for 5.35mCi and 655
for 4.45mCi, corresponding to a 12.6% reduction in photon
counts. The radiation activity of 5.35mCi resulted in a
current of 18.47pA and 4.45mCi directly equating to a
13.6% reduction in activity.
Conclusion
The sensor demonstrates excellent stability, with a
standard deviation of 18 counts. The current
repeatability, with a maximum percentage deviation of
3.3%, is within accepted limits, however it is envisaged
that the future experimental set-up employing a
brachytherapy phantom, will significantly improve this.
Electronic Poster: Brachytherapy: Miscellaneous
EP-1801 HDR-plesiotherapy for the treatment of
extramammary paget’s disease. A case report.
M.F. Ropero Carmona
1
, J. Lupiani Castellanos
1
, J. Quirós
Rivero
1
, A. Ruiz Herrero
1
, M.A. Gonzalez Ruiz
1
, J. Cabrera
Rodriguez
1
, Y. Ríos Kavadoy
1
, J.L. Muñoz Garcia
1
, P.
Almendral Manzano
1
1
Hospital Universitario Infanta Cristina, Radiotherapy
Oncologist, Badajoz, Spain
Purpose or Objective
In 1889, Crocker first described extramammary Paget’s
disease (EMPD). It is considered a rare adenocarcinoma
that originates from the skin or skin appendages in areas
with apocrine glands. EMPD classification is based on the
presence or absence of associated malignancies: Primary
or intraepithelial and Secondary. It is more common
postmenopausal women. The main anatomical location is
the vulva (65%), followed by the perianal region, scrotum,
penis and axilla. The disease presents with well-defined
eczematous eruption or leukokeratotic plaque, and a
tendency for multifocal lesions.
The standard treatment for local EMPD is surgical
resection, although this approach might not be suitable for
all patients. Topical treatments such as Imiquimod cream,
5-fluorouracil cream and CO2 laser may also be used, with
variable results. Recently, radiotherapy (RT) has been
widely used to treat EMPD. RT can be used as the primary
treatment in elderly patients with comorbidities who are
considered medically inoperable, or in patients who want
to preserve body function or structure.
In a review of the literature, we found only three patients
of Paget extramammary treated with HDR-plesiotherapy
by custom mold.
Material and Methods
We present a case of Paget’s disease treated by HDR-
plesiotherapy with a custom made mold with curative
intention. A 80-year-old female presented with a 2-year
history of a skin lesion in the glutes, intergluteal folds and
vulva, about 11-12 cm, whith pruritus, erythema, and
punctate bleeding. Positive biopsy for EMPD. Additional
exams did not reveal an underlying malignancy.
The patient was treated initially by means of topical
applications of imiquimod cream but in the absence of
response she was referred to the Radiation Oncology
Department. Treated by HDR-plesiotherapy with a
custom-made mold with up to a final dose 50 Gy in 10
fractions of 500 cGy, two days a week (EQD2 62.5Gy).
Results
Acute adverse effects include epithelitis grade 2 and
epithelitis small areas grade 3, which resolve with topical
measures. After three months of treatment, the patient
had complete response and resolution epithelitis.
Conclusion
In our opinion, HDR plesiotherapy with a custom-made
mold appears to be an ideal alternative for elderly
patients with comorbilities, not candidates for aggressive
surgical management or who refuse surgery.
EP-1802 The role of the high dose rate brachytherapy
in the conservative treatment of esophageal cancer.
A. Lozhkov
1
, A.V. Vazhenin
1
, T.M. Sharabura
1
1
Chelyabinsk Regional Oncol.Centre, Department for
Radiotherapy and Radio-Oncology, Chelyabinsk, Russian
Federation
Purpose or Objective
To evaluate the results of add to EBRT intraluminal HDR
brachytherapy.
Material and Methods
Between 2008 and 2015, 82 people with cancer of the
thoracic esophagus T2-3N0-1M0 and refusal of surgery
received radiation therapy.
In the first phase all patients underwent external beam
radiotherapy up to 40-50 Gy. Subsequently, the patients
were divided into 3 groups. The first group included 30
patients who received concomitant radiotherapy using
brachytherapy, in the 2nd group -30 patients who received
EBRT 60-70 Gy, in 3 group -22 patients received EBRT 40-