ESTRO 2023 - Abstract Book

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ESTRO 2023

1 Hospital Universitario 12 de Octubre, Radiation Oncology, Madrid, Spain; 2 Hospital Universitario 12 de Octubre, Medical Physicist, Madrid, Spain Purpose or Objective To describe, in a case report, the treatment of Extramammary Testicular Paget's Disease with Contact Brachytherapy (Plesiotherapy). Materials and Methods Extramammary Paget's disease (EMPD) is a locally invasive intraepithelial neoplasm of apocrine glands such as the penoscrotal area, vulva and occasionally the axillae. The lesions present clinically as well-demarcated erythematous plaques that may be erosive or ulcerated. The present clinical case focuses on a 76-year-old male with a diagnosis of Extramammary Paget's penoscrotal area disease with intraepidermal involvement without ulceration and intraductal involvement of the dermal sweat gland (adenocarcinoma in situ of sweat gland origin). On examination, the skin of the root of the penis and scrotal pouch shows an erythematous and raised lesion that exceeds the midline but predominantly affects the left side, scaly and with pruritic lacerations. There is itching on rubbing, with two nodular lesions on the skin of the penile base.

Plesiotherapy is a technique is based on superficial fixation of the high dose rate radioactive source (HDR) with the lesion. So that the radioactive source reaches the superficial proximity of the area to be treated.

The 90% isodose should cover at least 95% of the volume, and the surface dose should not exceed 150%.

The number of plastic catheters and the spacing between them depend on the of the area to be treated.

The treatment dose is prescribed 5 mm deep from the surface of the cast. At the beginning of each session, the customized cast is placed adhered to the lesion as precisely and securely as possible. The external applicator is connected to equipment that includes a high-dose radioactive source (HDR) with Iridium-192.

Results In this case, the treatment regimen includes a total dose of 50Gy.

With fractionated doses of 2Gy by means of the 12 radioactive sources distributed symmetrically and equidistantly.