Purpose: We report on methods and outcomes of post-operative endocavitary brachytherapy after prior irradiation and salvage surgery in a patient with maxillary alveolar squamous cell carcinoma (SCC).
Material and methods: A 67-year-old male with right maxillary alveolar SCC was referred for brachytherapy after prior definitive chemoradiotherapy and salvage posterior maxillectomy. A personalized endocavitary applicator was fabricated using dental impression plastic tray, vinyl polysiloxane paste, and four flexible catheters to deliver fourteen 3.5 Gy high-dose-rate fractions. High-risk and intermediate-risk clinical target volumes were treated to 3.7 Gy (D90) and 2.4 Gy (D98), with mandibular dose limited to 2.3 Gy (D2cc) per fraction. These corresponded to total 2 Gy equivalent doses (EQD2) of 72.8 Gy, 40.5 Gy, and 34 Gy, respectively.
Results: The patient developed grade 2 mucositis and was disease-free for six months. He had biopsy-confirmed local recurrence at 8 months. He refused further treatment and expired within a month.
Conclusions: This simple approach to a personalized endocavitary applicator is feasible and allows for lower costs and less treatment delays, while ensuring patient comfort and convenience.
Keywords: alveolar cancer; case report; endocavitary brachytherapy; high-dose-rate; re-irradiation.
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