Plesiotherapy with 3D-printed custom molds for extramamary testicular Paget´s disease (EMPD)
Sandra Guardado Gonzalez,
Spain
PO-2189
Abstract
Plesiotherapy with 3D-printed custom molds for extramamary testicular Paget´s disease (EMPD)
Authors: Claudia F. Pedrero1, Sandra Guardado Gonzalez1, Sandra Fernandez Alonso1, Cristian Arias Guillén1, Enrique Capón Sáez1, Gustavo Pozo Rodríguez2, Alejandro Ferrando Sanchez2, José Fermín Pérez-Regadera Gómez1
1Hospital Universitario 12 de Octubre, Radiation Oncology, Madrid, Spain; 2Hospital Universitario 12 de Octubre, Medical Physicist, Madrid, Spain
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Purpose or Objective
To describe, in a case report, the treatment of Extramammary Testicular Paget's Disease with Contact Brachytherapy (Plesiotherapy).
Material 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.
No toxicity at the six-month check-up
The estimated time to evaluate remission of the lesions post-radiotherapy is three and six months.
As acute toxicity he presented Dermitis GII and Mucositis GII in testicular pouch and penile body with gradual resolution thanks to local care by the nursing staff. The response to treatment has been satisfactory at the expense of checking the definitive result during the next year.
Tolerance has been good with excellent collaboration at all times.
The patient completed treatment in February 2022.
The duration of the treatment covers the period from 27/12/2021 to 01/02/2022 including 5 weekly sessions.
Conclusion
Extramammary Paget's disease is a rare neoplasm with a favorable prognosis if diagnosed in early stages.
Plesiotherapy offers excellent locoregional control while preserving the function and esthetics of the affected organ.
This technique can reduce the air between lesion and applicator, improve precision and uniformity of the dose and offer greater protection to organs at risk.