High-dose-rate surface mold with tumor translucency brachytherapy for a 103-year-old patient with skin cancer, dementia, tremor, and kyphosis: a case report.

Abstract

Cancer treatment for centenarians can be challenging. High-dose-rate surface mold brachytherapy is a non-invasive, radical treatment modality for surface cancer. Further, it is used for patients who cannot remain at rest or have poor posture. We performed this treatment on a 103-year-old female patient with forehead skin cancer, dementia, tremors, and kyphosis since radical surgery and external beam radiotherapy were not feasible. A custom-made surface mold with tube applicators was developed with vinyl sheet and silicone. The vinyl sheet was utilized to enable tumor visualization through the mold and to confirm the tumor position relative to the mold. The mold with tumor translucency was fixed to the tumor surface, and the radioisotope (Ir-193) was sent remotely through tube applicators for irradiation. The planning-aim doses were 48 Gy in eight fractions. The positional relationship between the mold and the tumor was confirmed similarly during irradiation by checking them through the vinyl sheet before and after irradiation. We treated the patient, although she was in constant motion during irradiation. The local tumor was well-controlled without any metastatic disease evidence. The tumor disappeared before her eventual death 11 months post-treatment. No serious adverse events were reported during the follow-up period. Our results indicate that high-dose-rate surface mold with tumor translucency brachytherapy is an effective cancer treatment for centenarians with dementia, tremors, and kyphosis.