Angio Sarcoma Scalp (ASS) is a rare solid tumor with a high risk of local recurrence. This study is to report the utility of high dose rate (HDR) brachytherapy as a primary/boost treatment for an ASS following external beam radiation therapy. A patient with ASS underwent wide local excision and skin graft. In view of positive margin she was planned for EBRT with 50Gy in 25 fraction and mould brachytherapy. A 0.5cm thick gel bolus was customized and was used to cover the scar of about 10 cm diameter.10 flexible interstitial applicators were sandwiched between these two gel bolus at a distance of 1 cm. Markings were made on patients skull to ensure precise placement of the mould. Patient underwent computerized tomography (CT) simulation with the customized mould fixed over the treatment area. CTV is drawn and applicators were reconstructed in varian eclipse version 17 planning system. Dose of 13.5Gy in 3 fractions was planned and delivered as BD. Similarly another patient was treated with customized wax bolus of 0.5 cm thick with 6 flexible interstitial applicators. Dose of 50Gy in 10 fractions was planned and delivered as BD. Treatment was delivered with 20 channel GammaMedplus iX HDR brachytherapy machine using Iridium 192 source. 

In ASS cases with positive dissection margin this is an effective treatment option. Our customized mould provides high conformity to the scalp’s anatomy, optimizing dose to tumor while sparing surrounding normal tissues. Also we were able to deliver surface mould brachytherapy precisely with utmost patient comfort. The customized surface mould ensured proper coverage to the scar, compared to the standard flap. Customized surface mould HDR brachytherapy as primary or followed by EBRT provides excellent tumor control with minimal toxicity hence it is a promising treatment modality for ASS.

Biju P Thomas has completed his Masters in Radiation Physics from Calicut University, Kerala, India. He is the head of Medical Physics department of Radiation Oncology, Caritas Cancer Institute, Kerala, India. He has many National and International presentations and publications. He has been serving as faculty of Radiation Physics/Biophysics and board of examinations in various universities in Kerala, India. He is a full member of Member of Institute of Physics and Engineering in Medicine (MIPEM) and a certified Clinical Scientist from Health and Care Professions Council (HCPC).