Dermatofibrosarcoma protuberans of the upper eyelid treated with surface mould high-dose-rate brachytherapy
Abstract
Dermatofibrosarcoma protuberans (DFSP) is a rare spindle cell tumor, comprising less than 0.1% of all malignant neoplasms. The trunk is the most commonly affected area, followed by the extremities and the head and neck. Of the latter cases, involvement of the periorbital area has been infrequently reported. Surgery is the cornerstone of treatment but is associated with a high rate of recurrence if margins remain close or positive. This rate has been shown to be considerably decreased by the use of adjuvant radiotherapy. However, most reported cases utilize external beam radiation therapy (EBRT) in the treatment of DFSP, including those with primary periorbital locations. We report a case of a 40-year-old male, presenting with a small nodule on the right upper eyelid, diagnosed as DFSP with positive margins post-surgery and treated with adjuvant customized surface mould high-dose-rate (HDR) brachytherapy in a low-resource setting.
Keywords: brachytherapysoft tissue sarcoma
References
- Williams N, Morris CG, Kirwan JM, et al. Radiotherapy for dermatofibrosarcoma protuberans. Am J Clin Oncol. 2014; 37(5): 430–432.
- Goshe JM, Lewis CD, Meine JG, et al. Primary dermatofibrosarcoma protuberans invading the orbit. Ophthalmic Plast Reconstr Surg. 2012; 28(3): e65–e67.
- Burkhardt B, Soule E, Winkelmann RK, et al. Dermatofibrosarcoma protuberans. Am J Surg. 1966; 111(5): 638–644.
- Mopper C. Dermatofibrosarcoma protuberans. Arch Dermatol. 1957; 76(2): 258.
- Haas RLM, Miah AB, LePechoux C, et al. Preoperative radiotherapy for extremity soft tissue sarcoma; past, present and future perspectives on dose fractionation regimens and combined modality strategies. Radiother Oncol. 2016; 119(1): 14–21.
- Naghavi AO, Fernandez DC, Mesko N, et al. American Brachytherapy Society consensus statement for soft tissue sarcoma brachytherapy. Brachytherapy. 2017; 16(3): 466–489.
- Benedict SH, Yenice KM, Followill D, et al. Stereotactic body radiation therapy: the report of AAPM Task Group 101. Med Phys. 2010; 37(8): 4078–4101.
- Castle KO, Guadagnolo BA, Tsai CJ, et al. Dermatofibrosarcoma protuberans: long-term outcomes of 53 patients treated with conservative surgery and radiation therapy. Int J Radiat Oncol Biol Phys. 2013; 86(3): 585–590.
- Bashir S, Tariq M, Aslam HM, et al. Orbital dermatofibrosarcoma protuberans with intracranial extension preceded by recurrent leiomyoma of the orbit: a case report. J Med Case Rep. 2015; 9: 96.
- Erickson BP, Henry C, Alabiad CR. Recurrent Dermatofibrosarcoma Protuberans Masquerading as a Lacrimal Sac Neoplasm: A Case Report and Review. Ophthalmic Plast Reconstr Surg. 2015; 31(5): e135–e138.
- Nakra T, Cook T, Douglas RS, et al. Dermatofibrosarcoma protuberans metastatic to the orbit. Arch Ophthalmol. 2004; 122(8): 1240–1241.
- Sharudin SN, Tan SW, Mohamad NF, et al. Orbitofacial dermatofibrosarcoma protuberans with intranasal extension. Orbit. 2018; 37(3): 196–200.
- Banu P, Rukhsana N, Jabber MA, et al. Hypofractionated Radiotherapy for Post-Operative Breast Cancer Patients at Delta Hospital — an Evaluation of Clinical Experience. Delta Med College J. 2015; 3(1): 4–8.
- Schittkowski MP, Wrede A. Dermatofibrosarcoma protuberans with primary orbital manifestation. Orbit. 2013; 32(2): 117–119.
- Bonadies A, Elia F, Solivetti FM, et al. Electrochemotherapy of a Multirecurrent Dermatofibrosarcoma Protuberans of the Orbital Margin: A Case Report. Anticancer Res. 2015; 35(11): 6121–6126.
- Brazzo BG, Saffra N. Dermatofibrosarcoma protuberans of the brow and eyelid. Ophthalmic Plast Reconstr Surg. 2004; 20(4): 332–334.
- Shah C, Ouhib Z, Kamrava M, et al. The American Brachytherapy society consensus statement for skin brachytherapy. Brachytherapy. 2020; 19(4): 415–426.
- Klein EE, Esthappan J, Li Z. Surface and buildup dose characteristics for 6, 10, and 18 MV photons from an Elekta Precise linear accelerator. J Appl Clin Med Phys. 2003; 4(1): 1–7.
- Podgorsak EB. External Photon Beams: Physical Aspects. In: Podgorsak EB. ed. Radiation Oncology Physics: A Handbook for Teachers and Students. International Atomic Energy Agency, Vienna 2005: 161–217.
- Lal P, Sharma R, Mohan H, et al. Dermatofibrosarcoma protuberans metastasizing to lymph nodes: a case report and review of literature. J Surg Oncol. 1999; 72(3): 178–180, doi: 10.1002/(sici)1096-9098(199911)72:3<178::aid-jso12>3.0.co;2-7.
- Kreicher KL, Kurlander DE, Gittleman HR, et al. Incidence and Survival of Primary Dermatofibrosarcoma Protuberans in the United States. Dermatol Surg. 2016; 42 Suppl 1: S24–S31.