Name of the Procedure:

Remote afterloading high dose rate (HDR) radionuclide skin surface brachytherapy, including basic dosimetry for lesions over 2.0 cm in diameter and involving 2 or more channels, or multiple lesions.

Summary

Remote afterloading HDR brachytherapy is a type of radiation treatment where a high dose of radiation is delivered directly to the skin lesions using a remote device. The procedure targets and treats large skin lesions or multiple lesions using precise dosimetry, minimizing exposure to surrounding healthy tissue.

Purpose

This procedure is primarily used to treat certain types of skin cancers and other surface lesions. The goals are to effectively destroy cancerous cells, reduce the size of the lesion, and prevent recurrence while minimizing side effects.

Indications

• Large skin cancers or lesions larger than 2.0 cm in diameter.
• Multiple skin lesions requiring treatment.
• Patients who are not suitable candidates for surgical removal of the lesions.
• Conditions like basal cell carcinoma, squamous cell carcinoma, and melanoma.

Preparation

• No specific dietary restrictions are typically required.
• Patients may need to stop certain medications that can affect blood clotting.
• Pre-procedure imaging studies such as CT scans or MRIs may be needed to map the lesion.
• Skin must be clean and free of any lotions or creams on the day of the procedure.

Procedure Description

1. Preparation: The lesion area is cleaned and sterilized.
2. Setup: Applicators/channels are placed close to or on the lesion, guided by imaging studies for precision.
3. Planning: Customized dosimetry is conducted to calculate the exact radiation dose.
4. Remote Afterloading: The radiation source is remotely placed into the applicators, ensuring accurate dose delivery to the lesion.
5. Radiation Delivery: High dose radiation is delivered for a specified period, usually a few minutes, before the source is retracted.
6. Completion: The applicators are removed and the area may be dressed if needed.

Technology used includes remote afterloading machines, customized dosimetry software, and applicators.

Duration

The procedure typically takes about 30-60 minutes, depending on the number of lesions and their size.

Setting

This procedure is usually performed in a radiation oncology department within a hospital or specialized outpatient clinic.

Personnel

• Radiation oncologist
• Medical physicist
• Radiation therapist
• Oncology nurse

Risks and Complications

• Skin irritation, redness, and swelling at the treatment site.
• Rare risk of infection at the applicator insertion points.
• Potential for tissue damage or ulceration with high doses of radiation.
• Temporary or permanent changes in skin pigmentation.

Benefits

• Targeted treatment of skin lesions with high precision.
• Minimizes radiation exposure to surrounding healthy tissues.
• Non-invasive alternative to surgery.
• Immediate treatment impact with potential reduction in lesion size visible within weeks.

Recovery

• Patients can typically resume normal activities immediately, though some may experience tenderness.
• Post-procedure care includes keeping the treated area clean and moisturizing.
• Regular follow-up appointments to monitor the treatment site and overall health.
• Complete healing and final results may take several weeks.

Alternatives

• Surgical excision of the lesion.
• Cryotherapy or freezing the lesion.
• Topical chemotherapy or immunotherapy.
• External beam radiation therapy. Each alternative has its own pros and cons, such as longer recovery times for surgery or less precise targeting with external beam radiation.

Patient Experience

• During the procedure, the patient may feel minimal discomfort as it is usually non-invasive.
• Post-procedure, mild pain, and skin irritation are common, which can be managed with prescribed ointments and pain relief medications.
• Patients should expect follow-up visits to ensure the lesion is healing properly and no recurrence of the lesion is observed.