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  • Successful treatment of squamous cell carcinoma of the lip with electron beam therapy: a symphony of medicine and physics

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Successful treatment of squamous cell carcinoma of the lip with electron beam therapy: a symphony of medicine and physics
  1. Irfan Ahmad,
  2. Kundan Singh Chufal,
  3. Chandi Prasad Bhatt,
  4. Sandeep Rathour
  1. Department of Radiation Oncology, Batra Hospital & Medical Research Centre, New Delhi, India
  1. Correspondence to Dr Irfan Ahmad, irfan.a{at}icloud.com

https://doi.org/10.1136/bcr-2017-219771

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    Description

    A female aged 57 years, a professional flautist by occupation presented with a history of non-healing ‘pimple’ on her left upper lip, which was gradually increasing in size over 6 months. There was history of occasional yellowish discharge and bleeding, provoked by her attempts to remove it. On examination, there was a firm non-tender swelling with fine, white crusting, measuring 5 mm at its widest along with surrounding induration of 1 cm (figure 1A), without involvement of the inner mucosa of lip.

    Figure 1

    Pretreatment and post-treatment images. (A) The visible lesion (black arrow) was surrounded by a 1 cm circumferential region of induration (white arrow) appreciated on palpation. These were marked on patients skin and a 2 cm margin (blue arrow) was also marked to serve as the planning target volume. Care was taken to exclude the nasal ala from this volume. To ensure reproducibility a custom treatment setup was devised by our radiation technologist, which included a sterile styrofoam block to keep the mouth open. A sterile rubber-coated flexible lead shield of 5 mm thickness was then placed over the teeth, snugly fitting the gingivo-buccal sulcus. Finally, a custom-moulded sterile wax sheet measuring 1 cm in thickness was interposed between the mucosa of upper lip and the lead shield. Care was taken to ensure that the treatment surface was as even as …

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    Footnotes

    • Contributors IA is the treating senior resident (radiotherapy), author of the paper, responsible for drafting the manuscript and revising it. He is the guarantor. KSC is the supervising treating consultant (radiotherapy) and participated in article formulation, editing and oversight. CPB is the medical physicist, responsible for generating the radiation treatment plan, performing quality assurance of delivered plan and also participated in article editing. SR is the radiation technologist, responsible for creating the treatment setup, ensuring reproducible setup and treatment delivery during the course of treatment. He also participated in article editing.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.