RESUMO
Chordomas are rare and locally aggressive tumours that arise from embryonic remnants of the notochord, with a predilection for the skull base, mobile spine, and sacrum. Sacral or sacrococcygeal chordomas can be particularly difficult to manage because of their large size at presentation and involvement of adjacent organs and neural structures. Although the recommended definitive therapy for such tumours is either en bloc resection with or without adjuvant radiotherapy (RT) or definitive fractionated RT with charged particle therapy, older and/or less-fit patients may not necessarily be accepting of said approaches due to the potential morbidities and challenging logistic requirements. Here, we report a case of a 79-year-old male presenting with intractable lower limb pain and neurologic deficits due to a large de novo sacrococcygeal chordoma. The patient was successfully treated with a 5-fraction course of stereotactic body radiotherapy (SBRT), given with palliative intent, with complete relief of his symptoms achieved approximately 21 months after RT and without the development of any iatrogenic toxicities. In view of this case, ultra-hypofractionated SBRT may be a suitable option for the palliation of large de novo sacrococcygeal chordomas for selected patients to reduce their symptom burden and improve their quality of life.
RESUMO
PURPOSE: Permanent tattoo marks used in radiation therapy remain for the duration of treatment and essentially for the rest of the patient's life. This study compared the initial positioning setup errors and body image perception between patients with ultraviolet (UV) and conventional dark ink tattoos. METHODS AND MATERIALS: Thirty-four patients from February 2018 to March 2019, who underwent radiation therapy (RT) to the breast or chest wall for ductal carcinoma in situ or breast cancer were prospectively recruited and randomized (1:1) to receive either conventional dark ink or UV ink tattoos. Each patient received the assigned tattoos during computed tomography (CT) simulation and initial treatment setup shifts were compared. A 9-item body-image survey was administered to all patients at 3 time points: CT simulation, last week of RT, and 6 weeks post-RT. Feedback from CT and treatment staff in terms of setup time and challenges were collated. RESULTS: The median age of the patient cohort was 46 years old. No statistically significant difference was observed between the mean setup errors for the conventional dark ink group (0.11 cm inferior, 0.01 cm left, 0.11 cm posterior) and UV ink group (0.01 cm superior, 0.01 cm right, 0.06 cm posterior; P = NS). Similar responses were observed in the body-image survey between the 2 groups across all time points (P = NS). The majority of the patients (dark ink 82.3% vs UV ink 88.2%) did not feel less sexually attractive as a result of the tattoo at 6 weeks post-RT. At 6 weeks post-RT, patients in both groups were satisfied with the appearance of the tattoo and did not feel cautious about their choice of clothes (82.4% vs 88.2%; P = NS). In addition, 88.6% of staff (n = 35) felt minimum effect of UV ink on the overall setup time, and 94.3% found no difficulty localizing the UV ink tattoos during patient positioning. CONCLUSIONS: No difference in setup accuracy was found using UV ink tattoos, and it could be implemented clinically with minimal effect on the existing workflow. Patients expressed high satisfaction and self-confidence with the use of UV ink tattoos.