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Use of neoprene mask-case report: patient sensitization during radiotherapy treatment

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Angiosarcoma is a rare and aggressive subtype of vascular sarcoma that affects the head and neck region in more than half of the cases especially the scalp. The case report referred to a 78-yearold male patient diagnosed with scalp epithelioid angiosarcoma with scattered lesions. When diagnosing treatment with systemic chemotherapy and due to a good chemotherapy response concomitance with local radiotherapy throughout the scalp was indicated by IMRT-RapidArc associated with 5mm neoprene mask and immobilization mask. Radiotherapy is one of the forms of treatment particularly the irradiation of the entire scalp due to its infiltrative characteristics and conventionally it uses the combination of photon and electron beams in lateral fields with wax bolus or superflab for dose superficialization. Due to the convexity of the entire scalp this type of bolus has disadvantages in daily reproducibility and air gap formation which may interfere with dose distribution. However, a treatment technique already described in the literature was chosen through IMRT which allows a more precise concave dose distribution, with protection of adjacent structures (brain) associated with a 5mm thick Neoprene mask for bolus effect. Therefore, the patient had to wear both masks (Neoprene + immobilization) during the treatment day which is the great challenge of this new form of treatment. The main of this report was to demonstrate the patient‘s tolerance to the technique employed in face of the daily positioning challenge made by the nursing staff and radiotherapy technicians so that the treatment could be successfully completed. Finally, it was evident that this innovative technique despite its challenges had optimistic results. The nursing team played a fundamental role in sensitizing this patient as well as the technical team in managing it daily.


radiotherapy, neoprene, immobilization mask, head and neck, scalp