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Granulomatous slack skin disease: a new combined proton and photon therapy approach with a reported case response

Published online by Cambridge University Press:  30 July 2014

Jonathan B. Farr ,
Allan F. Thornton ,
Avril O’Ryan-Blair ,
Chris E. Allgower ,
Arnold L. Schroeter  and
Andries N. Schreuder
Jonathan B. Farr*
Affiliation:
Midwest Proton Radiotherapy Institute (Renamed Indiana Health Proton Therapy Center in 2008), Indiana University, Bloomington, IN, USA
Allan F. Thornton
Affiliation:
Midwest Proton Radiotherapy Institute (Renamed Indiana Health Proton Therapy Center in 2008), Indiana University, Bloomington, IN, USA
Avril O’Ryan-Blair
Affiliation:
Midwest Proton Radiotherapy Institute (Renamed Indiana Health Proton Therapy Center in 2008), Indiana University, Bloomington, IN, USA
Chris E. Allgower
Affiliation:
Midwest Proton Radiotherapy Institute (Renamed Indiana Health Proton Therapy Center in 2008), Indiana University, Bloomington, IN, USA
Arnold L. Schroeter
Affiliation:
Mayo Clinic, Department of Dermatology, Rochester, MN, USA
Andries N. Schreuder
Affiliation:
Midwest Proton Radiotherapy Institute (Renamed Indiana Health Proton Therapy Center in 2008), Indiana University, Bloomington, IN, USA
*
Correspondence to: Jonathan B. Farr, Department of Radiological Sciences, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Mail Stop 220, Memphis, TN 38105 2794, USA. Tel: +901 595 8059. Fax: +901 595 3981. E-mail: jonathan.farr@stjude.org
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Abstract

Purpose

Here, we report the feasibility and long-term efficacy of a granulomatous slack skin disease (GSSD) treatment with combined high-energy photon and proton beams.

Patient and methods

A GSSD patient with abdominal disease volume 25×15×2–4 cm deep was recommended for treatment at this institution. In addition to photons and electrons, high-energy protons delivered with advanced planning techniques and patient positioning were used. The patient was irradiated to a total dose of 40 Gy by using 20 Gy matched photon and electrons followed by 20 Gy equivalent protons delivered by using innovative range compensation and patient positioning.

Results

The test patient tolerated the treatment well and is now a 10-year survivor of the disease.

Conclusions

Treatment of GSSD with protons is feasible. The range and narrow penumbra properties of the proton beam provided an ideal capability to match fields accurately to cover large volumes while also sparing underlying normal tissues.

Keywords

granulomatous slack skin diseaseproton therapyrobotic patient positioning
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 14 , Issue 1 , March 2015 , pp. 4 - 9
Copyright
© Cambridge University Press 2014 

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