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Purpose Locally residual nasopharyngeal carcinoma (NPC) is associated with increased risk of local failure, if additional treatment is not applied. The objective of this paper was to report the treatment effect of fibre-optic endoscope-guided three-dimensional high-dose-rate interstitial brachytherapy (3D HDR ISBT) boost, integrated with radical external beam radiotherapy (EBRT) for deep-seated NPC residual lesion. Case report A 52-year-old female, with a diagnosis of NPC and biopsy-proven low-differentiated squamous cell carcinoma (SCC) in left nasopharynx; the tumor size was 3.9 × 2.2 × 2.6 cm3 before treatment (T2N0M0). Three months after completion of EBRT, with a dose of 69.96 Gy in 33 fractions and concurrent chemotherapy with cisplatin, the residual tumor (3.3 × 1.8 × 2.2 cm3) was treated with 3D HDR ISBT boost under fibre-optic endoscope guidance. The brachytherapy dose was 14 Gy in 2 fractions of 7 Gy each. Results The removal of deep-seated residual tumor was securely achieved by 3D HDR ISBT, guided with fibre-optic endoscope. The refractory tumor in the patient healed uneventfully after fibre-optic endoscope-guided 3D HDR ISBT, without a recurrence during 26 months of follow-up. Conclusions Fibre-optic endoscope-guided 3D HDR ISBT boost could be an additional treatment strategy for locoregional residual NPC after radical EBRT, especially for deep invasive lesion.

Purpose The aim of the report was the evaluation of application with image-guided high-dose-rate (HDR) interstitial brachytherapy in patients undergoing conventional chemo-radiotherapy for perineal locally recurrent rectal cancer (LRRC). Material and methods 75-year-old female patient presented with LRRC three years after total mesorectal excision (TME) surgery for rectal cancer with tubular adenocarcinoma (stage IIIB). Despite conventional chemotherapy and external beam radiotherapy, the re-recurrent lesion expanded as 4.5 × 5.5 cm2 located in perineum with skin invasion. The loco-regional recurrent tumor was treated with HDR interstitial brachytherapy under ultrasound guidance and magnetic resonance imaging-based treatment planning. The brachytherapy dose was 50 Gy in 10 fractions of 5 Gy each for 5 weeks. Results Removal of the perineal LRRC was securely achieved by image-guided HDR interstitial brachytherapy technique. The refractory tumor healed uneventfully after interstitial brachytherapy without recurrence during 26 months of follow-up. The patient had good quality of life without serious complications of treatment. Conclusions Image-guided HDR interstitial brachytherapy in selected patient with LRRC in perineum is a proven, effective, and safe treatment method with relatively long-term outcome.

The aim of this study is to report an uncommon case of nasal keloid treated with adaptive image-guided high-dose-rate (HDR) intracavitary brachytherapy. A 34-year-old female presented with nasal keloid after facial trauma was treated with scar resection and HDR intracavitary brachytherapy with a customized eccentric applicator. The total dose was 21 Gy in 6 fractions. During 3 years of follow-up, there was no evidence of recurrence at the local site, and no complications. In conclusion, HDR intracavitary brachytherapy is an effective way to prevent the recurrence of nasal keloids post-surgery.