Scalp uniform bolus application (SCUBA) technique for homogenous scalp and regional nodal irradiation

Abstract

Angiosarcoma is a rare and aggressive malignant neoplasm of unknown etiology, representing only 1% of all sarcomas, with half occurring in the head and neck region.1 It is a subtype of vascular sarcoma, and usually affects patients in the sixth or seventh decade of life. Treatment includes resection with wide margins, with postoperative scalp radiation therapy frequently recommended, given the local failure rate of approximately 50%. Increasingly, systemic or targeted agents are utilized with the aim of improving the 5-year survival rate, which is usually less than 20%.2 Metastatic disease is common, and usually involves lungs and liver. In the head and neck, surgery can be difficult because of the infiltrating nature of the disease and the anatomic constraints of the head and neck that make wide surgical margins difficult to achieve. In such cases, definitive radiation therapy with (neoadjuvant or concurrent) chemotherapy is commonly utilized. Conventionally, total scalp irradiation is delivered using megavoltage photons and electrons, usually 6 MV