Radical treatment of angiosarcoma of the scalp using megavoltage electron beam therapy

Angiosarcoma of the scalp is a multifocal neoplasm that is often initially managed by wide excision and surgical reconstruction. Invariably, adjuvant radiotherapy is required to improve local control. Primary radical radiotherapy to the scalp is not well documented. The major limitation is the technical problem of treating homogeneously an extensive superficial curved volume. We describe a practical technique that can be administered with a standard linear accelerator capable of high-energy electron production. The technique uses a multiple abutted fixed field set-up at constant source to surface distance and the patient is immobilized in a custom wax helmet which also serves to optimize the electron absorbed dose in the treatment volume. Surgical excision and reconstruction is reserved for the salvage of local relapse.