Total skin electron irradiation: evaluation of dose uniformity throughout the skin surface

Anacak, Yavuz; Arican, Zumre; Bar-Deroma, R.; Tamir, Ada; Kuten, Abraham

doi:10.1016/s0958-3947(02)00235-2

Cited by 34 publications

(31 citation statements)

References 7 publications

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“…Total skin electron irradiation (TSEI) is one of the most effective treatments of malignant skin diseases, such as mycosis fungoides (MF) and cutaneous lymphomas 1 , 2 , 3 , 4 The goal is to treat the entire body surface to a limited depth with a relatively uniform dose (e.g.,

\pm 10 %

) (5) . In order to deliver the treatment dose at a shallow depth, low‐energy electrons are considered for TSEI, which is commonly performed with a 6 MeV beam.…”

Section: Introductionmentioning

confidence: 99%

Validation of total skin electron irradiation (TSEI) technique dosimetry data by Monte Carlo simulation

Nevelsky

Borzov

Daniel

et al. 2016

J Applied Clin Med Phys

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Total skin electron irradiation (TSEI) is a complex technique which requires many nonstandard measurements and dosimetric procedures. The purpose of this work was to validate measured dosimetry data by Monte Carlo (MC) simulations using EGSnrc‐based codes (BEAMnrc and DOSXYZnrc). Our MC simulations consisted of two major steps. In the first step, the incident electron beam parameters (energy spectrum, FWHM, mean angular spread) were adjusted to match the measured data (PDD and profile) at SSD=100 cm for an open field. In the second step, these parameters were used to calculate dose distributions at the treatment distance of 400 cm. MC simulations of dose distributions from single and dual fields at the treatment distance were performed in a water phantom. Dose distribution from the full treatment with six dual fields was simulated in a CT‐based anthropomorphic phantom. MC calculations were compared to the available set of measurements used in clinical practice. For one direct field, MC calculated PDDs agreed within 3%/1 mm with the measurements, and lateral profiles agreed within 3% with the measured data. For the OF, the measured and calculated results were within 2% agreement. The optimal angle of 17° was confirmed for the dual field setup. Dose distribution from the full treatment with six dual fields was simulated in a CT‐based anthropomorphic phantom. The MC‐calculated multiplication factor (B12‐factor), which relates the skin dose for the whole treatment to the dose from one calibration field, for setups with and without degrader was 2.9 and 2.8, respectively. The measured B12‐factor was 2.8 for both setups. The difference between calculated and measured values was within 3.5%. It was found that a degrader provides more homogeneous dose distribution. The measured X‐ray contamination for the full treatment was 0.4%; this is compared to the 0.5% X‐ray contamination obtained with the MC calculation. Feasibility of MC simulation in an anthropomorphic phantom for a full TSEI treatment was proved and is reported for the first time in the literature. The results of our MC calculations were found to be in general agreement with the measurements, providing a promising tool for further studies of dose distribution calculations in TSEI.PACS number(s): 87.10. Rt, 87.55.K, 87.55.ne

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\pm 10 %

) (5) . In order to deliver the treatment dose at a shallow depth, low‐energy electrons are considered for TSEI, which is commonly performed with a 6 MeV beam.…”

Section: Introductionmentioning

confidence: 99%

Validation of total skin electron irradiation (TSEI) technique dosimetry data by Monte Carlo simulation

Nevelsky

Borzov

Daniel

et al. 2016

J Applied Clin Med Phys

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“…The large dose variation at the ankle (2% higher than prescription in the first fraction and 26% higher in the second fraction) is probably due to the inconsistency in positioning, similar to the cases of total skin electron irradiation (no‐shield) delivered in our clinic. Several studies 12 , 13 , 14 , 15 , 16 have shown large variation range of dose to different body parts in total skin irradiation with six‐pair dual field technique as well.…”

Section: Resultsmentioning

confidence: 99%

The dose penumbra of a custom‐made shield used in hemibody skin electron irradiation

Rivers

AlDahlawi

Wang

et al. 2016

J Applied Clin Med Phys

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We report our technique for hemibody skin electron irradiation with a custom‐made plywood shield. The technique is similar to our clinical total skin electron irradiation (TSEI), performed with a six‐pair dual field (Stanford technique) at an extended source‐to‐skin distance (SSD) of 377 cm, with the addition of a plywood shield placed at 50 cm from the patient. The shield is made of three layers of standard 5/8” thick plywood (total thickness of 4.75 cm) that are clamped securely on an adjustable‐height stand. Gafchromic EBT3 films were used in assessing the shield's transmission factor and the extent of the dose penumbra region for two different shield‐phantom gaps. The shield transmission factor was found to be about 10%. The width of the penumbra (80%‐to‐20% dose falloff) was measured to be 12 cm for a 50 cm shield‐phantom gap, and reduced slightly to 10 cm for a 35 cm shield‐phantom gap. In vivo dosimetry of a real case confirmed the expected shielded area dose.PACS number(s): 87.53.Bn

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“…The EORTC recommends a total dose of 31 to 36 Gy prescribed to the skin surface to produce a dose of at least 26 Gy at a depth of 4mm in the truncal skin along the central axis [8]. In the report by Anacak and colleagues, data of thermoluminescent dosimetry (TLD) measurements for TSEBT demonstrated that the dose in homogeneity throughout the skin surface is around 15% [9]. However, for less radiosensitive skin lymphomas, ±15% in homogeneity is not acceptable and innovative techniques are required.…”

Section: Discussionmentioning

confidence: 99%

Helical Irradiation of the Total Skin with Dose Painting to Replace Total Skin Electron Beam Therapy for Therapy-Refractory Cutaneous CD4+ T-Cell Lymphoma

Hsieh

Shueng

Lin

et al. 2013

BioMed Research International

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A 36-year-old woman was diagnosed with a therapy-refractory cutaneous CD4+ T-cell lymphoma, T3N0M0B0, and stage IIB. Helical irradiation of the total skin (HITS) and dose painting techniques, with 30 Gy in 40 fractions interrupted at 20 fractions with one week resting, 4 times per week were prescribed. The diving suit was dressed whole body to increase the superficial dose and using central core complete block (CCCB) technique for reducing the internal organ dose. The mean doses of critical organs of head, chest, and abdomen were 2.1 to 29.9 Gy, 2.9 to 8.1 Gy, and 3.6 to 15.7 Gy, respectively. The mean dose of lesions was 84.0 cGy. The dosage of left side pretreated area was decreased 57%. The tumor regressed progressively without further noduloplaques. During the HITS procedure, most toxicity was grade I except leukocytopenia with grade 3. No epitheliolysis, phlyctenules, tumor lysis syndrome, fever, vomiting, dyspnea, edema of the extremities, or diarrhea occurred during the treatment. HITS with dose painting techniques provides precise dosage delivery with impressive results, sparing critical organs, and offering limited transient and chronic sequelae for previously locally irradiated, therapy-refractory cutaneous T-cell lymphoma.

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Total skin electron irradiation: evaluation of dose uniformity throughout the skin surface

Cited by 34 publications

References 7 publications

Validation of total skin electron irradiation (TSEI) technique dosimetry data by Monte Carlo simulation

Validation of total skin electron irradiation (TSEI) technique dosimetry data by Monte Carlo simulation

The dose penumbra of a custom‐made shield used in hemibody skin electron irradiation

Helical Irradiation of the Total Skin with Dose Painting to Replace Total Skin Electron Beam Therapy for Therapy-Refractory Cutaneous CD4+ T-Cell Lymphoma

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