Clinical implementation of total skin electron beam (TSEB) therapy: A review of the relevant literature

Diamantopoulos, Stefanos; Platoni, Kalliopi; Dilvoi, Maria; Nazos, Ioannis; Geropantas, K.; Maravelis, G; Tolia, Maria; Beli, I; Efstathopoulos, Efstathios; Pantelakos, P.; Panayiotakis, George; Kouloulias, Vassilis

doi:10.1016/j.ejmp.2010.09.001

Cited by 42 publications

(43 citation statements)

References 48 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%

“…This technique has been considered as a safe and effective treatment, and has been selected by a majority of institutions in the last 20 years as the preferred modality (2) . The Stanford technique is characterized by the use of: 1) an extended SSD (more than 3 m); 2) dual large electron fields with central axis angled by approximately

\pm 20^{\circ}

from the horizontal; and 3) six patient positions relative to each of the two large angled TSEI beams (anterior, posterior, and four lateral obliques).…”

Section: Introductionmentioning

confidence: 99%

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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%

\pm 20^{\circ}

from the horizontal; and 3) six patient positions relative to each of the two large angled TSEI beams (anterior, posterior, and four lateral obliques).…”

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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show abstract

“…This technique is also commonly used for cutaneous T-cell lymphoma or mycosis fungoides as it maintains a uniform dose distribution over the entire area of the skin. A summary of various TSEB techniques is provided in AAPM TG-30 1 and a recent review is given by Diamantopoulos et al 2 However, TSEB has a few technical and dosimetric challenges. A large electron field has to be delivered with reasonable uniformity.…”

Section: Introductionmentioning

confidence: 99%

Total skin electron beam therapy using an inclinable couch on motorized table and a compensating filter

Fuse

Suzuki

Shida

et al. 2014

Review of Scientific Instruments

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Total skin electron beam is a specialized technique that involves irradiating the entire skin from the skin surface to only a few millimetres in depth. In the Stanford technique, the patient is in a standing position and six different directional positions are used during treatment. Our technique uses large electron beams in six directions with an inclinable couch on motorized table and a compensating filter was also used to spread the electron beam and move its intensity peak. Dose uniformity measurements were performed using Gafchromic films which indicated that the surface dose was 2.04 ± 0.05 Gy. This technique can ensure the dose reproducibility because the patient is fixed in place using an inclinable couch on a motorized

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“…Total Skin Electron Irradiation (TSEI) is one of the best treatments of malignant skin diseases, such as Mycosis Fungoides (MF) and Cutaneous Lymphomas 1, 2, 3, 4. The goal is to treat the entire surface of the skin with a relatively uniform dose, e.g., ± 10% 5.…”

Section: Introductionmentioning

confidence: 99%

Room scatter effects in Total Skin Electron Irradiation: Monte Carlo simulation study

Nevelsky

Borzov

Daniel

et al. 2017

J Applied Clin Med Phys

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PurposeTotal Skin Electron Irradiation (TSEI) is a complex technique which usually involves the use of large electron fields and the dual‐field approach. In this situation, many electrons scattered from the treatment room floor are produced. However, no investigations of the effect of scattered electrons in TSEI treatments have been reported. The purpose of this work was to study the contribution of floor scattered electrons to skin dose during TSEI treatment using Monte Carlo (MC) simulations.MethodsAll MC simulations were performed with the EGSnrc code. Influence of beam energy, dual‐field angle, and floor material on the contribution of floor scatter was investigated. Spectrum of the scattered electrons was calculated. Measurements of dose profile were performed in order to verify MC calculations.ResultsFloor scatter dependency on the floor material was observed (at 20 cm from the floor, scatter contribution was about 21%, 18%, 15%, and 12% for iron, concrete, PVC, and water, respectively). Although total dose profiles exhibited slight variation as functions of beam energy and dual‐field angle, no dependence of the floor scatter contribution on the beam energy or dual‐field angle was found. The spectrum of the scattered electrons was almost uniform between a few hundred KeV to 4 MeV, and then decreased linearly to 6 MeV.ConclusionsFor the TSEI technique, dose contribution due to the electrons scattered from the room floor may be clinically significant and should be taken into account during design and commissioning phases. MC calculations can be used for this task.

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Clinical implementation of total skin electron beam (TSEB) therapy: A review of the relevant literature

Cited by 42 publications

References 48 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

Total skin electron beam therapy using an inclinable couch on motorized table and a compensating filter

Room scatter effects in Total Skin Electron Irradiation: Monte Carlo simulation study

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