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, Chen‐Hsi; Shueng, Pei‐Wei; Lin, Shih-Chiang; Tien, Hui‐Ju; Shiau, An‐Cheng; Chou, Yueh-Hung; Wu, Meng‐Hao; Wang, Jen‐Yu; Chen, Chi‐Kuan; Chen, Yu-Jen

doi:10.1155/2013/717589

Cited by 17 publications

(39 citation statements)

References 18 publications

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“…The standard deviation in the monitor chamber daily output varies less than 0.5%. This stability allows for the delivery of longer complex treatment plans (e.g., TBI and total skin treatments) without the risk of treatment interruption. The dosimetric stability and system reliability have led to greater clinical utility.…”

Section: Discussionmentioning

confidence: 99%

Long‐term dosimetric stability of multiple TomoTherapy delivery systems

Smilowitz

Dunkerley

Hill

et al. 2017

J Applied Clin Med Phys

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The dosimetric stability of six TomoTherapy units was analyzed to investigate changes in performance over time and with system upgrades. Energy and output were tracked using monitor chamber signal, onboard megavoltage computed tomography (MVCT) detector profile, and external ion chamber measurements. The systems (and monitoring periods) include three Hi‐Art (67, 61, and 65 mos.), two TomoHDA (31 and 26 mos.), and one Radixact unit (11 mos.), representing approximately 10 years of clinical use. The four newest systems use the Dose Control Stability (DCS) system and Fixed Target Linear Accelerator (linac) (FTL). The output stability is reported as deviation from reference monitor chamber signal for all systems and/or from an external chamber signal. The energy stability was monitored using relative (center versus off‐axis) MVCT detector signal (beam profile) and/or the ratio of chamber measurements at 2 depths. The clinical TomoHDA data were used to benchmark the Radixact stability, which has the same FTL but runs at a higher dose rate. The output based on monitor chamber data of all systems is very stable. The standard deviation of daily output on the non‐DCS systems was 0.94–1.52%. As expected, the DCS systems had improved standard deviation: 0.004–0.06%. The beam energy was also very stable for all units. The standard deviation in profile flatness was 0.23–0.62% for rotating target systems and 0.04–0.09% for FTL. Ion chamber output and PDD ratios supported these results. The output stability on the Radixact system during extended treatment delivery (20, 30, and 40 min) was comparable to a clinical TomoHDA system. For each system, results are consistent between different measurement tools and techniques, proving not only the dosimetric stability, but also these quality parameters can be confirmed with various metrics. The replacement history over extended time periods of the major dosimetric components of the different delivery systems (target, linac, and magnetron) is also reported.

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Section: Discussionmentioning

confidence: 99%

Long‐term dosimetric stability of multiple TomoTherapy delivery systems

Smilowitz

Dunkerley

Hill

et al. 2017

J Applied Clin Med Phys

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“…Photodynamic therapy had limited response. In the case of symptomatic painful lesions and for cosmetic reasons, palliative radiotherapy is often considered as the standard of care using electron beam therapy [ 5 , 7 ]. Complete response (CR) rate of 50% was reported [ 7 ], but we believe that generous target volume and higher CR are needed for future transplant and chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…Tomotherapy technique use for scalp lesions is reported including our own [ 6 ], but there are only three tomotherapy reports in advanced lymphoma/leukemia with an excellent outcome: total body skin irradiation replacing electron beam [ 7 - 8 ] and the circumference of thorax [ 9 ]. We present the tomotherapy use for the large volume of the posterior back above the waist, posterior shoulders, and lower neck without compromising future chemotherapy and stem cell transplant.…”

Section: Introductionmentioning

confidence: 99%

Secondary Cutaneous Involvement in Follicular Diffuse Lymphoma Treated with Helical Tomotherapy

Dar

Jordan²,

Yartsev³

2017

Cureus

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Non-Hodgkin’s lymphoma is a complex heterogeneous group of disease entities that involves nodal and extranodal tissues. Cutaneous involvement can occur either as a primary or secondary in course of disease. Radiation therapy with either total body or localized treatments is often used for local control and symptom relief, depending on the target volume. We describe a 60-year-old male with a remote history of stage IA left neck follicular lymphoma treated with radiation 20 years ago and previous relapses aggressively treated by chemotherapy. Treatment to a large volume of back and posterior shoulders on a helical tomotherapy radiotherapy system is reported. The skin lesions responded completely with no toxicity. Palliative radiotherapy to a fairly large and complex volume of skin with modest dose avoiding underlying critical tissues on tomotherapy is feasible, well tolerated with an excellent durable response, without compromising future chemotherapy and stem cell transplant for systemic relapse.

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“…This technique can be of value for centers without capability of electron treatment of the entire skin, but also for partial irradiation of the skin. A few studies have previously reported on TSI with HT, In this work, we evaluate the robustness of TSI with HT and implementation of virtual and physical bolus in the form of a wet suit and verify phantom data with clinical data.…”

Section: Introductionmentioning

confidence: 99%

A Helical tomotherapy as a robust low‐dose treatment alternative for total skin irradiation

Haraldsson

Engleson

Bäck

et al. 2019

J Applied Clin Med Phys

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Mycosis fungoides is a disease with manifestation of the skin that has traditionally been treated with electron therapy. In this paper, we present a method of treating the entire skin with megavoltage photons using helical tomotherapy (HT), verified through a phantom study and clinical dosimetric data from our first two treated patients. A whole body phantom was fitted with a wetsuit as bolus, and scanned with computer tomography. We accounted for variations in daily setup using virtual bolus in the treatment plan optimization. Positioning robustness was tested by moving the phantom, and recalculating the dose at different positions. Patient treatments were verified with in vivo film dosimetry and dose reconstruction from daily imaging. Reconstruction of the actual delivered dose to the patients showed similar target dose as the robustness test of the phantom shifted 10 mm in all directions, indicating an appropriate approximation of the anticipated setup variation. In vivo film measurements agreed well with the calculated dose confirming the choice of both virtual and physical bolus parameters. Despite the complexity of the treatment, HT was shown to be a robust and feasible technique for total skin irradiation. We believe that this technique can provide a viable option for Tomotherapy centers without electron beam capability.

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

Cited by 17 publications

References 18 publications

Long‐term dosimetric stability of multiple TomoTherapy delivery systems

Long‐term dosimetric stability of multiple TomoTherapy delivery systems

Secondary Cutaneous Involvement in Follicular Diffuse Lymphoma Treated with Helical Tomotherapy

A Helical tomotherapy as a robust low‐dose treatment alternative for total skin irradiation

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