Total skin electron irradiation for mycosis fungoides: relationship between acute toxicities and measured dose at different anatomic sites

Desai, Kanta R.; Pezner, Richard D.; Lipsett, James A.; Vora, Nayana; Luk, Kenneth H.; Wong, Jeffrey Y.C.; Chan, Sandra L.; Findley, David O.; Hill, L. Robert; Marin, Lorraine; Archambeau, John O.

doi:10.1016/0360-3016(88)90306-9

Cited by 58 publications

(39 citation statements)

References 13 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 occurrence of pigmentary changes, especially lentigines and pigmented nail band, nail dystrophy, and nail shedding, is well documented in patients during PUVA therapy and electron-beam radiation [11,13,14]. …”

Section: Discussionmentioning

confidence: 99%

Nail Changes in Early Mycosis Fungoides

Ehsani

Nasimi

Azizpour

et al. 2017

Skin Appendage Disord

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Background: Mycosis fungoides (MF) has a wide range of clinical presentations and it has been reported rarely to involve the nail apparatus. Objective: We intended to evaluate the frequency and characteristics of nail changes in patients with biopsy-proven MF. Methods: A retrospective analysis of 60 patients with MF who were evaluated at our cancer center from 2013 to 2014 was performed to identify patients with nail changes. Histological examinations of the skin around the nail apparatus were obtained from 10 patients with periungual skin erythema and scaling. Results: In 45 patients out of 60 cases, the skin around the nail apparatus was normal, and only in 5 patients of these 45 cases, nail changes were detected. These changes included leukonychia, longitudinal ridging, nail thickening, and opacity. In the remaining 15 patients, erythema and scaling was observed in periungual skin, and 13 of them demonstrated nail changes including longitudinal ridging, nail thickening, fragility of the nail plate, subungual hyperkeratosis, pigmented nail band, Beau's lines, onychomadesis, koilonychia, nail thinning, distal notching, subungual debris, leukonychia, and pitting. In biopsies of periungual skin, none of 10 cases revealed histological findings consistent with MF. Conclusions: Evidence of nail changes was observed in 18 cases (30%). The most common nail changes detected in MF patients included longitudinal ridging, nail thickening, nail fragility, and leukonychia.

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“…Acute treatment toxicity was graded using the Common Terminology Criteria for Adverse Events. 15 Cutaneous infection was suspected when findings consistent with cellulitis, folliculitis, impetigo, or abscess occurred: (1) in areas surrounding skin breakdown from tumor or ulceration, (2) in areas not usually prone to radiation dermatitis using our technique, (3) in patients who were previously prone to infection, (4) when the dose received was lower than the dose typically necessary to cause radiation dermatitis, or (5) or infectious disease specialist if there was a suspicion of infection. In concordance with National Comprehensive Cancer Network guidelines, oral cephalexin, dicloxacillin, or trimethoprimsulfamethoxazole were started upon suspicion of cutaneous infection.…”

Section: Assessment Of Infection and Toxicitymentioning

confidence: 99%

“…[5][6][7] Infection has been shown to be a significant cause of death in MF 8 and an elevated baseline incidence of cutaneous infection is documented. 9 A predisposition to skin infection results from disruption of the skin barrier and potential immunosuppression from lymphoma.…”

mentioning

confidence: 97%

Acute toxicity and risk of infection during total skin electron beam therapy for mycosis fungoides

Lloyd

Chen

Foss

et al. 2013

Journal of the American Academy of Dermatology

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Total skin electron irradiation for mycosis fungoides: relationship between acute toxicities and measured dose at different anatomic sites

Cited by 58 publications

References 13 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

Nail Changes in Early Mycosis Fungoides

Acute toxicity and risk of infection during total skin electron beam therapy for mycosis fungoides

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