Total Skin Treatment with Helical Arc Radiotherapy

Nien, Hsin-Hua; Hsieh, Chen‐Hsi; Shueng, Pei‐Wei; Tien, Hui‐Ju

doi:10.3390/ijms24054492

Cited by 5 publications

(3 citation statements)

References 136 publications

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“…Hsieh et al [ 7 ] used 30 Gy in 40 fractions; Schaff et al [ 17 ] used 12 Gy in 8 fractions; and Haraldsson et al [ 8 ] used 32 Gy in 24 fractions. Therefore, institutes need to choose an appropriate prescription dose and number of fractions according to the actual situation of the patient [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Investigation of total skin helical tomotherapy using a 3D-printed total skin bolus

Wang,

Pi,

Liu

et al. 2023

BioMed Eng OnLine

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Objective To investigate the effectiveness of using a 3D-printed total skin bolus in total skin helical tomotherapy for the treatment of mycosis fungoides. Materials and methods A 65-year-old female patient with a 3-year history of mycosis fungoides underwent treatment using an in-house desktop fused deposition modelling printer to create a total skin bolus made of a 5-mm-thick flexible material, which increased the skin dose through dose building. The patient's scan was segmented into upper and lower sections, with the division line placed 10 cm above the patella. The prescription was to deliver 24 Gy over 24 fractions, given 5 times per week. The plan parameters consisted of a field width of 5 cm, pitch of 0.287 and modulation factor of 3. The complete block was placed 4 cm away from the planned target region to reduce the area of the internal organs at risk, especially the bone marrow. Dose delivery accuracy was verified using point dose verification with a "Cheese" phantom (Gammex RMI, Middleton, WI), 3D plane dose verification with ArcCHECK (Model 1220, Sun Nuclear, Melbourne, FL), and multipoint film dose verification. Megavoltage computed tomography guidance was also utilized to ensure the accuracy of the setup and treatment. Results A 5-mm-thick 3D-printed suit was used as a bolus to achieve a target volume coverage of 95% of the prescribed dose. The conformity index and homogeneity index of the lower segment were slightly better than those of the upper segment. As the distance from the skin increased, the dose to the bone marrow gradually decreased, and the dose to other organs at risk remained within clinical requirements. The point dose verification deviation was less than 1%, the 3D plane dose verification was greater than 90%, and the multipoint film dose verification was less than 3%, all of which confirmed the accuracy of the delivered dose. The total treatment time was approximately 1.5 h, which included 0.5 h of wearing the 3D-printed suit and 1 h with the beam on. Patients only experienced mild fatigue, nausea or vomiting, low-grade fever, and grade III bone marrow suppression. Conclusion The use of a 3D-printed suit for total skin helical tomotherapy can result in a uniform dose distribution, short treatment time, simple implementation process, good clinical outcomes, and low toxicity. This study presents an alternative treatment approach that can potentially yield improved clinical outcomes for mycosis fungoides.

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Section: Discussionmentioning

confidence: 99%

Investigation of total skin helical tomotherapy using a 3D-printed total skin bolus

Wang,

Pi,

Liu

et al. 2023

BioMed Eng OnLine

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“…Total Skin electron therapy (TSET) or Total Skin Electron Irradiation therapy (TSEI) has been used for many years to treat mycosis fungoides [1]- [10]. Stanford-based Karzmark et al developed a widely used static dual-beam, six-position called Stanford method for TSET [1] [2] [3].…”

Section: Introductionmentioning

confidence: 99%

“…Alternative techniques, such as the translational approach [9], involve translating the patient on a stretcher through an electron beam wide enough to cover the patient's transverse dimensions. Finally, the helical arc radiotherapy has also been used for TSET [10]. All these techniques have been clinically implemented for TSET treatment.…”

Section: Introductionmentioning

confidence: 99%

Dual-Fields Rotational Total Skin Electron Therapy: Investigation and Implementation

Xu,

Rusu,

Garza

2024

IJMPCERO

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Purpose: To present a protocol of a dual-field rotational (DFR) total skin electron therapy (TSET) and to provide an assessment of clinical implementation, dosimetry properties, and skin dose evaluation. Methods and Materials: The DFR-TSET combined the Stanford 6-field and McGill rotational methods. Dual 6 MeV electron beams in high dose total skin electron mode were used for DFR-TSET on a commercial linac. Beam profiles and dosimetric properties were measured using solid phantoms. The dose rate at expanded sourceto-surface distance (SSD) was a combination of static rate and rotational rate.In vivo dosimetry of patient skin was performed on patients' skin using film, metal oxide semiconductor field-effect transistors (MOSFET), and optically stimulated luminescent dosimeters (OSLD). Results: Dual field rotational total skin electron therapy exhibited good (≤±10%) uniformity in the beam profiles in the vertical direction at an extended SSD of 332 cm with a gantry angulation of ±20˚ deviated from the horizontal direction. In-vivo measurements confirmed acceptable uniformity of the patients' total body surfaces and revealed anatomically self-blocked or shielded areas where under-dosing occurred. Conclusions: The clinical implementation of DFR-TSET effectively utilizes the special mode on a linac. This technique provides short beam-on times, uniform dose distribution, large treatment field, and reduced dose of x-ray contamination to the patients. In-vivo measurements indicate satisfactory delivery and dose uniformity of the prescribed dose. Electron boost fields are recommended at normal SSDs to address underdosed areas.

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