Abstract
PurposeTotal skin electron therapy (TSET) is a technique to treat cutaneous lymphomas. While TSET is rarely required in pediatric patients, it poses particular problems for the delivery. It was the aim of the present work to develop a method to deliver TSET to young children requiring anesthetics during treatment.MethodsA customized cradle with a thin window base and Poly(methyl‐methacrylate) (PMMA) frame was built and the patient was treated in supine position. Two times six fields of 6 MeV electrons spaced by 60° gantry angles were used without electron applicator and a field size of 36 × 36 cm2. The two sets of six fields were matched at approximately 65% surface dose by rotating the patient around an axis 30 cm distance from beam central axis, effectively displacing the two sets of fields in sup/inf direction by 60 cm. Electron energy was degraded using a 12 mm PMMA block on the gantry. Focus to skin distance was maximized by displacing the patient in opposite direction of the beam resulting in a different couch position for each field.ResultsA 2‐yr‐old patient was treated in 12 fractions of 1.5 Gy over 2.4 weeks. Dose to skin was verified daily using thermoluminescence dosimetry and/or radiochromic film. The treatment parameters were adjusted slightly based on in vivo dosimetry resulting in a dose distribution for most of the treatment volume within ±20% of the prescribed dose. Six areas were boosted using conventional electron therapy.Conclusion TSET can be delivered to pediatric patients using a customized couch top on a conventional linear accelerator.
Highlights
Total skin electron therapy (TSET) is a radiation technique used for more than 50 yr to treat cutaneous T‐cell lymphomas (CTCL).[1]
The patient was a 2‐yr‐old female to be treated with total skin electron irradiation
Areas of low dose were to be identified using in vivo dosimetry and boosted using conventional electron irradiation
Summary
Total skin electron therapy (TSET) is a radiation technique used for more than 50 yr to treat cutaneous T‐cell lymphomas (CTCL).[1] These lymphomas are relatively rare[2] but can have devastating effects on affected individuals. Mycosis fungoides is a type of CTCL often associated with a red rash of large parts of the patients’ skin. One effective treatment option is the use of electron radiation to treat the surface of the patient. J Appl Clin Med Phys 2018; 19:6:109–116
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