In response to Dr. Khuntia et al.

Abstract

We thank Dr. Khuntia et al. for their comments on our recent work concerning scalp irradiation ( 1 Bedford J.L. Childs P.J. Hansen V.N. et al. Treatment of extensive scalp lesions with segmental intensity-modulated photon therapy. Int J Radiat Oncol Biol Phys. 2005; 62: 1549-1558 Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar ). While we agree that intensity-modulated radiation therapy (IMRT) is well suited to this treatment site, we are cautious in our acceptance that helical tomotherapy provides a major benefit compared with static therapy with a limited number of fields. Locke et al. evaluated static tomotherapy using Peacock Planner (Nomos Corporation, Sewickley, PA) and found the brain dose to be unacceptably high for total scalp treatment ( 2 Locke J. Low D.A. Grigireit T. et al. Potential of tomotherapy for total scalp treatment. Int J Radiat Oncol Biol Phys. 2002; 52: 553-559 Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar ). Our work using static segmental beams was consistent with theirs in that we were able to achieve a lower brain dose but for partial scalp irradiation only. Dr. Khuntia et al. now claim that they can achieve a similarly low brain dose to us, but for total scalp irradiation. Helical tomotherapy as a means of administering total or partial scalp irradiation: In regards to Bedford et al. (Int J Radiat Oncol Biol Phys 2005;62:1549–1558)International Journal of Radiation Oncology, Biology, PhysicsVol. 64Issue 4PreviewBedford et al. (1) recently described an effective step-and-shoot intensity-modulated radiotherapy (IMRT) method of irradiating extensive areas of the scalp. Their positive results contrast with those of Locke et al. (2), who found nontarget dose to be unacceptable with serial tomotherapy. The authors admit that the differences might exist in part because they addressed partial, unilateral scalp lesions, whereas Locke et al. evaluated total scalp irradiation. We recently described an approach that works well for unilateral or total scalp irradiation (3). Full-Text PDF