The optimal treatment of keloid scars remains unclear. Current protocols advise treatment with triamcinolone injection, when applicable, and surgery followed by adjuvant radiotherapy. However, the dosage and treatment modality of the radiotherapy vary among centres. This retrospective case series evaluated the long-term results of a single institution regarding keloid treatment using surgical excision, adjuvant external radiotherapy with site-dependent dosage, and wound site immobilisation with surgical tape and pressure treatment. A review of the patient registry from Tampere University Hospital, Finland, between the years 2010 and 2018 was conducted. A total of 73 keloids on 58 patients were excised, followed by a site-dependent dose of external radiotherapy with electron beam therapy (EBT). The mean follow-up time was 19.6 months. In total, 91.8% of the keloids were in remission at the end of follow-up, resulting in a 8.2% recurrence rate detected at 19.6 months on average. The highest recurrence rate-at 15%-was detected in the earlobe, which received the lowest level of irradiation according to the author's protocol. The results suggest that surgical excision with adjuvant EBT is highly efficient for keloid treatment in adult patients, and should be considered the first option in keloid treatment whenever excision is feasible. The recurrence rate of earlobe keloids with the current lower dose of EBT was higher than previously published and warrants further investigation.

Reduced-Dose Total Skin Electron Beam Radiation Therapy in Mycosis Fungoides and Sézary Syndrome: Systematic Review and Meta-Analysis.

Primary Cutaneous Lymphomas (PCLs) are rare extranodal non-Hodgkin lymphomas that present in the skin without extracutaneous disease at diagnosis; they are exceptionally uncommon in children and frequently mimic benign dermatoses, delaying recognition. We report a case series of three pediatric patients managed at a national referral center. Case 1: A 16-year-old with erythrodermic mycosis fungoides (stage IIIA) refractory to multiple systemic and skin-directed therapies who achieved remission after haploidentical allogeneic hematopoietic stem-cell transplantation. Case 2: A 3-year-old with aggressive cytotoxic CD8-positive Tcell lymphoma with EBV-associated disease and severe infectious complications during CHOP-based therapy, culminating in death despite salvage treatments and EBRT. Case 3: A 10-year-old with CD30-positive primary cutaneous anaplastic large cell lymphoma with a relapsing course, treated with BFM-90 chemotherapy, gemcitabine, pegylated doxorubicin plus total skin electron beam therapy, and ongoing PUVA with good dermatologic control. Across cases, diagnosis relied on clinicopathologic correlation with immunohistochemistry and staging CT; serum IgE was elevated in all three children. Pediatric PCLs show heterogeneous behavior and therapeutic responses. Early biopsy of atypical or treatment-refractory eruptions, comprehensive histopathology and immunophenotyping, targeted EBV testing when suggested, and appropriate use of skin-directed radiotherapy (EBRT/TSEBT) and transplantation in selected refractory disease are essential. Multidisciplinary management and equitable access to specialized therapies are critical to optimize outcomes.

PurposeThis study evaluates the dosimetric impact of integrating thin metallic scatter foils with Cerrobend contact skin collimators to improve dose uniformity, conformality, and distal tissue sparing in small superficial electron fields.Materials and methodsElectron beams of 8, 12, and 15 MeV from an Elekta Versa HD LINAC were delivered through a Cerrobend skin collimator with a 2.0 cm aperture at 100.0 cm SSD. Thin aluminum (Al) and lead (Pb) foils (< 2.50 mm) were placed on the collimator. Gafchromic EBT3 film in a solid‐water phantom was used to measure depth‐dose distributions and isodose profiles following TG‐235–consistent calibration.ResultsScatter foils produced thickness‐ and Z‐dependent modulation of beam characteristics. At 8 MeV, the thickest Pb foil (1.07 mm) reduced the practical range (Rp) by ∼45% and shifted Dmax proximally by ∼0.5 cm, yielding substantial distal tissue sparing. Al foils caused smaller Rp reductions (15%–25%) but improved lateral dose uniformity, producing smoother and more symmetric isodose contours. The 90% isodose diameter decreased with foil thickness for both materials, with Pb showing the largest contraction (∼20%–25%, energy‐dependent), enhancing field conformality. Penumbra width increased slightly for thin foils but stabilized or narrowed for larger thicknesses. These effects diminished at 15 MeV, indicating reduced sensitivity of high‐energy electrons to thin‐foil perturbation.ConclusionsThin metallic foils placed on Cerrobend skin collimators enable a controllable balance between dose uniformity (improved with Al) and conformality with distal sparing (enhanced with Pb). This simple, LINAC‐independent configuration offers a cost‐effective method for modulating small‐field electron beam characteristics and may serve as a practical adjunct for treating superficial lesions.

IntroductionCarbon dots (CDs) have great potential application in disease treatment, but there were rare detailed reports on the application of CDs in radiotherapy so far.MethodsIn this study, N and Fe3+ doped CDs (N-Fe-CDs) were prepared with a one-step hydrothermal method. The properties of N-Fe-CDs before and after 10 MeV electron beam irradiation (EBI) were characterized by TEM, XRD, XPS, FT-IR, and PL. Cell toxicity experiments and irradiation experiments on tumor-bearing mice were conducted to explore the EBI effects and N-Fe-CDs for the efficacy of the synergistic treatment of lung cancer.Results and DiscussionThe fluorescence intensity of N-Fe-CDs was significantly weakened after EBI. When the N-Fe-CDs’ concentration was ≤2.7 × 10−2 mg/mL, its cytotoxicity was almost zero. The tumor regression in the “CDs solution injection followed by EBI” group was significantly greater than other groups. EBI can weaken fluorescence of the N-Fe-CDs and the N-Fe-CDs can enhance the therapeutic effect of electron beam therapy for lung cancer.

Monte Carlo methods are state-of-the-art when it comes to dosimetric computations in radiotherapy. However, the execution time of these methods suffers in high-collisional regimes. We address this problem by introducing a kinetic-diffusion particle tracing scheme. This algorithm, first proposed in the context of neutral transport in fusion energy, relies on the explicit simulation of the exact kinetic motion in low-collisional regimes and dynamically switches to an approximate random walk in high-collisional regimes. The random walk corresponds to an advection-diffusion process that preserves the first two moments (mean and variance) of the kinetic motion. We derive an analytic formula for the mean kinetic motion and discuss the addition of a multiple scattering distribution to the algorithm. In contrast to neutral transport, the electron beam therapy setting does not readily admit to an analytical expression for the variance of the kinetic motion, and we therefore resort to the use of a lookup table. We test the algorithm for dosimetric computations in electron beam therapy on a 2D CT scan of a lung patient. Using a simple particle model, our Python implementation of the algorithm is nearly 33 times faster than an equivalent kinetic simulation at the cost of a small modeling error.

We evaluated a combination of brentuximab vedotin and ultra-hypofractionated low-dose total skin electron beam therapy in 14 patients with tumour-stage mycosis fungoides (MF). The overall response rate was 100%, with 64% of patients achieving complete remission; treatment was well tolerated, with limited toxicity. Translational analyses indicated synergistic activity, evidenced by increased CD30 expression and tumour cell death, supporting this approach as a promising treatment option for MF.

Background: Keloid is an abnormal proliferation of scar tissue that extends beyond the boundaries of the original wound, commonly seen in individuals with darker skin. Hence this study seeks to investigate the radiotherapy treatment for keloid patients in sub-Saharan Africa. Methodology: This retrospective study utilized data from both physical and electronic medical records at the NSIA-LUTH Cancer Centre, covering the period from May 2019 to January 2025. A total of 100 patients diagnosed with keloids during this time were reviewed. 73 keloid patients identified during the study period received radiotherapy (RT). Descriptive and inferential statistics, including Pearson correlation and Chi-square tests, were performed using SPSS version 27.0. Results: Seventy-three patients with a mean age of 36.21 ± 13.72 years (range 15 - 84) were enrolled. More than half of the population 37 (50.7%) were female and 36 (49.3%) were male. Body mass index (BMI) showed that 15 (20.5%) were healthy weight, 13 (17.8%) each were overweight and obese. 14 (19.2%) reported a family history of keloids, and comorbidities were present in 6 (8.2%). Multiple site affectation were the commonest sites in 17 (23.3%) of cases and ear lobes accounting for 12 (16.4%). Recurrence was reported in 30 (41.1%) of patients. The most common causes of keloids in this population were injury and wound 11 (15.1%). The time elapsed between the onset of lesions and diagnosis was 10 years and above for most patients 20 (27.4%). 34 (46.6%) of patients had surgical excision. All patients were treated with electron beam therapy. Different RT dose regimens were applied in this study, including 12/4Gy 18 (25%), 12/3Gy 12 (16%), 9/3Gy 11 (15%), and 16/4Gy 9 (12%). There was a strong statistical significance between keloid recurrence and surgery (r = 0.544, p &lt; 0.001). Conclusion: This study highlights high incidence of keloids among young adults, especially females and rate of recurrence. This study dose regimens aligns with international best practices. There is a need for early detection of high-risk patients, combined therapy regimens, and tailored follow-up protocols to reduce recurrence.

Erythrodermic mycosis fungoides (eMF) and Sézary syndrome (SS) often show delayed and non-durable clinical responses to systemic therapies. A total of 35 patients with eMF or SS were treated with total skin electron beam therapy (TSEBT). Response rates, patient-reported outcomes, survival data, median time to next treatment (TTNT), and progression-free survival (PFS)were evaluated. The analysis included 21 patients with SS and 14 with eMF. The median radiation dose was 12Gy. At 3months post-TSEBT, the overall response rate was 89%. A total of 25 patients (71%) required subsequent systemic therapy. The median TTNT was 20months, and the median PFS was 14months. Patients reported marked reductions in pruritus, decreased skin disease burden, and improved health-related quality of life scores. Notably, both TTNT and PFS were longer in patients who received subsequent therapy compared to those who did not. Grade ≥3 radiation-related toxicity was observed in 6% of patients. In the translational arm of the study, several potential peripheral blood biomarkers were identified. Low-dose TSEBT is an effective treatment option for patients with eMF and SS, facilitating subsequent therapies and enabling long-term disease control. The treatment is associated with significant quality-of-life improvements and low toxicity.

A retrospective review of total skin electron beam therapy in folliculotropic mycosis fungoides.

Implementation of a patient-reported outcome assessment during radiotherapy for mycosis fungoides and other cutaneous lymphomas

Clinical features and outcomes of patients with non-erythrodermic mycosis fungoides with high blood tumor burden

Radiation Therapy Utilization for Primary Cutaneous T-Cell Lymphoma Is Lowest Among Patients Living in the Most Geographically Accessible Areas: An Australian Study.

Effectiveness of cerrobend alloy metal as prominent shielding material for electron beam therapy

This study explores the opposing dosimetric behavior of concave geometries and establishes a framework for understanding the effects of surface curvature in radiotherapy. We hypothesized that concave surfaces would produce inverse dosimetric perturbations compared with convex geometries, with important implications for treatment planning accuracy. Using validated GATE Monte Carlo simulations with phase-space data from PRIMO for a Varian Clinac 2100C accelerator, we examined concave hemispherical cavities of 2 cm depth with radii ranging from 5 to 20 cm in water phantoms. Electron beams of 6, 9, and 12 MeV, as well as 6 MV photon beams, were studied across multiple field sizes. Comparisons with our previous convex surface data enabled quantification of geometric asymmetry through a novel Geometric Perturbation Factor (GPF). The results showed that concave surfaces produced effects opposite to convex geometries: R50 decreased linearly with curvature (R50 = -5.37ρ, -9.58ρ, -14.23ρfor 6, 9, and 12 MeV, respectively), in contrast to the increases observed for convex surfaces. Notably, concave perturbations were 15-17 times stronger than convex effects for identical curvatures, and surface doses increased by up to 15% for concave compared with decreases for convex geometries. Photon beams exhibited minimal sensitivity (≤3% variation) for both geometries. This comparative analysis highlights a fundamental asymmetry in radiotherapy dose perturbations, showing that concave surfaces induce significantly stronger and opposing effects relative to convex geometries. These findings underscore the need for geometry-specific correction factors in treatment planning systems, particularly for electron beam therapy where geometric effects are most pronounced.

PurposeIn electron beam therapy targeting superficial thoracic and abdominal lesions, the source‐to‐surface distance (SSD) varies due to patient respiration. This study aimed to investigate the percentage depth dose (PDD) and off‐center ratio (OCR) of 6, 9, and 12 MeV electron beams at extended SSDs; and to assess the variations in dose caused by respiratory motion.MethodsPDDs and OCRs for 6, 9, and 12 MeV electron beams were measured using a Blue Phantom 2 with 5 cm circular aperture and 10 × 10 cm2 fields at SSDs ranging from 98 to 105 cm. The dose differences at the maximum depth (dmax) were calculated relative to an SSD of 100 cm. We simulated patient respiratory motion of 0–4 cm during irradiation with 5 cm circular aperture and 10 × 10 cm2 fields by placing a water‐equivalent phantom with a parallel‐plate ionization chamber on a QUASAR Platform. The gantry angle was set to 270°, and the SSD was set to 100 cm. The dose differences at dmax were calculated relative to a motion amplitude of 0 cm.ResultsExtending the SSD by 3 cm reduced the dose by > 5% for all energies. For a 6 MeV electron beam with a 5 cm circular aperture, extending the SSD to 105 cm resulted in a dose reduction of 13.42% and expansions of the field size by 2.0 mm and the penumbra by 4.2 mm. A respiratory motion amplitude of 3 cm resulted in dose variations of > 3% for all energies and field sizes. The largest dose difference of 5.36% was observed for a 6 MeV electron beam with a 5 cm circular aperture.ConclusionsThe results demonstrate that extending the SSD by 3 cm reduced the dose by >5% for all energies, providing a useful quantitative benchmark for quality assurance in superficial electron therapy. Respiratory motion management may be warranted for electron beam therapy when respiratory‐induced SSD variations exceed 3 cm.

The Influence of Dose on Response Duration of Total Skin Electron Beam Therapy (TSEBT) for Mycosis Fungoides in the Modern Era of TSEBT Dose Reduction

BackgroundExtending the source‐to‐surface distance (SSD) is an effective approach to cover a large irradiation area in electron beam therapy for large planning target volumes (PTVs). However, the accuracy of dose calculations at extended SSDs has not been fully validated.PurposeThis study evaluated the dose calculation accuracy of the electron Monte Carlo (eMC) algorithm implemented in Varian's Eclipse radiation therapy planning system (RTPS) under extended SSD conditions.MethodsSimulations were conducted using Eclipse version 13.6 for 6, 12, and 18 MeV electron beams, with SSDs ranging from 100 to 140 cm. A 25 cm × 25 cm applicator and a virtual water phantom were utilized to compute percent depth dose (PDD), off‐axis ratio (OAR), and output factor (OPF). The calculated values were compared with measured data and independent Monte Carlo (MC) simulations performed using Particle and Heavy Ion Transport System (PHITS), referred to as PHITS‐MC in this study.ResultsThe eMC algorithm achieved high accuracy along the central axis, with PDD deviations within 2 mm and OPF differences within 3% across all SSDs, including 140 cm. However, eMC exhibited increasing deviations in OAR field size (>3 mm) at SSD ≥ 120 cm. A detailed parameter‐based analysis further revealed underperformance in OAR calculations at field peripheries for low‐energy beams (6 MeV), compared with PHITS‐MC.ConclusionThe findings delineate the performance and limitations of the eMC algorithm under extended SSD conditions. These limitations should be considered in algorithm evaluation and quality assurance processes. The results provide guidance for algorithm assessment and may serve as a foundation for future studies to explore its clinical relevance in large‐field electron beam therapy.

Mycosis fungoides (MF) is the commonest subtype of cutaneous lymphoma, characterized by the infiltration of malignant T-cell clones into the skin. It accounts for approximately 60% of all cutaneous T-cell lymphoma diagnoses. MF has three distinct clinical stages - patch, plaque and tumour - presenting most commonly on the buttocks, trunk and breast. The presentation often mimics common inflammatory dermatoses such as eczema and psoriasis. Despite numerous theories, the aetiology of MF remains mostly unknown. Since its first description in 1806, diagnosis has remained a challenge and requires careful clinicopathological correlation. Patients may require multiple skin biopsies, especially at the patch stage, to identify the characteristic epidermotropic infiltrates of small-to-medium-sized lymphocytes. First-line management involves skin-directed therapies such as topical corticosteroids and phototherapy. If these are unsuccessful, systemic medications such as interferon-α, oral bexarotene, methotrexate and novel antibody therapies are trialled. MF can also respond to localized radiotherapy, total skin electron beam therapy and haematopoietic stem cell transplantation. Despite being primarily a cutaneous lymphoma, MF can progress to involve other organs. This review provides a comprehensive overview of the epidemiology, clinical features, diagnosis and management of MF.

HighlightsWhat are the main findings?This study showed that the miniature fiber-optic inorganic scintillator detector demonstrates excellent dose rate linearity and repeatability when measuring electron beam doses in radiotherapy, and also performs well in measuring beam profile curves.This miniature detector shows significant discrepancies when measuring PDD curves compared to the true PDD curves; however, the results can be corrected through calibration curves.What is the implication of the main finding?Completing this work endows the miniature detector with the potential for application in an electron-beam radiotherapy environment, thereby contributing to the treatment of superficial cancers such as skin cancer.Over the past few decades, electron beams have been widely used to treat malignant and benign tumors located in the superficial regions of patients. This study utilized an inorganic scintillator (Gd2O2S:Tb)-based radiation detector to test its response characteristics in an electron-beam radiotherapy environment, in order to determine the application potential of this detector in electron-beam therapy. Owing to the extremely high time resolution of this inorganic scintillator detector (ISD), it is even capable of measuring the pulse information of electron beams generated by the accelerator. The results indicate that for certain accelerator models, such as the IX3937, the pulse pattern of the output electron beam is notably different from that during the output of X-rays, showing no significant periodicity. The experimental results also demonstrate that this ISD exhibits excellent repeatability and dose linearity (R2 of 0.9993) when measuring electron beams. Finally, the PDD (Percentage Depth Dose) curves and OAR (Off-Axis Ratio) curves of the ISD were also tested under electron-beam conditions at 6 MeV and 9 MeV, respectively.