Document Type : Original Research

Authors

1 MSc student, Department of Medical Physics, Tehran University of Medical Sciences, Tehran, Iran

2 PhD, Department of Medical Physics, Tehran University of Medical Sciences, Tehran, Iran

3 MD, Oncology Specialist, Cancer Institute of Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran

4 PhD, Department of Anatomy, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background: The Total Skin Electron Therapy (TSET) targets the whole of skin using 6 to 10 MeV electrons in large field size and large Source to Surface Distance (SSD). Treatment in sleeping position leads to a better distribution of dose and patient comfort.
Objective: This study aims to investigate the uniformity of absorbed dose in the sleeping Stanford technique on the Rando phantom using dosimetry.
Material and Methods: It is an experimental study which was performed using 6 MeV electron irradiation produced by Varian accelerator in the AP and PA positions with gantry angles of 318/3, 0 and 41/5 degrees, and RAO, LAO, RPO and LPO with 291/4 gantry angle and 45 degrees of collimator angle in the sleeping position.
Results: The results show that the dose uniformity achieved in this technique is in the range of (100 ± 25%) and, the dose accuracy was 6%.
Conclusion: Total Skin Electron Therapy (TSET) technique in sleeping position is very suitable for elderly and disabled patients, and meets the required dose uniformity. Furthermore, the use of a flattening filter is recommended for the more dose distribution uniformity.

Keywords

  1. Jones GW, Rosenthal D, Wilson LD. Total skin electron radiation for patients with erythrodermic cutaneous T-cell lymphoma (mycosis fungoides and the Sézary syndrome). Cancer: Interdisciplinary International Journal of the American Cancer Society. 1999;85:1985-95. doi: 10.1002/(sici)1097-0142(19990501)85:9%3c1985::aid- cncr16%3e3.0.co;2-o.
  2. Ravi A, Nisce LZ, Nori D. Total skin electron beam therapy in the management of cutaneous malignancies. Clin Dermatol. 2001;19:354-6. doi: 10.1016/s0738-081x(01)00167-5. PubMed PMID: 11479048.
  3. Burket LW, Greenberg MS, Glick M. Burket’s oral medicine: diagnosis & treatment. PMPH-USA; 2003.
  4. Bagshaw MA, Schneidman HM, Farber EM, Kaplan HS. Electron beam therapy of mycosis fungoides. Calif Med. 1961;95:292.
  5. Scarantino CW, Rini CJ, Aquino M, Carrea TB, Ornitz RD, Anscher MS, et al. Initial clinical results of an in vivo dosimeter during external beam radiation therapy. Int J Radiat Oncol Biol Phys. 2005;62:606-13. doi: 10.1016/j.ijrobp.2004.09.041. PubMed PMID: 15890606.
  6. Wood NK, Goaz PW, Jacobs MC. Periapical radiolucencies. Differential Diagnosis of Oral and Maxillofacial Lesions. 1997:252-77.
  7. Diamandidou E, Cohen PR, Kurzrock R. Mycosis fungoides and Sezary syndrome [see comments]. Blood. 1996;88:2385-409.
  8. Rodriguez-Cortes J, Rivera-Montalvo T, Villasenor Navarro LF, Flores-Lopez O, Roman J, Hernandez-Oviedo JO. Thermoluminescent dosimetry in total body irradiation. Appl Radiat Isot. 2012;71 Suppl:35-9. doi: 10.1016/j.apradiso.2012.04.014. PubMed PMID: 23039951.
  9. Tadros AA, Tepperman BS, Hryniuk WM, Peters VG, Rosenthal D, Roberts JT, et al. Total skin electron irradiation for mycosis fungoides: failure analysis and prognostic factors. Int J Radiat Oncol Biol Phys. 1983;9:1279-87. doi: 10.1016/0360-3016(83)90258-4. PubMed PMID: 6885540.
  10. Archer BR, Glaze S, North LB, Bushong SC. Dosimeter placement in the Rando phantom. Med Phys. 1977;4:315-8. doi: 10.1118/1.594320. PubMed PMID: 882065.
  11. Le JB, Bridier A, Bounik H, Schlienger M. Whole cutaneous irradiation in mycosis fungoides with 55KV x-rays. Technical study. Bull Cancer. 1977;64:313-22.
  12. Scholtz W. About the influence of X-rays radiate on the skin in healthy and sick Conditions. Archive for Dermatology and Syphilis. 1902;59:421-46. doi: 10.1007/bf01930719.
  13. Fuks ZY, Bagshaw MA, Farber EM. Prognostic signs and the management of the mycosis fungoides. Cancer. 1973;32:1385-95. PubMed PMID: 4202190.
  14. Hoppe RT, Fuks Z, Bagshaw MA. The rationale for curative radiotherapy in mycosis fungoides. Int J Radiat Oncol Biol Phys. 1977;2:843-51. doi: 10.1016/0360-3016(77)90182-1. PubMed PMID: 591404.
  15. Khan F. Clinical radiation generators. The Physics of Radiation Therapy. 2010:45-70.
  16. Chen Z, Agostinelli AG, Wilson LD, Nath R. Matching the dosimetry characteristics of a dual-field Stanford technique to a customized single-field Stanford technique for total skin electron therapy. International Journal of Radiation Oncology Biology Physics. 2004;59:872-85. doi: 10.1016/j.ijrobp.2004.02.046.
  17. Lucic F, Sanchez-Nieto B, Caprile P, Zelada G, Goset K. Dosimetric characterization and optimization of a customized Stanford total skin electron irradiation (TSEI) technique. J Appl Clin Med Phys. 2013;14:231-42. doi: 10.1120/jacmp.v14i5.4388. PubMed PMID: 24036877.
  18. Haybittle J. The protection of multicurie strontium-yttrium (90) sources. Phys Med Biol. 1957;1:270. doi: 10.1088/0031-9155/1/3/305.
  19. Deufel CL, Antolak JA. Total skin electron therapy in the lying-on-the-floor position using a customized flattening filter to accommodate frail patients. J Appl Clin Med Phys. 2013;14:115-26. doi: 10.1120/jacmp.v14i5.4309. PubMed PMID: 24036864. PubMed PMCID: PMC5714577.
  20. Wu JM, Leung SW, Wang CJ, Chui CS. Lying-on position of total skin electron therapy. Int J Radiat Oncol Biol Phys. 1997;39:521-8. PubMed PMID: 9308958.
  21. Baugh G, Al-Alawi T, Fletcher C, Mills J, Grieve R. A preliminary comparison of total skin electron treatment techniques to demonstrate the application of a mid-torso phantom for measurement of dose penetration. The British Journal of Radiology. 2011;84:1125-30. doi: 10.1259/bjr/52924135.
  22. Karzmark CJ, Loevinger R, Steele RE, Weissbluth M. A technique for large-field, superficial electron therapy. Radiology. 1960;74:633-44. doi: 10.1148/74.4.633. PubMed PMID: 14404611.
  23. Ragona R, Anglesio S, Madon E, Urgesi A, Rampino M, Monetti U. Total skin therapy with electron beams. I. Physical and geometric factors. Radiol Med. 1990;80:151-4. PubMed PMID: 2251408.
  24. Monzari SF, Geraily G, Salmanian S, Toolee H, Farzin M. Fabrication of anthropomorphic phantoms for use in total body irradiations studies. Journal of Radiotherapy in Practice. 2019:1-6. doi: 10.1017/S1460396919000591.
  25. Villarreal-Barajas JE, Khan RF. Energy response of EBT3 radiochromic films: implications for dosimetry in kilovoltage range. J Appl Clin Med Phys. 2014;15:4439. doi: 10.1120/jacmp.v15i1.4439. PubMed PMID: 24423839. PubMed PMCID: PMC5711253.
  26. Harden SV, Routsis DS, Geater AR, Thomas SJ, Coles C, Taylor PJ, et al. Total body irradiation using a modified standing technique: a single institution 7 year experience. Br J Radiol. 2001;74:1041-7. doi: 10.1259/bjr.74.887.741041. PubMed PMID: 11709470.
  27. Vollans SE, Perrin B, Wilkinson JM, Gattamaneni HR, Deakin DP. Investigation of dose homogeneity in paediatric anthropomorphic phantoms for a simple total body irradiation technique. Br J Radiol. 2000;73:317-21. doi: 10.1259/bjr.73.867.10817050. PubMed PMID: 10817050.
  28. Najafi M, Geraily G, Shirazi A, Esfahani M, Teimouri J. Analysis of Gafchromic EBT3 film calibration irradiated with gamma rays from different systems: Gamma Knife and Cobalt-60 unit. Medical Dosimetry. 2017;42(3):159-68.
  29. Reynard EP. Rotational Total Skin Electron Irradiation (RTSEI) with a 6 MeV Electron Linear Accelerator. McGill University Libraries; 2007.
  30. Platoni K, Diamantopoulos S, Panayiotakis G, Kouloulias V, Pantelakos P, Kelekis N, et al. First application of total skin electron beam irradiation in Greece: setup, measurements and dosimetry. Phys Med. 2012;28:174-82. doi: 10.1016/j.ejmp.2011.03.007. PubMed PMID: 21515082.
  31. Anacak Y, Arican Z, Bar-Deroma R, Tamir A, Kuten A. Total skin electron irradiation: evaluation of dose uniformity throughout the skin surface. Med Dosim. 2003;28:31-4. doi: 10.1016/S0958-3947(02)00235-2. PubMed PMID: 12747616.
  32. Funk A, Hensley F, Krempien R, Neuhof D, Van Kampen M, Treiber M, et al. Palliative total skin electron beam therapy (TSEBT) for advanced cutaneous T-cell lymphoma. Eur J Dermatol. 2008;18:308-12. doi: 10.1684/ejd.2008.0394. PubMed PMID: 18474461.
  33. Poli MER, Todo AS, Campos LL, editors. Dose Measurements in the treatment of mycosis fungoides with total skin irradiation using a 4 MeV electron beam. Proceedings of 10th International Congress of The International Radiation Protection Association. Hirishima, Japan: IRPA-10; 2000. p. 7-68.
  34. Fuse H, Suzuki K, Shida K, Mori Y, Takahashi H, Kobayashi D, et al. Total skin electron beam therapy using an inclinable couch on motorized table and a compensating filter. Rev Sci Instrum. 2014;85:064301. doi: 10.1063/1.4882336. PubMed PMID: 24985829. PubMed PMCID: PMC4098054.