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  • Title: A technique for total skin electron therapy (TSET) of an anesthetized pediatric patient.
    Author: Kron T, Donahoo G, Lonski P, Wheeler G.
    Journal: J Appl Clin Med Phys; 2018 Nov; 19(6):109-116. PubMed ID: 30267453.
    Abstract:
    PURPOSE: Total 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. METHODS: A 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. RESULTS: A 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.
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