Light and shadows of a new technique: is photon total-skin irradiation using helical IMRT feasible, less complex and as toxic as the electrons one?
Abstract Background Radiotherapy is one of the standard treatments for cutaneous lymphoma and Total Skin Electrons Beam Irradiation (TSEBI) is generally used to treat diffuse cutaneous lymphoma and some cases of localized disease. Helical IMRT (HI) allows to treat complex target with optimal dose di...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2018-08-01
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| Series: | Radiation Oncology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13014-018-1100-4 |
| _version_ | 1811288235407572992 |
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| author | Michela Buglione Luigi Spiazzi Mauro Urpis Liliana Baushi Rossella Avitabile Nadia Pasinetti Paolo Borghetti Luca Triggiani Sara Pedretti Federica Saiani Alfredo Fiume Diana Greco Stefano Ciccarelli Alessia Polonini Renzo Moretti Stefano Maria Magrini |
| author_facet | Michela Buglione Luigi Spiazzi Mauro Urpis Liliana Baushi Rossella Avitabile Nadia Pasinetti Paolo Borghetti Luca Triggiani Sara Pedretti Federica Saiani Alfredo Fiume Diana Greco Stefano Ciccarelli Alessia Polonini Renzo Moretti Stefano Maria Magrini |
| author_sort | Michela Buglione |
| collection | DOAJ |
| description | Abstract Background Radiotherapy is one of the standard treatments for cutaneous lymphoma and Total Skin Electrons Beam Irradiation (TSEBI) is generally used to treat diffuse cutaneous lymphoma and some cases of localized disease. Helical IMRT (HI) allows to treat complex target with optimal dose distribution and organ at risk sparing, so helical tomotherapy has been proposed as alternative technique to TSEBI but only one preliminary report has been published. Methods Three patients treated (from May 2013 to December 2014) with Helical IMRT, with a total dose between 24 and 30 Gy, were retrospectively evaluated. Data about dosimetric features, response and acute toxicity were registered and analyzed. Planned target coverage was compared with daily in vivo measures and dose calculation based on volumetric images used for set up evaluation as well. Results The patients had a mean measured surface fraction dose ranging from 1.54 Gy up to 2.0 Gy. A planned target dose ranging from 85 to 120% of prescription doses was obtained. All doses to Organs At Risk were within the required constraints. Particular attention was posed on “whole bone marrow” planned V10Gy, V12Gy and V20Gy values, ranging respectively between 23 and 43%, 20.1 and 38% and 9.8 and 24%. A comparison with the theoretical homologous values obtained with TSEBI has shown much lower values with TSEBI. Even if treatment was given in sequence to the skin of the upper and lower hemi-body, all the patients had anaemia, requiring blood transfusions, leukopenia and thrombocytopenia. Conclusion Based on our limited results TSEBI should still be considered the standard method to treat total skin because of its pattern of acute and late toxicities and the dose distribution. In this particular case the better target coverage obtained with HI can be paid in terms of worse toxicity. Helical IMRT can instead be considered optimal in treating large, convex, cutaneous areas where it is difficult to use multiple electrons fields in relation with the clinical results and the limited and reversible toxicities. |
| first_indexed | 2024-04-13T03:33:29Z |
| format | Article |
| id | doaj.art-1faf3b2a98a84d5dbb035f002002619d |
| institution | Directory Open Access Journal |
| issn | 1748-717X |
| language | English |
| last_indexed | 2024-04-13T03:33:29Z |
| publishDate | 2018-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj.art-1faf3b2a98a84d5dbb035f002002619d2022-12-22T03:04:23ZengBMCRadiation Oncology1748-717X2018-08-0113111210.1186/s13014-018-1100-4Light and shadows of a new technique: is photon total-skin irradiation using helical IMRT feasible, less complex and as toxic as the electrons one?Michela Buglione0Luigi Spiazzi1Mauro Urpis2Liliana Baushi3Rossella Avitabile4Nadia Pasinetti5Paolo Borghetti6Luca Triggiani7Sara Pedretti8Federica Saiani9Alfredo Fiume10Diana Greco11Stefano Ciccarelli12Alessia Polonini13Renzo Moretti14Stefano Maria Magrini15Radiation Oncology Department, University and Spedali Civili Hospital – BresciaMedical Physics, Spedali Civili Hospital – BresciaRadiation Oncology Department, University and Spedali Civili Hospital – BresciaRadiation Oncology Department, University and Spedali Civili Hospital – BresciaMedical Physics, Spedali Civili Hospital – BresciaRadiation Oncology Department, University and Spedali Civili Hospital – BresciaRadiation Oncology Department, University and Spedali Civili Hospital – BresciaRadiation Oncology Department, University and Spedali Civili Hospital – BresciaRadiation Oncology Department, University and Spedali Civili Hospital – BresciaMedical Physics, Spedali Civili Hospital – BresciaMedical Physics, Spedali Civili Hospital – BresciaRadiation Oncology Department, University and Spedali Civili Hospital – BresciaRadiation Oncology Department, University and Spedali Civili Hospital – BresciaMedical Physics, Spedali Civili Hospital – BresciaMedical Physics, Spedali Civili Hospital – BresciaRadiation Oncology Department, University and Spedali Civili Hospital – BresciaAbstract Background Radiotherapy is one of the standard treatments for cutaneous lymphoma and Total Skin Electrons Beam Irradiation (TSEBI) is generally used to treat diffuse cutaneous lymphoma and some cases of localized disease. Helical IMRT (HI) allows to treat complex target with optimal dose distribution and organ at risk sparing, so helical tomotherapy has been proposed as alternative technique to TSEBI but only one preliminary report has been published. Methods Three patients treated (from May 2013 to December 2014) with Helical IMRT, with a total dose between 24 and 30 Gy, were retrospectively evaluated. Data about dosimetric features, response and acute toxicity were registered and analyzed. Planned target coverage was compared with daily in vivo measures and dose calculation based on volumetric images used for set up evaluation as well. Results The patients had a mean measured surface fraction dose ranging from 1.54 Gy up to 2.0 Gy. A planned target dose ranging from 85 to 120% of prescription doses was obtained. All doses to Organs At Risk were within the required constraints. Particular attention was posed on “whole bone marrow” planned V10Gy, V12Gy and V20Gy values, ranging respectively between 23 and 43%, 20.1 and 38% and 9.8 and 24%. A comparison with the theoretical homologous values obtained with TSEBI has shown much lower values with TSEBI. Even if treatment was given in sequence to the skin of the upper and lower hemi-body, all the patients had anaemia, requiring blood transfusions, leukopenia and thrombocytopenia. Conclusion Based on our limited results TSEBI should still be considered the standard method to treat total skin because of its pattern of acute and late toxicities and the dose distribution. In this particular case the better target coverage obtained with HI can be paid in terms of worse toxicity. Helical IMRT can instead be considered optimal in treating large, convex, cutaneous areas where it is difficult to use multiple electrons fields in relation with the clinical results and the limited and reversible toxicities.http://link.springer.com/article/10.1186/s13014-018-1100-4Total skin irradiationTotal skin electrons beam irradiation - TSEBIPhotonsRadiotherapyBone marrowPrimary cutaneous lymphoma (PCL) |
| spellingShingle | Michela Buglione Luigi Spiazzi Mauro Urpis Liliana Baushi Rossella Avitabile Nadia Pasinetti Paolo Borghetti Luca Triggiani Sara Pedretti Federica Saiani Alfredo Fiume Diana Greco Stefano Ciccarelli Alessia Polonini Renzo Moretti Stefano Maria Magrini Light and shadows of a new technique: is photon total-skin irradiation using helical IMRT feasible, less complex and as toxic as the electrons one? Radiation Oncology Total skin irradiation Total skin electrons beam irradiation - TSEBI Photons Radiotherapy Bone marrow Primary cutaneous lymphoma (PCL) |
| title | Light and shadows of a new technique: is photon total-skin irradiation using helical IMRT feasible, less complex and as toxic as the electrons one? |
| title_full | Light and shadows of a new technique: is photon total-skin irradiation using helical IMRT feasible, less complex and as toxic as the electrons one? |
| title_fullStr | Light and shadows of a new technique: is photon total-skin irradiation using helical IMRT feasible, less complex and as toxic as the electrons one? |
| title_full_unstemmed | Light and shadows of a new technique: is photon total-skin irradiation using helical IMRT feasible, less complex and as toxic as the electrons one? |
| title_short | Light and shadows of a new technique: is photon total-skin irradiation using helical IMRT feasible, less complex and as toxic as the electrons one? |
| title_sort | light and shadows of a new technique is photon total skin irradiation using helical imrt feasible less complex and as toxic as the electrons one |
| topic | Total skin irradiation Total skin electrons beam irradiation - TSEBI Photons Radiotherapy Bone marrow Primary cutaneous lymphoma (PCL) |
| url | http://link.springer.com/article/10.1186/s13014-018-1100-4 |
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