Patient Positioning and Treatment Techniques in Total Skin Irradiation: A Scoping Review

Area of Science:

• Radiation Oncology
• Dermatology
• Medical Physics

Background:

• Total skin irradiation (TSI) is a radiotherapy technique for cutaneous lymphomas like mycosis fungoides.
• Accurate patient positioning is vital for homogeneous radiation distribution and minimizing healthy tissue exposure.

Purpose of the Study:

• To systematically review and categorize patient positioning techniques used in clinical total skin irradiation.
• To identify and compare the strengths and limitations of different TSI positioning methods.

Main Methods:

• A scoping review following PRISMA extension and Arksey and O'Malley framework.
• Electronic searches conducted across EMBASE, PubMed, SCOPUS, and Web of Science.
• Inclusion of 44 original studies detailing TSI positioning techniques.

Main Results:

• The Stanford technique was predominant (75%), with variations noted.
• Rotational techniques (11.4%) and tomotherapy (6.8%) were also analyzed.
• Mixed studies compared Stanford and rotational methods, noting similar dose uniformity but differing efficiency.

Conclusions:

• The Stanford technique, though widespread, has limitations driving the exploration of alternatives.
• Rotational techniques address some Stanford limitations; tomotherapy offers immobilization but has toxicity concerns.
• Future research should optimize the balance of efficacy, safety, and practicality in TSI positioning.