Related Experiment Video
Updated: Aug 29, 2026
Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
Published on: February 6, 2019
Total scalp irradiation using pencil beam scanning proton therapy for dermatofibrosarcoma protuberans: case study and
Sheng Huang1,2, Erika Jang1, Haibo Lin1
1New York Proton Center, New York, NY, USA.
Background:
This report describes a patient with extensive dermatofibrosarcoma protuberans of the scalp treated with a technically challenging total scalp irradiation (TSI) plan using intensity-modulated proton therapy (IMPT).
Case Description:
A 33-year-old female presented with a rapidly progressive extensive scalp lesion status post wide local excision with rotational flap reconstruction. Pathology identified diffuse positive margins and high-risk features. A 4-field multi-field-optimized IMPT plan was generated and planned to deliver 6,000 cGy in 30 fractions robustly optimized using 3 mm setup and 3.5% range uncertainty. A volumetric-modulated arc radiotherapy (VMAT) plan matched for target coverage was generated for comparison purposes. The patient successfully completed treatment and remains without evidence of disease at 9 months. IMPT achieved acceptable target coverage with adequate dose homogeneity and robustness. Optimal treatment planning utilized noncoplanar fields, overlapping field dose gradients, and Monte Carlo dose calculations. Organs at risks (OARs) doses with IMPT were significantly reduced compared to VMAT, particularly for the normal brain, hippocampus, pituitary gland, cochlea, and optic structures.
Conclusions:
TSI using IMPT is dosimetrically favorable with unique technical considerations. It achieves dramatic dose sparing to critical OARs compared to modern photon techniques and should be considered when irradiation of an extensive scalp volume is indicated to reduce the long-term toxicity risk of unintentional integral dose.
