ESTRO consensus recommendations on total skin electron beam technique - Endorsed by ILROG

Total skin electron beam therapy (TSEBT) is an established radiation treatment modality for the management of cutaneous T-cell lymphoma (CTCL). In recent years, there has been an increasing interest in dose de-escalation strategies aimed at lowering treatment-induced side effects whilst maintaining efficacy. This evolution in clinical practice has highlighted the need for consistent technical standards to ensure treatment quality and comparability across medical institutions. A unified set of recommendations for TSEBT in the modern era was sought by the European Society for Radiotherapy and Oncology (ESTRO) Guidelines Sub-Group on Physics, including physical requirements, with the aim of harmonizing clinical practice, promoting homogeneity for clinical trials, and facilitating wider adoption of the technique.

The ESTRO Guidelines Committee developed these recommendations using a Delphi consensus methodology. An expert panel consisting of radiation oncologists and medical physicists with specific expertise in the radiation treatment of primary cutaneous lymphoma was convened. Panel members completed a 14-question survey focusing on key technical aspects of TSEBT.

Consensus was achieved on the principal physical and technical components of TSEBT delivery, including prescribed dose levels, field dimensions, treatment techniques, and QA requirements. Areas of agreement reflect current best practices and address sources of variability that may impact treatment reproducibility.

ESTRO recommendations provide a standardised framework for the delivery of TSEBT in the management of CTCL, supporting safe implementation and consistency across medical institutions in the context of reduced-dose treatment approaches.