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A method for total skin electron treatment for infants
Insights
Treating pediatric mycosis fungoides with total skin electron beam radiation requires technique adaptation for infants. This study modified the standard technique to ensure uniform radiation dose delivery, crucial for preventing complications in children.
Area of Science:
- Radiation Oncology
- Pediatric Oncology
- Medical Physics
Background:
- Mycosis fungoides necessitates total skin surface radiation treatment.
- Treating infants presents unique challenges due to small body part diameters and the need for anesthesia.
- Standard total skin electron beam techniques can lead to excessive, uneven radiation doses in pediatric patients.
Abstract:
Diseases such as mycosis fungoides require the treatment of a patient's total skin surface with superficial radiation. In a unique clinical situation, a 14-month-old child presented with a need for total skin treatment. A typical total skin technique requires overlapping electron beams, using 6 body positions, each with the gantry rotated for 2 angulations, or '6 positions-12 fields'. Adaptation of this technique for infants is complicated by the small diameter of some body parts, and by the necessity to treat while the patient is anesthetized. Even degraded, low energy electrons can easily penetrate fingers and toes. Therefore, dose from 6 positions becomes additive, and the total dose to small circumferences can be 3 to 4 times more than skin dose on the torso, raising concerns about uneven bone growth in the developing child. Special phantoms were designed for extensive dosimetry needed to determine both dose rate and dose summation from the overlapping beams. Computerized electron pencil beam calculations were compared to TLD measurements. Unique compensating techniques were used to deliver uniform dose. A modification of the 6 position-12 field technique will be described; and accessories used to reduce high dose regions will be illustrated.