Total skin irradiation using helical tomotherapy for refractory mycosis fungoides-type
cutaneous T cell lymphoma(PDF)
《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]
- Issue:
- 2021年第9期
- Page:
- 1061-1067
- Research Field:
- 医学放射物理
- Publishing date:
Info
- Title:
- Total skin irradiation using helical tomotherapy for refractory mycosis fungoides-type
cutaneous T cell lymphoma
- Author(s):
- WANG Haiyang1; WANG Xin1; PI Yifei1; PEI Yuntong1; YANG Ya1; HAN Bin1; JIA Fei1; LIU Lele1; WANG Fangna1; KONG Fanyang1;
HU Jinyan1; FAN Ruitai1; PEI Xi2; XU Xie2; GUO Yuexin1
- 1. Department of Radiation Oncology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China 2. School of
Nuclear Science and Technology, University of Science and Technology of China, Hefei 230026, China
- Keywords:
- helical tomotherapy total skin irradiation cutaneous T-cell lymphoma mycosis fungoides
- PACS:
- R144.1；R811.1
- DOI:
- 10.3969/j.issn.1005-202X.2021.09.003
- Abstract:
- Objective To explore the method using helical tomotherapy for total skin irradiation to treat refractory mycosisfungoides-
type cutaneous T cell lymphoma. Methods A male patient with a 7-year medical history who was diagnosed with
multiple mycosis fungoides-type cutaneous T cell lymphoma was treated with total skin irradiation, with a 5 mm neoprene
diving suit as a tissue compensator to increase the total skin dose through dose build-up effect. The upper and lower target
areas targets of the patient were scanned, separately, with 10 cm above the patella as the dividing line. The total prescription
was 24 Gy, and the treatment scheme was a single 1.2 Gy treatment for 20 times, 5 times per week. The treatment plan was
designed with a field width of 5 cm, a pitch of 0.287 and a modulation factor of 2.5. A complete mode was added to the center
of the body to decrease the dose delivered to internal organs-at-risk, especially the total bone marrow dose, thereby reducing
the incidence of bone marrow suppression. The accuracy of dose delivery was ensured through Cheese Phantom point dose,
ArcCHECK three-dimensional plane dose and total body multi-point EBT3 film verifications. Finally, MVCT guidance was used to ensure the accuracies of set-up and treatment. Results For both upper and lower targets, 95% of target volume
received the prescribed dose, but the conformity index and homogeneity index of the lower target were slightly better than
those of the upper target. The total bone marrow dose was gradually increased with the reduced distance from the skin, while
the doses of other organs-at-risk were within the clinically acceptable range. The accuracy of the actual dose delivery was
guaranteed by multiple verifications, including point dose verification deviation less than 1%, Gamma passing rate of threedimensional
plane dose verification greater than 90%, and film multi-point dose verification deviation less than 5%. The
entire treatment took about 1 hour (including set-up and image guidance). At the later period of treatment, the patient only
experienced slight fatigue, mild nausea and vomiting, low-grade fever and grade 3 bone marrow suppression. After the
completion of treatment, the patient achieved complete remission. Conclusion The proposed method which has the
characteristics of uniform dose distribution, short treatment time, simple implementation process, excellent treatment effect
and low toxic and side effects is suitable for widespread clinical application. However, the choices of the tissue compensator
for the dose build-up layer and the toxic and side effects after treatment, especially bone marrow suppression, need to be
further researched.
Last Update: 2021-09-27