open access

Vol 19, No 2 (2014)
Special Issue Papers
Published online: 2014-03-01
Submitted: 2013-03-11
Get Citation

Advantages and implications of high dose rate (HDR) total skin electron irradiation (TSEI) for the management of Mycosis Fungoides. Indian experience

Dillip Kumar Parida, Goura Kishore Rath
DOI: 10.1016/j.rpor.2013.07.001
·
Rep Pract Oncol Radiother 2014;19(2):104-108.

open access

Vol 19, No 2 (2014)
Special Issue Papers
Published online: 2014-03-01
Submitted: 2013-03-11

Abstract

Background

Mycosis Fungoides (MF) is an indolent lymphoproliferative disorder affecting dermis caused by abnormal proliferation of CD4+ T-cells. Radiation therapy is the most effective modality of treatment for MF which offers cure in limited stage disease and desirable palliation in advance stage disease. Treating entire skin having many curved surfaces and folds with radiation is the real challenge for the radiation oncologist. Many techniques, dose schedules and modifications in total skin electron irradiation (TSEI) have been tried since 1950s. TSEI treatment is a very time consuming, inconvenient and physically challenging to both patient as well as oncologist.

Aim

At our center TSEI was performed since 1983 with conventional linear accelerator where the treatment time was prolonged beyond two hours, which was very difficult or the patient, oncologist, technical officer and eating away the machine time hampering the treatment of other patients. From 1998 we shifted to high dose rate (HDR) mode, in order to bring down the treatment time of a single patient every day from two and half hour to 15[[ce:hsp sp="0.25"/]]min. The reduction of treatment time increases patient compliance and at the same time saved machine time.

Materials and methods

Between 1998 and 2003, eleven pathological diagnosed MF patients were treated using HDR TSEI. All the patients were male between 40 and 70 years of age, who had the history of having the disease for 7–22 months. Four patients had T2 and seven patients had T3 stage disease with more than 90% skin surface involvement. TSEI was performed with 4[[ce:hsp sp="0.25"/]]MeV electrons with a daily fraction size of 120[[ce:hsp sp="0.25"/]]cGy to a total dose of 36[[ce:hsp sp="0.25"/]]Gy. At the end of 36[[ce:hsp sp="0.25"/]]Gy, boost dose of 10[[ce:hsp sp="0.25"/]]Gy was delivered to self shielding regions like sole, scalp and perineum. Considering the treatment related toxicities and consequent treatment interruptions, in the first seven patients, the last four patients were treated using similar HDR TSEI technique with modified treatment schedule, where the treatment was given on an alternate day basis following 2nd week of initiation of treatment.

Results

The patients were followed over a period of 144 months with a median of 72 months. Nine patients are alive without any evidence of disease, one patient relapsed and one died due to progression of disease. The most common radiation related morbidities are erythema, skin blisters, various degree of desquamations, swelling of joints (specially small joints) etc. which are controlled by treatment interruptions and conservative measures. By modifying the treatment schedule, the incidence of toxicity as well as treatment interruptions were brought down.

Conclusions

We can conclude that HDR-TSEI is an excellent and safe therapeutic modality for the patients with MF both curative as well as palliative without any added toxicity profile, provided patient positioning is done properly.

Abstract

Background

Mycosis Fungoides (MF) is an indolent lymphoproliferative disorder affecting dermis caused by abnormal proliferation of CD4+ T-cells. Radiation therapy is the most effective modality of treatment for MF which offers cure in limited stage disease and desirable palliation in advance stage disease. Treating entire skin having many curved surfaces and folds with radiation is the real challenge for the radiation oncologist. Many techniques, dose schedules and modifications in total skin electron irradiation (TSEI) have been tried since 1950s. TSEI treatment is a very time consuming, inconvenient and physically challenging to both patient as well as oncologist.

Aim

At our center TSEI was performed since 1983 with conventional linear accelerator where the treatment time was prolonged beyond two hours, which was very difficult or the patient, oncologist, technical officer and eating away the machine time hampering the treatment of other patients. From 1998 we shifted to high dose rate (HDR) mode, in order to bring down the treatment time of a single patient every day from two and half hour to 15[[ce:hsp sp="0.25"/]]min. The reduction of treatment time increases patient compliance and at the same time saved machine time.

Materials and methods

Between 1998 and 2003, eleven pathological diagnosed MF patients were treated using HDR TSEI. All the patients were male between 40 and 70 years of age, who had the history of having the disease for 7–22 months. Four patients had T2 and seven patients had T3 stage disease with more than 90% skin surface involvement. TSEI was performed with 4[[ce:hsp sp="0.25"/]]MeV electrons with a daily fraction size of 120[[ce:hsp sp="0.25"/]]cGy to a total dose of 36[[ce:hsp sp="0.25"/]]Gy. At the end of 36[[ce:hsp sp="0.25"/]]Gy, boost dose of 10[[ce:hsp sp="0.25"/]]Gy was delivered to self shielding regions like sole, scalp and perineum. Considering the treatment related toxicities and consequent treatment interruptions, in the first seven patients, the last four patients were treated using similar HDR TSEI technique with modified treatment schedule, where the treatment was given on an alternate day basis following 2nd week of initiation of treatment.

Results

The patients were followed over a period of 144 months with a median of 72 months. Nine patients are alive without any evidence of disease, one patient relapsed and one died due to progression of disease. The most common radiation related morbidities are erythema, skin blisters, various degree of desquamations, swelling of joints (specially small joints) etc. which are controlled by treatment interruptions and conservative measures. By modifying the treatment schedule, the incidence of toxicity as well as treatment interruptions were brought down.

Conclusions

We can conclude that HDR-TSEI is an excellent and safe therapeutic modality for the patients with MF both curative as well as palliative without any added toxicity profile, provided patient positioning is done properly.

Get Citation

Keywords

Mycosis Fungoides; Total skin electron irradiation; HDR TSEI

About this article
Title

Advantages and implications of high dose rate (HDR) total skin electron irradiation (TSEI) for the management of Mycosis Fungoides. Indian experience

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 19, No 2 (2014)

Pages

104-108

Published online

2014-03-01

DOI

10.1016/j.rpor.2013.07.001

Bibliographic record

Rep Pract Oncol Radiother 2014;19(2):104-108.

Keywords

Mycosis Fungoides
Total skin electron irradiation
HDR TSEI

Authors

Dillip Kumar Parida
Goura Kishore Rath

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: journals@viamedica.pl