Dosimetric characterization and optimization of a customized Stanford Total Skin Electron Irradiation (TSEI) technique

Total skin electron irradiation (TSEI) has been used as a treatment for mycosis fungoides. Our center has implemented a modified Stanford technique with six pairs of 6 MeV adjacent electron beams, incident perpendicularly on the patient who remains lying on a translational platform, at 200 cm from the source. The purpose of this study is to perform a dosimetric characterization of this technique and to investigate its optimization in terms of energy characteristics, extension, and uniformity of the treatment field. In order to improve the homogeneity of the distribution, a custom-made polyester filter of variable thickness and a uniform PMMA degrader plate were used. It was found that the characteristics of a 9 MeV beam with an 8 mm thick degrader were similar to those of the 6 MeV beam without filter, but with an increased surface dose. The combination of the degrader and the polyester filter improved the uniformity of the distribution along the dual field (180cm long), increasing the dose at the borders of field by 43%. The optimum angles for the pair of beams were ± 27°. This configuration avoided displacement of the patient, and reduced the treatment time and the positioning problems related to the abutting superior and inferior fields. Dose distributions in the transversal plane were measured for the six incidences of the Stanford technique with film dosimetry in an anthropomorphic pelvic phantom. This was performed for the optimized treatment and compared with the previously implemented technique. The comparison showed an increased superficial dose and improved uniformity of the 85% isodose curve coverage for the optimized technique.