Clinical application of lying-on-the-floor total skin electron irradiation for frail patients with cutaneous lymphoma: An emphasis on the importance of.

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Clinical application of lying-on-the-floor total skin electron irradiation for frail patients with cutaneous lymphoma: An emphasis on the importance of in vivo dosimetry Jaden D. Evans, MD, Laura L. Haley, BS, Sarah E. Locher, PhD, Michael P. Grams, PhD, Christopher L. Deufel, PhD, John A. Antolak, PhD, James A. Martenson, MD Advances in Radiation Oncology Volume 1, Issue 2, Pages 101-105 (April 2016) DOI: 10.1016/j.adro.2016.03.005 Copyright © 2016 The Authors on behalf of the American Society for Radiation Oncology Terms and Conditions

Figure 1 Patient's initial presentation to radiation oncology after 3 different courses of systemic therapy and before total skin electron irradiation. Advances in Radiation Oncology 2016 1, 101-105DOI: (10.1016/j.adro.2016.03.005) Copyright © 2016 The Authors on behalf of the American Society for Radiation Oncology Terms and Conditions

Figure 2 Patient 2 months after total skin electron irradiation. Advances in Radiation Oncology 2016 1, 101-105DOI: (10.1016/j.adro.2016.03.005) Copyright © 2016 The Authors on behalf of the American Society for Radiation Oncology Terms and Conditions

Figure 3 Lying-on-the-floor total skin electron irradiation setup with the customized flattening filter technique. (A) Radiochromic film was used at various anatomical locations for in vivo measurements. (B) Schematic of anteroposterior and posteroanterior treatment fields (adapted from Deufel and Antolak5; used with permission). Note that only the anteroposterior setup is shown here. (C-E) The patient is oriented perpendicular to the LINAC waveguide (prone treatment fields not illustrated). His umbilicus was positioned directly below the central axis, 5 cm from the spoiler, and the gantry was angled to 300°, 0°, and 60°, respectively. Advances in Radiation Oncology 2016 1, 101-105DOI: (10.1016/j.adro.2016.03.005) Copyright © 2016 The Authors on behalf of the American Society for Radiation Oncology Terms and Conditions

Figure 4 The left posterior oblique, right posterior oblique, left anterior oblique, and right anterior oblique positions were delivered with the gantry rotated to 300° with the patient oriented parallel to the LINAC waveguide and the umbilicus approximately 230 cm from isocenter (supine treatment fields not illustrated). Advances in Radiation Oncology 2016 1, 101-105DOI: (10.1016/j.adro.2016.03.005) Copyright © 2016 The Authors on behalf of the American Society for Radiation Oncology Terms and Conditions