Influencing Factors of Total Skin Irradiation With Helical Tomotherapy

PURPOSE: To investigate the influencing factors of total skin irradiation (TSI) with helical tomotherapy for guiding the clinical selection of the suitable parameters and optimizing the plan quality and efficiency. MATERIALS AND METHODS: Six patients with mycosis fungoides (MF) who received TSI were retrospectively selected. They were all dressed with 5 mm thick diving suits during the CT scan and treatment as a bolus to increase the superficial dose through buildup. The dose prescription was 24 Gy in 20 fractions and 5 times per week. During the planned pretreatment, Ring0, Ring1, Ring2, Ring3, and Ring4 of 1 cm thick away from the planning target volume (PTV) at the distances of 0, 1, 2, 3, and 4 cm and other normal tissues (NTs) were generated, respectively. The auxiliary structures were completely blocked during planning; while the field widths were 5 and 2.5 cm, the pitches were 0.287 and 0.215, the modulation factors were 4 and 3, and the other parameters remained consistent. Finally, the dose parameters of PTV and auxiliary structures, as well as the beam on time (BOT) and gantry period, were compared and analyzed. RESULTS: when the auxiliary structures were completely blocked with distance to PTV (d(PTV)) above 3 cm were used, the mean dose (D(mean)), conformity index (CI), and heterogeneity index (HI) of the PTV met the clinical requirements. As the d(PTV) gradually increased, the BOT decreased while the volume of normal tissue that received excessive radiation increased correspondingly. If the d(PTV) was less than 3 cm, the clinical requirements were not met. The field widths (FWs), pitches, and modulation factors (MFs) had no effect on PTV(mean) and the HI. The FW of 2.5 cm was slightly better than 5 cm for the CI. The FW and MF had a significant impact on the BOT, which gradually increased with decreasing FW and increasing MF. Pitch had no effect on the BOT. CONCLUSION: During planning with TSI patients, d(PTV) is the key factor that has a significant influence on the plan quality. We found that the plan with the d(PTV) above 3 cm can meet clinical objectives. The BOT increases as the d(PTV) increases. The FWs also have an effect on the CI and BOT. Therefore, it is necessary to comprehensively balance these factors to optimize the quality and efficiency of the plan. We also found that different MFs and pitches have no obvious effect on the results.