Simultaneous integrated boost with helical arc radiotherapy of total skin (HEARTS) to treat cutaneous manifestations of
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RESEARCH
Open Access
Simultaneous integrated boost with helical arc radiotherapy of total skin (HEARTS) to treat cutaneous manifestations of advanced, therapy-refractory cutaneous lymphoma and leukemia - dosimetry comparison of different regimens and clinical application Chen-Hsi Hsieh1,2,3*† , Hui-Ju Tien1,4†, Yuan-Bin Yu5, Yuan-Hung Wu2,4,6,7, Pei-Wei Shueng1,2, Yueh-Feng Lu1, Shan-Ying Wang4,8 and Li-Ying Wang9,10*
Abstract Background: Helical irradiation of the total skin (HITS) was modified as simultaneous integrated boost (SIB)-helical arc radiotherapy of total skin (HEARTS) technique and applied to an acute myeloid leukemia (AML) patient with disseminated leukemia cutis. Methods: The original HITS plan was revised for different regimens, i.e. HEARTS, low-dose HEARTS and SIB-HEARTS. The uniformity index (UI), conformity index (CI), and dose of organs at risk (OARs) were used to evaluate the plans. Additionally, the SIB-HEART (21/15 Gy) was delivered to the total skin and chloromas. Results: No significant differences were observed for the CI and UI between HITS and HEARTS regimens. Compared with HITS, the reduced mean doses to various bone marrows ranged from 17 to 88%. The mean OARs doses for the head, chest and abdomen of a patient with AML treated with SIB-HEARTS (21/15 Gy) were 2.1 to 21.9 Gy, 1.8 to 7.8 Gy and 1.7 to 3.3 Gy, respectively. No severe adverse effects were noted except for grade 4 leukocytopenia and thrombocytopenia. Conclusion: HEARTS and different regimens reduced the dose to OARs and bone marrow while maintaining the uniformity and conformity. SIB-HEARTS deliveries different doses to the total skin and enlarged tumors simultaneously. Trial registration: Retrospectively registered and approved by the Institutional Review Board of our hospital (FEMH-106151-C). Keywords: HEARTS, Helical tomotherapy, Lymphoma, Leukemia, Total skin electron beam therapy
* Correspondence: [email protected]; [email protected] † Chen-Hsi Hsieh and Hui-Ju Tien contributed equally to this work. 1 Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan 9 School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan Full list of author information is available at the end of the article © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Hsieh et al. Radiation Oncology
(2019) 14:17
Introduction Total skin electron beam therapy (TSEBT) is used to deliver 2
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