Radiation Oncology/Total Scalp

Total Scalp Irradiation

• Scalp lesions are common in angiosarcoma, lymphoma, and melanoma
• There are multiple approaches, from electron only fields, to mixed electron/photon fields, IMRT, and brachytherapy

Brachytherapy

• Leipzig; 2007 PMID 17406803 -- "Helmet mold-based surface brachytherapy for homogeneous scalp treatment: a case report." (Liebmann A, Strahlenther Onkol. 2007 Apr;183(4):211-4.)
  • Description of brachytherapy mold using a customized polyethylene helmet, using HDR IR-192
  • Conclusion: safe and practicable

• Japan; 2003 PMID 12810835 -- "Iridium-192 brachytherapy for hemorrhagic angiosarcoma of the scalp: a case report." (Nakamura R, Jpn J Clin Oncol. 2003 Apr;33(4):198-201.)
  • Case report. Description of HDR Ir-192 mold.

• Ankara; 2002 (Turkey) PMID 12419458 -- "Mold brachytherapy can be an optional technique for total scalp irradiation." (Ozyar E, Int J Radiat Oncol Biol Phys. 2002 Nov 15;54(4):1286.)
  • Case report. Description of HDR Ir-192 helmet; 48 catheters. Prescribed 40.5 Gy at 1cm (0.5 cm skin depth), over 3 weeks

IMRT/Tomotherapy

• Wisconsin
  • 2006 PMID 16504768 -- "Helical tomotherapy as a means of administering total or partial scalp irradiation: In regards to Bedford et al.", Khuntia D, Int J Radiat Oncol Biol Phys. 2006 Mar 15;64(4):1288-9; author reply 1289-90.)
    • Helical tomotherapy, no bolus
    • Conclusion: excellent dosimetry, fast (~25 min) treatment times
  • 2005 PMID 16112468 -- "Total scalp irradiation using helical tomotherapy." (Orton N, Med Dosim. 2005 Fall;30(3):162-8.)
    • Comparison of IMRT and helical tomotherapy plans
    • Conclusion: EUD better and brain dose lower with tomotherapy plans

• Royal Marsden; 2005 (UK) PMID 16029817 -- "Treatment of extensive scalp lesions with segmental intensity-modulated photon therapy." (Bedford JL, Int J Radiat Oncol Biol Phys. 2005 Aug 1;62(5):1549-58.)
  • Comparison of static electrons, electron arc therapy, and 5-field photon IMRT for large, but only partial, scalp lesions
  • Conclusion: IMRT improves homogeneity to PTV, but increases dose to the brain

• Washington Univ; 2002 PMID 11872304 -- "Potential of tomotherapy for total scalp treatment." (Locke J, Int J Radiat Oncol Biol Phys. 2002 Feb 1;52(2):553-9.)
  • Evaluation of IMRT plan and lateral photon/electron technique
  • Conclusion: lateral photon/electron technique superior; IMRT substantial dose to lens, brain, and orbit

• MC Virginia; 1996 PMID 8665137 -- "Short communication: Total craniofacial photon shell technique for radiotherapy of extensive angiosarcomas of the head." (Kinard JD, Br J Radiol. 1996 Apr;69(820):351-5.)
  • Case report. Description of arc therapy

Mixed photons/electrons

• MD Anderson; 1993 PMID 8365936 -- "Dosimetric evaluation of total scalp irradiation using a lateral electron-photon technique." (Tung SS, Int J Radiat Oncol Biol Phys. 1993 Sep 1;27(1):153-60.)
  • Dosimetric evaluation of a modified opposed-lateral electron/photon UCSF technique
  • Conclusion: practical, acceptable dosimetry, adapted this technique for use at MDACC

• UCSF; 1989 PMID 2504182 -- "Treatment of the scalp using photon and electron beams." (Akazawa C, Med Dosim. 1989;14(2):129-31.)
  • Description of lateral opposed photons matched with lateral opposed electrons

Electrons

• MD Anderson; 1991 PMID 1917604 -- "Evaluation of a total scalp electron irradiation technique." (Able CM, Int J Radiat Oncol Biol Phys. 1991 Sep;21(4):1063-72.)
  • Dosimetric evaluation of 12-beam electron technique