A scattering‐foil free electron beam to increase dose rate for total skin electron therapy (TSET)

Background Electron beams are used at extended distances ranging between 300 to 700 cm to uniformly cover the entirety of the patient's skin for total skin electron therapy (TSET). Even with electron beams utilizing the high dose rate total skin electron (HDTSe) mode from the Varian 23iX or TrueBeam accelerators, the dose rate is only 2500 cGy/min at source‐to‐surface distance (SSD) = 100 cm. At extended distances, the decrease in dose rate leads to long beam delivery times that can limit or even prevent the use of the treatment for patients who, in their weakened condition, may be unable to stand on their own for extended periods of time. Previously, to increase dose rate, a customized 6 MeV electron beam was created by removing the x‐ray target, flattening filter, beam monitor chamber, and so forth. from the beam path (Chen, et at IJROBP 59, 2004) for TSET. Using this scattering‐foil free (SFF) electron beam requires the treatment distance be extended to 700 cm to achieve dose uniformity from the single beam. This room size requirement has limited the widespread use of the 6 MeV‐SFF beam. Purpose This study explores an application of a dual‐field technique with a 6 MeV‐SFF beam to provide broad and uniform electron fields to reduce the treatment distances in order to overcome treatment room size limitations. Methods The EGSnrc system was used to generate incident beams. Gantry angles between 6 MeV‐SFF dual‐fields were optimized to achieve the similar patient skin dose distribution resulting from a standard 6 MeV‐HDTSe dual‐field configuration. The patient skin dose comparisons were performed based on the patient treatment setup geometries using dose‐volume‐histograms. Results Similar dose coverage can be achieved between 6 MeV‐SFF and 6 MeV‐HDTSe beams by reducing gantry angles between dual‐field geometries by 8° and 7° at treatment distances of 400 and 500 cm, respectively. To achieve 95% mean dose to the first 5 mm of skin depth in the torso area, the mean dose to depths of 5–10 mm and 10–15 mm below the skin surface was 74% (74%) and 49% (50%) of the prescribed dose when using 6 MeV‐SFF (6 MeV‐HDTSe) beam, respectively. Conclusions The 6 MeV‐SFF electron beam is feasible to provide similar TSET skin dose coverage at SSD ≥ 400 cm using a dual‐field technique. The dose rate of the 6 MeV‐SFF beam is about 4 times that of current available 6 MeV‐HDTSe beams at treatment distances of 400–500 cm, which significantly shortens the treatment beam‐on time and m