Revisiting Stanford Technique for Treatment of Mycosis Fungoid Patient with a Cardiac Pacemaker
S Deore*, X Xu, L Luo, T Kwiatkowski, M Atanas, Rochester General Hospital, Rochester, NYSU-E-T-37 Sunday 3:00PM - 6:00PM Room: Exhibit Hall
Purpose: Implement a dual six field electron beam treatment technique for treatment of Mycosis Fungoid patient with a cardiac pacemaker.
Introduction: Total skin electron beam therapy for treatment of mycosis fungoids requires large size of treatment fields obtained at 4 to 5 meters distance (TG 30). A large field treatment with a cardiac pacemaker presents significant challenge for mycosis fungoid treatment. The Stanford technique with adequate shielding for pacemaker was implemented.
Materials and Methods: A 82 year old gentleman with mycosis fungoid stage IB was planned for treatment with large field electron beams at extended distance. The standard Stanford technique of six dual fields was implemented on Varian Clinac iX. A custom made stand was designed to reproduce & support patient for daily treatment. A treatment distance of 4.8 meters using 6 MeV electrons was implemented. To achieve uniform dose delivery along patient height, a gantry angle of ±15° was finalized. A P-11 parallel plate chamber was used for TG-51 and profile measurements. The B factor concept from Stanford technique was used for absolute dose calculations. For the pacemaker 6 mm thick lead shield was used to reduce maximum dose < 2Gy during entire course of the treatment.
Results: Patient received 20 Gy to entire skin surface in 20 fractions, followed by additional boost dose of 10 Gy to localized active lesions. During entire course of treatment nail bed and eyes were shielded. Patient tolerated entire course of treatment very well.
Conclusions: The early response was promising. The functional evaluation by cardiologist did not indicate any radiation damage to the pacemaker.