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Cutaneous radiotherapy for malignant lymphoma

Implementation

Conventional simulation

Local skin areas are usually treated with electrons where energy and use of bolus is customized for each patient. The field border on the skin should be 2 cm from visible tumor. X-rays (photons with 50–150 keV) are considered for very superficial lesions up to 2-3 mm, but compared to electrons, have a longer tail on the depth dose curve, and therefore give larger doses to deeper structures. For curved surfaces, electrons may be difficult to use, and irradiation with photons and use of bolus may be more simple, for example, on parts of an extremity.  

With extensive involvment of the skin on a foot or leg, irradiation in a water bath is an option. This treatment provides good dose coverage in the skin around the entire foot and leg. This treatment causes significant dermatitis with desquamation and edema in large areas in most patients after a short time.

Fractionation

Fractionation and total dose for indolent lymphomas is normally 2 Gy x 15 or 3 Gy x 8, and for aggressive lymphomas, 2 Gy x 20. For palliation of advanced mycosis fungoides, 2 Gy 4 is also used.

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