A radiotherapy technique for palliative total scalp irradiation

Total scalp irradiation is used to treat different conditions: melanoma, lymphoma, angiosarcoma, mycosis fungoides, basal, and squamous cell carcinoma. Treatment of the total scalp is typically reserved for diffuse disease presentations and its intent, therefore, is most commonly palliative. Planning and delivering total scalp irradiation is technically challenging, in order to deliver a homogeneous dose to the scalp and meanwhile sparing the brain and all its healthy structures. Many techniques and different approaches have been described in the literature (1-8). More of these have been developed by photons obtaining a good conformation of dose to target and protection of surrounding normal tissue as well (9-13). However, despite new technology and technical solutions, megavoltage electron beams remain the traditional and most common choice for total scalp irradiation in elderly patients (13). To achieve a homogeneous dose distribution, the latter requires normal incidence with respect to the treatment surface. Thus, because of the scalp’s shape does not permit normal incidence by a single electron field, several electron beams techniques have been developed to solve the problem of the electron beam junctions (1-5)