Initial experience with a novel device for supporting a debilitated patient during total skin electron beam therapy

Total skin electron beam therapy (TSET) is the specialized and effective therapy for mycosis fungoides and Sézary syndrome. The Stanford TSET technique, which is the one most often used, requires the patient to remain standing for an extended time. Here, we report on the invention of a device to assist in patient positioning for TSET and how the device is used in clinical care. Our novel device comprises supports for the patient's head and upper limbs plus a bicycle-style saddle seat. We used the device during delivery of TSET for Sézary syndrome in a 30-year-old woman. Radiation was delivered from six angles every 2 days (three angles daily) by the Stanford technique using 6 MeV, 2 Gy per fraction, for a total of 12 Gy every 2 days. The total treatment time each day was about 1 hour. During the first 5 days of treatment, the patient required breaks during irradiation because of general malaise and nausea caused by chemotherapy. At each treatment session, glass dosimeters were used to measure the delivered doses to the parietal, bilateral axillary, anterior chest, bilateral medial thigh, and bilateral plantar areas. Glass dosimeter measurements showed underdoses in the medial thigh dose on both sides, thereby suggesting scattering and attenuation caused by the saddle seat. However, the patient experienced great relief from being able to straddle the seat, given her debilitated physical condition and the imposed blindness from lead contact lenses that she wore to protect her corneas. The patient's risk of falling was ameliorated, and she underwent treatment in safety. Our novel device to support a patient in debilitated physical condition receiving TSET carries a risk of dose reduction to the medial thigh, but the risk of falling is significantly reduced.