A method to improve dose uniformity during total skin electron beam therapy in patients with pendulous breasts

Cutaneous lymphomas are particularly radiosensitive and amenable to palliative radiation therapy. Total skin electron beam therapy (TSEB) is effective for palliation of Sézary syndrome and cutaneous T-cell lymphoma with large body surface area involvement. Focal radiation therapy is often used for treatment of localized disease. Treatment of cutaneous T-cell lymphoma can often pose technical challenges that require creative, patient-specific solutions. The electron beam used in TSEB is superficially penetrating. Although technique-dependent variation exists in the depth of penetration, delivery of an effective dose is generally limited to a depth of less than 1 cm. The inframammary fold of a pendulous breast is generally deeper than 1 cm and therefore will not receive an adequate radiation dose when treated by this technique. The use of a thin brassiere, as suggested in American Association of Physicists Report 23, may overcome this problem in some patients. We report the use of a sling made from nylon stockings to suspend large, pendulous