Challenging Cases

Total Skin Electron Beam Therapy

Total Skin Electron Beam Therapy (TSET) is a radiation technique which is used to treat patient’s entire/total skin surface using electron beams .

TSET is used to treat Cutaneous T-Cell Lymphoma and/or Mycosis Fungoides. Mycosis Fungoides (MF) is a malignancy of helper T cells and accounts for 50% of all cutaneous lymphomas. Clinically it can present as erythematous and scaling skin patches which are generally annular or arc shaped. These later on progress to form infiltrative scaling plaques, nodules and sometimes have superficial ulcerations.

Aim while treating such type of cutaneous lymphomas is to deliver a therapeutic prescribed dose to entire skin of the body to a shallow depth by sparing the deep seated tissues and organs.

Technically TSET is a complex treatment and requires experienced team of Radiation Oncologists, Medical Physicists and Technologists to carry it out well. TSET requires complex dosimetry and quality assurance processes before and during treatment.

Everyday Patients nail bed and eyes are shielded before treatment using special applicators and lead goggles. (Fig 4)

At Max Hospital, Shalimar Bagh we have been treating patients of mycosis fungoides/cutaneous lymphomas with TSET regularly and with very rewarding results.

For each treatment, patients are  asked to stand in  different positions, alternating daily (total 6 positions) in front of Linear Accerlator. Each position exposes entire  patient’s skin to the radiation beam of  low energy electrons. (Figure 2-3)

Figure 2 – Patient positioned in front of Linear Accelerator

Figure 3- Clinical sketch of six treatment positions used for delivering TSET


  • Itchy skin –  keep skin moisturized, wear cotton cloths
  • Dry cracking skin – apply moisturizer
  • Sun sensitivity- wear sunglass , cap and full gown
  • Fatigue – take rest and eat healthy food
  • Temperature  regulation- Avoid humid hot weather and drink plenty of water
  • Partial temporary hair loss

Treatment Outcomes

TSET is the most effective treatment modality for MF.  It is a technically challenging and   demanding treatment modality and requires stringent quality assurance and team work.

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