International Journal of Dermatology 2005, 44, 828–830 © 2004 The International Society of Dermatology 828 Abstract Introduction Total skin electron irradiation (TSEI) therapy is the treatment of choice for mycosis fungoides. However, conventional TSEI therapy is time consuming as well as patient unfriendly. Therefore we used high-dose rate (HDR) mode TSEI in these patients. High-dose rate mode of TSEI is a technological innovation attached to a Linear Accelerator (Philips, SL-20, Netherlands), which can deliver an electron beam of 30 Gy/min at the iso-center. The iso-center faces the patient, 100 cm away from the target of the linear accelerator. The patient is treated at a distance of 10 feet from the iso-center of the linear accelerator. The dose delivered to the skin was 1.13 Gy/min, making the treatment execution much easier and patient compliance much better. Methods Seven male patients between 40 and 64 years in age having mycosis fungoides for 9–18 months were treated by TSEI using high-dose rate mode between 1998 and 2000. The TSEI was performed according to the Stanford technique, delivering a total dose of 36 Gy. Each patient received a dose of 1.2 Gy/field/day. There were six fields, i.e. anterior, posterior, left and right anterior obliques, and left and right posterior obliques in both the upper and lower parts of the body. The eyes and nails were shielded at each session of radiotherapy. The times taken at each session of the therapy and radiation-associated side-effects were determined in each patient. The patients were followed up to 26 months (median 9 months) to look for any relapse. Results Three patients had early stage disease (IB) whereas four patients had advanced disease (IIB). Six patients out of these had complete remission following TSEI while one patient died as a result of progression of the disease during treatment. The treatment time taken at each treatment session in each individual patient was approximately 15 min. Radiation-associated morbidity was seen in all patients. Cutaneous lesions relapsed in two patients after 4 and 10 months, respectively, while four patients were alive without the disease at the end of 2 years. Conclusions Total skin electron irradiation using high-dose rate mode delivery of electrons is an easy, better, compliant and effective therapeutic modality for treatment of mycosis fungoides with an acceptable range of toxicities. Blackwell Publishing Ltd. Oxford, UK IJD International Journal of Dermatology 1365-4632 Blackwell Publishing Ltd, 2003 45 Report High dose rate mode TSEI in MF Parida et al. REPORT Total skin electron irradiation therapy in mycosis fungoides using high-dose rate mode: A preliminary experience Dillip K. Parida, MD, Kaushal K. Verma, MD, Subhash Chander, MD, R. C. Joshi, MSc, Dip. RP, PhD, and Goura K. Rath, MD From the Departments of Radiation Oncology, and Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India Correspondence Dr Kaushal K. Verma Additional Professor Department of Dermatology and Venerology All India Institute of Medical Sciences New Delhi – 110029 India E-mail: kkverma61@hotmail.com Introduction Mycosis fungoides (MF) is a rare malignant, debilitating dis- ease of the skin with an indolent course and poor prognosis. In spite of the availability of some good, newer therapeutic modalities, the survival as well as ultimate outcome in this disease has not much changed. Radiotherapy using total skin electron irradiation (TSEI) is considered to be one of the best therapies and many studies have proven the beneficial effects of this treatment both as curative as well as palliative modality. 1–4 However, treating a patient of MF with TSEI poses a real challenge for the radiation oncologist, medical physicist as well as for the patient because of the time taken for the patient set up and the treatment delivery, which takes approximately 2 h per treatment session for each patient. High-dose rate (HDR) mode gives a 4-MeV electron beam at a dose rate of 30 Gy/min at the iso-center, which corresponds to a dose of 1.13 Gy/min on the skin of the patient. It gives acceptable beam uniformity and dose depth while maintain- ing a low level of X-ray contamination. In this study we evalu- ated (i) the feasibility of HDR mode in treating patients of MF, (ii) the total treatment duration and the patient compli- ance, and (iii) the dosimetric set up. Materials and Methods Seven clinically diagnosed and histopathologically proven patients of CTCL were treated with TSEI using high-dose rate (HDR) mode