Effect of topical agents on skin surface dose in volumetric modulated arc therapy for head and neck cancer.

In volumetric modulated arc therapy (VMAT), the effect of an increase in skin surface dose due to topical agents might be negligible. We investigated the bolus effects of three types of topical agents in VMAT for head and neck cancer (HNC). Topical agents of different thicknesses (0.1, 0.5 and 2 mm) were prepared. When each topical agent was set, the surface doses were measured for the anterior static field and VMAT, with and without a thermoplastic mask. No significant differences were observed among the three topical agents. For topical agent thicknesses of 0.1, 0.5 and 2 mm, the increases in surface dose for the anterior static field without the thermoplastic mask were 7-9, 30-31 and 81-84%, respectively. With the thermoplastic mask, the corresponding increases were 5, 12-15 and 41-43%, respectively. The increases in surface dose for VMAT without the thermoplastic mask were 5-8, 16-19 and 36-39%, respectively, and those with the thermoplastic mask were 4, 7-10 and 15-19%, respectively. The rate of increase in surface dose with the thermoplastic mask was smaller than that without the thermoplastic mask. The increase in surface dose with topical agents of clinical standard thickness (0.02 mm) was estimated to be 2% with the thermoplastic mask. The increase in surface dose with topical agents in dosimetric simulation, compared with control situation, is not significant in clinical conditions for HNC patients.

Hepatic blood flow responses to mechanical stimulation of the skin in anaesthetised rats.

The aim of the present study was to investigate how hepatic blood flow (HBF) changes in response to mechanical stimulation of different areas of the skin in anaesthetised rats, by focusing on involvement of the hepatic sympathetic nerves in and contribution of systemic circulatory changes to the HBF responses. HBF was measured at the surface of the left lateral lobe using the laser Doppler flowmetry. Both innocuous and noxious mechanical stimuli were applied to skin areas of the abdomen and hindlimb. Innocuous mechanical stimulation (brushing) of the abdomen and hindlimb did not significantly change HBF, while noxious mechanical stimulation (pinching) of the abdomen and hindlimb did. The responses to pinching were dependent on the sites stimulated. Pinching of the abdomen decreased, while pinching of the hindlimb increased the HBF. The decrease of HBF in response to abdominal pinching remained after the spinal cord was transected at T1-2 level, but the response was diminished after hepatic sympathetic nerves were severed. On the other hand, the increase of HBF in response to hindlimb pinching was dependent on the increase in blood pressure, and was not influenced by the severance of hepatic sympathetic nerves, and the responses to hindlimb pinching were almost absent after the spinal cord was transected. Based on these results, we suggest that noxious mechanical stimulation of the skin produces changes of HBF, either as a reflex response via activation of the hepatic sympathetic nerves or as a passive response to systemic circulatory changes, depending on the sites stimulated.