{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T13:55:21Z","timestamp":1770818121981,"version":"3.50.1"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T00:00:00Z","timestamp":1768953600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To elucidate the dosimetric mechanisms underlying the increased incidence of acute radiation dermatitis associated with Helical TomoTherapy (TOMO) compared to Volumetric Modulated Arc Therapy (VMAT) in whole-breast irradiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and materials<\/jats:title>\n                    <jats:p>\n                      A retrospective analysis included 40 patients with right-sided breast cancer receiving hypofractionated whole-breast irradiation (40 Gy\/15 fractions), evenly matched between VMAT (Elekta Synergy) and helical TomoTherapy (TOMO) groups. Skin dose was evaluated using a multi-parametric approach: 1) Dose Surface Maps (DSM); 2) a novel 5-mm thick PTV-projected adjacent superficial tissue (P-PAST) structure; and 3) equivalent dose in 2-Gy fractions (EQD\n                      <jats:sub>2<\/jats:sub>\n                      , \u03b1\/\u03b2=10). Clinical skin toxicity was graded per RTOG criteria.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Clinically significant (Grade 2-4) acute skin toxicity was substantially more frequent with TOMO (70%) than with VMAT (30%, p=0.026). DSM showed TOMO produced a more confined high-dose region on the skin surface compared to VMAT. However, TOMO delivered significantly higher physical and biologically effective doses to the subcutaneous P-PAST region: mean EQD\n                      <jats:sub>2<\/jats:sub>\n                      was 44.47 \u00b1 1.33 Gy vs. 42.12 \u00b1 0.76 Gy for VMAT (p&amp;lt;0.001). D2cc and maximum dose EQD\n                      <jats:sub>2<\/jats:sub>\n                      were also elevated in the TOMO group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The heightened skin toxicity with TOMO is not predicted by conventional skin surface dose metrics but is explained by a significant dose escalation within the subcutaneous P-PAST region. Plan evaluation for TOMO should incorporate volumetric dose assessment of the dermal compartment to mitigate toxicity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1760716","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T05:35:02Z","timestamp":1768973702000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond surface dose: subcutaneous dose escalation underlies TomoTherapy\u2019s skin toxicity in breast radiotherapy"],"prefix":"10.3389","volume":"16","author":[{"given":"Jiao","family":"Xue","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, The First Affiliated Hospital of Soochow University","place":["Suzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenjun","family":"Zhao","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Radiation Medicine and Protection, School for 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