How did early orthovoltage radiation therapy affect the skin?

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linear accelerator; external beam radiation therapy — radiation therapy External beam radiation therapy (also known as external beam teletherapy, or long-distance therapy) being delivered using a machine known as a linear accelerator.

Early orthovoltage radiation therapy, which utilized X-rays in the range of 140 to 400 kilovolts, frequently caused serious and often intolerable skin burns.1

Because these machines operated at lower energy levels than modern equipment, the radiation was less capable of penetrating deep into the body, resulting in a higher concentration of the dose on the skin surface. In contrast, modern radiation therapy uses high-energy megavoltage beams (exceeding 1,000 kilovolts), which allow for deeper tissue penetration while significantly reducing the dose delivered to the skin.1