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Walter AE, Khan AU, DeWerd LA. Measurement of the modified TG43 parameters for the bare S7600 Xoft Axxent source model. Brachytherapy 2023; 22:260-268. [PMID: 36623989 DOI: 10.1016/j.brachy.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 01/09/2023]
Abstract
PURPOSE The purpose of this work is to provide measured data for the modified TG43 parameters [DeWerd et al.] for the newest, Galden-cooled S7600 Xoft Axxent source model. METHODS The measurement of radial dose distributions at distances of 1 cm to 4 cm from the source was performed using TLD100 microcubes, EBT3 film, and an Exradin A26 microionization chamber. The overall uncertainty and reproducibility of each dosimeter was evaluated for its use in determining the radial dose function and dose rate conversion coefficient. An acrylic phantom developed in house for previous works was used to measure the polar anisotropy function using TLD100 microcubes at distances of 1 cm, 2 cm, and 5 cm from the source. RESULTS The Exradin A26 chamber was deemed most suitable for measuring the radial dose function. Values determined had a maximum k = 1 uncertainty of 1.4%. The dose rate conversion coefficient measured with the chamber was found to be 9.33 ± 0.21cGy/hrμGy/min. TLD100 microcube measurements of the polar anisotropy had average uncertainties of 6%, 3%, and 2.5% at 1 cm, 2 cm, and 5 cm, respectively. CONCLUSIONS The modified TG43 parameters for the bare source were measured with reasonable uncertainty. The values determined will aid with the clinical implementation of the source for breast and endometrial cancer applications.
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Affiliation(s)
- Autumn E Walter
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin, Madison, WI; Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin, Madison, WI.
| | - Ahtesham U Khan
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Larry A DeWerd
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin, Madison, WI
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Investigation of isotropic radiation of low energy X-ray intra-operative radiotherapy by MAGAT gel dosimeter. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2021.109648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Alyani Nezhad Z, Geraily G, Hataminia F, Parwaie W, Ghanbari H, Gholami S. Bismuth oxide nanoparticles as agents of radiation dose enhancement in intraoperative radiotherapy. Med Phys 2021; 48:1417-1426. [PMID: 33387376 DOI: 10.1002/mp.14697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/31/2020] [Accepted: 12/20/2020] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Intraoperative radiotherapy (IORT) technique is an advanced radio therapeutic method used for delivery of a single high-dose radiation during surgery while removing healthy tissues from the radiation field. Nowadays, growing attention is being paid to IORT for its low-energy (kilovoltage) delivery as it requires less radiation protection, but suffers several disadvantages, including high-dose delivery and prolonged treatment time. The application of nanoparticles with high atomic number and high attenuation coefficients in kilovoltage energy may help overcome the mentioned shortcomings. This study was designed to investigate and quantify the mean dose enhancement factor (DEF) in the presence of nanoparticles using IORT method. METHODS Bismuth oxide nanoparticles (Bi2 O3 NPs), both in sheet and spherical formats, were synthesized using a novel hydrothermal method and characterized with x-ray diffraction (XRD), transmission electron microscopy (TEM), and Brunauer-Emmett-Teller (BET) analysis. Genipin-gelatin gel dosimeter (GENIPIN) was produced in three batches of pure with sheet and with spherical nanoparticles in concentration of 46.596 µg/ml, and irradiated with 50 kV x-rays. RESULTS Samples were scanned by a spectrophotometer, which indicated a DEF of 3.28 ± 0.37 and 2.50 ± 0.23 for sheet and spherical NPs, respectively. According to the results of this study, GENIPIN is a suitable dosimeter for the evaluation of three-dimensional dose distribution in the presence Bi2 O3 NPs. CONCLUSION As a result, IORT along with Bi2 O3 NPs has the potential to reduce treatment time and/or normal tissue dose; moreover, it could provide localized dose enhancement.
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Affiliation(s)
- Zahra Alyani Nezhad
- Department of Medical Physics and Medical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghazale Geraily
- Department of Medical Physics and Medical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hataminia
- Department of Medical Nanotechnology, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Wrya Parwaie
- Department of Medical Physics, Faculty of Paramedical Sciences, Ilam University of Medical Sciences, Ilam, Iran
| | - Hossein Ghanbari
- Department of Medical Nanotechnology, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Somayeh Gholami
- Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
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Feasibility of interstitial stepping-source electronic brachytherapy to locally inoperable tumors. J Contemp Brachytherapy 2020; 12:480-486. [PMID: 33299437 PMCID: PMC7701928 DOI: 10.5114/jcb.2020.100381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/16/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose Radiotherapy is the mainstay in the treatment of locally inoperable tumors. Interstitial electronic needle-based kilovoltage brachytherapy (EBT) could be an economic alternative to high-dose-rate (HDR) brachytherapy or permanent seed implantation (PSI). In this work, we evaluated if locally inoperable tumors treated with PSI at our institution may be suitable for EBT. Material and methods A total of 10 post-interventional computed tomography (CT) scans of patients, who received PSI and simulated stepping-source EBT applied with Intrabeam system and needle applicator were used. EBT treatment planning software with 3-dimensional image and projection of applicator were applied for designing trajectories and establishing dwell positions. Dwell position doses were summarized, and doses covering 90% of the target volume (D90) achieved with stepping-source EBT were compared to those of PSI. Additionally, conformality of dose distributions and total irradiation time were assessed using conformation number (CN) or conformal index (COIN). Results In all patients, D90 of EBT exceeded the prescribed dose or D90 of PSI on average by 4.7% or 21.3% relative to the prescribed dose, respectively. Mean number of trajectories was 5.0 for EBT and 6.9 for PSI. Average CN/COIN for EBT was 0.69, with a mean irradiation time of 27.8 minutes for standardized dose of 13 Gy. Conclusions Stepping-source EBT allowed for a conformal treatment of inoperable interstitial tumors with similar D90. Fewer trajectories were required for EBT in majority of cases.
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Keramati A, Javadinia SA, Gholamhosseinian H, Fanipakdel A, Homaei Shandiz F, Taghizadeh-Hesary F. A Review of Intraoperative Radiotherapy After Neoadjuvant Chemotherapy in Patients with Locally Advanced Breast Cancer: From Bench to Bedside. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-020-00465-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Hu X, He Y, Chen X, Xia T, Cao T, Jia H, Zhang L. Impact of intraoperative radiotherapy on the perioperative period of patients after breast-conserving surgery. Gland Surg 2020; 9:1535-1542. [PMID: 33224829 PMCID: PMC7667061 DOI: 10.21037/gs-20-727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND To investigate the effect of intraoperative radiotherapy (IORT) in the perioperative period of patients after breast-conserving surgery (BCS). METHODS The clinical data of 100 patients with early breast cancer undergoing breast-conserving surgery (BCS) followed by treatment with IORT using the Intrabeam system (Carl Zeiss Meditec, Oberkochen, Germany) (BCS + IORT group, n=100) between June 2016 and December 2019 were analyzed and compared with the data of 60 matched patients who only underwent breast-conserving therapy over the same period (BCS group, n=60). The surgical settings and postoperative acute complications between the groups were assessed. RESULTS There was no significant statistical difference between the groups in terms of age, tumor size, grading, lymph node status, hormone receptor status, and human epidermal growth factor receptor 2 (HER-2) status (P>0.05). The BCS + IORT group had a significantly longer surgery duration (P<0.05), but there was no significant statistical difference in terms of intraoperative blood loss, amount of bleeding, drainage tube removal time, postoperative length of hospitalization, incision suture removal time, or incidence of postoperative complications (P>0.05). CONCLUSIONS IORT using the Intrabeam system safely delivers radiation therapy, is well-tolerated, has acceptable acute toxicity, and does not significant increase the risk of surgery or the incidence of perioperative complications.
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Affiliation(s)
- Xiaowu Hu
- Department of Breast Surgery, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yong He
- Department of Radiotherapy, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xinxin Chen
- Department of Breast Surgery, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ting Xia
- Department of Breast Surgery, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tengfei Cao
- Department of Breast Surgery, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Haixia Jia
- Department of Breast Surgery, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lehong Zhang
- Department of Breast Surgery, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Sarria GR, Sperk E, Wenz F, Schneider F, Abo-Madyan Y, Giordano FA, Ehmann M. Adjuvant electronic brachytherapy for endometrial carcinoma: A 4-year outcomes report. Brachytherapy 2020; 19:635-641. [PMID: 32651094 DOI: 10.1016/j.brachy.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/27/2020] [Accepted: 06/04/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of the study was to report the outcomes of a single-center adjuvant electronic brachytherapy (e-BT) experience for patients with endometrial carcinoma. METHODS AND MATERIALS Patients were retrospectively assessed. Intracavitary e-BT was applied through a cylindrical applicator (diameters 2.5-3.5 cm). e-BT single doses ranged between 4 and 7 Gy (EQD2 ∼ 6-12, α/β of 10 Gy and an relative biological effectiveness of 1.3) at 5-mm depth. Adverse events are reported at first week, 1-3 months, 3-12 months, 12-24 months, and >24 months. The overall survival, disease-free survival, distant disease control rate, and local control rate were estimated using the Kaplan-Meier method. RESULTS Twenty-nine patients were assessed. The median age was 68 [48-86] years. External beam radiotherapy was added in n = 8 (27.6%) patients. Staging was 13.8% for T1a, 51.7% for T1b, 24.1% for T2, 6.9% for T3a, and 3.4% for T3b. Grading was G3 in 51.7% (n = 15), G2 in 20.7% (n = 6), and G1 in 27.6% (n = 8). Median followup was 47 months [5-88]. Overall Grade 1, 2, and 3 toxicity was 89.7% (n = 26), 17.2% (n = 5), and 6.9% (n = 2), respectively. No Grade 3 cystitis or proctitis or any Grade 4 or 5 toxicity occurred during followup. No local recurrences were detected. Estimated distant disease control rate was 92.1% (n = 2, distant metastasis at 7 and 11 months). Estimated 4-year overall survival was 84.8% (n = 4 events, two unrelated to disease) and disease-free survival was 84.6%. CONCLUSIONS Our data suggest that e-BT resembles a very-low-toxicity profile and a high local control rate in the adjuvant scenario for patients with endometrial carcinoma.
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Affiliation(s)
- Gustavo R Sarria
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Elena Sperk
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frederik Wenz
- University Medical Center Freiburg, Medical Faculty Freiburg, Freiburg University, Freiburg, Germany
| | - Frank Schneider
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Yasser Abo-Madyan
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany.
| | - Michael Ehmann
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Vidal M, Ibáñez P, Guerra P, Valdivieso-Casique MF, Rodríguez R, Illana C, Udías JM. Fast optimized Monte Carlo phase-space generation and dose prediction for low energy x-ray intra-operative radiation therapy. ACTA ACUST UNITED AC 2019; 64:075002. [DOI: 10.1088/1361-6560/ab03e7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Lee JH, Kim HN, Lim HS, Cho SO. Three‐dimensional‐printed vaginal applicators for electronic brachytherapy of endometrial cancers. Med Phys 2018; 46:448-455. [DOI: 10.1002/mp.13335] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/25/2018] [Accepted: 11/30/2018] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ju Hyuk Lee
- Department of Nuclear and Quantum Engineering Korea Advanced Institute of Science and Technology Daejeon 305‐701 Republic of Korea
| | - Hyun Nam Kim
- Department of Nuclear and Quantum Engineering Korea Advanced Institute of Science and Technology Daejeon 305‐701 Republic of Korea
| | - Hyung San Lim
- Department of Nuclear and Quantum Engineering Korea Advanced Institute of Science and Technology Daejeon 305‐701 Republic of Korea
| | - Sung Oh Cho
- Department of Nuclear and Quantum Engineering Korea Advanced Institute of Science and Technology Daejeon 305‐701 Republic of Korea
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Hill R, Healy B, Butler D, Odgers D, Gill S, Lye J, Gorjiara T, Pope D, Hill B. Australasian recommendations for quality assurance in kilovoltage radiation therapy from the Kilovoltage Dosimetry Working Group of the Australasian College of Physical Scientists and Engineers in Medicine. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2018; 41:781-808. [DOI: 10.1007/s13246-018-0692-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Shahhoseini E, Ramachandran P, Patterson WR, Geso M. Determination of dose enhancement caused by AuNPs with Xoft ® Axxent ® Electronic (eBx™) and conventional brachytherapy: in vitro study. Int J Nanomedicine 2018; 13:5733-5741. [PMID: 30310276 PMCID: PMC6165788 DOI: 10.2147/ijn.s174624] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Purpose The purpose of this study was to determine dose enhancement (DE) and the possible clinical benefits associated with the inclusion of gold nanoparticles (AuNPs) in cancer cells irradiated by either an 192Ir brachytherapy source or a Xoft® Axxent® Electronic (eBx™) Brachytherapy. Patients and methods Brachytherapy DE caused by AuNPs is investigated using two methods, namely 192Ir and eBx™ Brachytherapy. The second method, which was recently introduced clinically, operates at ~50 kV, which is also the optimal beam energy for DE. In this in vitro study, two cancer cell lines, lung (A549) and prostate (DU145), were used. Cells were incubated with 1 mM (2% w/w) concentration of AuNPs of ~15 nm in size. The control groups were exposed to a range of doses from 0 (control) to 6 Gy, with eBx™ and 192Ir sources separately. A clonogenic assay was conducted to determine cell survival curves. Results High dose enhancement factor (DEF) values were achieved in treated groups with low concentration of AuNPs with the 50 kV energy associated with the eBx™. The DE levels in eBx™ for Du145 and A549 cells were found to be 2.90 and 2.06, respectively. The results showed DEFs measured for the same cell lines using 192Ir brachytherapy to be 1.67 and 1.54 for Du145 and A549 cancer cells, respectively. This clearly indicates that much higher DE values are obtained in the case of eBx™ X-ray brachytherapy compared to 192Ir gamma brachytherapy. Conclusion The higher DE values obtained with eBx™ compared to 192Ir brachytherapy can be attributed to the lower average energy of the former and being closer to the optimal energy for DE. This could potentially be utilized by medical practitioners and clinicians to achieve the same tumor control with a significantly lower dose from the eBx™ compared to the 192Ir brachytherapy treatment, thus bringing huge benefits to the brachytherapy-treated patients.
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Affiliation(s)
- Elham Shahhoseini
- Discipline of Medical Radiation, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia,
| | - Prabhakar Ramachandran
- Discipline of Medical Radiation, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia, .,Department of Physical Sciences, Peter Mac Callum Cancer Centre, Melbourne, VIC, Australia
| | | | - Moshi Geso
- Discipline of Medical Radiation, School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia,
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Breast intraoperative radiotherapy: a review of available modalities, dedicated machines and treatment procedure. JOURNAL OF RADIOTHERAPY IN PRACTICE 2018. [DOI: 10.1017/s146039691800033x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AbstractBackgroundBreast intraoperative radiotherapy (IORT) is a partial irradiation technique that delivers a single fraction of radiation dose to the tumour bed during surgery. The use of this technique is increasing (especially in the Middle East), and therefore, it is essential to have a comprehensive approach to this treatment modality. The aim of this study is to conduct a literature review on available IORT modalities during breast irradiation as well as dedicated IORT machines and associated treatment procedures. The main IORT trials and corresponding clinical outcomes are also studied.Materials and MethodsA computerised search was performed through MEDLINE, PubMed, PubMed Central, ISI web of knowledge and reference list of related articles.ResultsIORT is now feasible through using two main modalities, including low-kilovolt IORT and intraoperative electron radiotherapy (IOERT). The dedicated machines employed and treatment procedure for mentioned modalities are quite different. The outcomes of implemented clinical trials showed that IORT is not inferior to external beam radiotherapy (EBRT) in specifically selected and well-informed patients and can be considered as an alternative to EBRT.ConclusionAlthough the clinical outcomes of introduced IORT methods are comparable, but based on the review results, it could be said that IOERT is the most effective technical method, in view of the treatment time and dose uniformity concepts. The popularity of IORT is mainly due to the distinguished obtained results during breast cancer treatment. Despite the presence of some technical challenges, it is expected that the IORT technique will become more widespread in the immediate future.
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Skin dose assessment with treatment planning system (TPS) and skin reaction evaluation of early breast cancer patients treated via an intraoperative radiation therapy (IORT) device. JOURNAL OF RADIOTHERAPY IN PRACTICE 2018. [DOI: 10.1017/s1460396918000237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractPurposeTo assess skin dose and incidence of skin reactions in early breast cancer patients treated via Intrabeam™ intraoperative radiation therapy (IORT) device.Materials and methodsIn total, 250 breast cancer patients treated with a single fraction of 20 Gy using 50 kV photon were recruited. The applicator to skin distance (ASD) was measured before the initiation of the radiation and the skin dose in each patient was accordingly calculated based on the treatment planning system (TPS).ResultsThe average skin doses calculated were equal to 7·91, 5·83, 3·96 and 2·14 Gy for 6–10, 10–15, 15–20 and 20–30 mm ASD values, respectively. It is noticeable that the skin doses could be lower than the TPS measurements up to 45%, mostly due to lack of backscatter radiation in breast tissue compared with the full scatter condition in the Zeiss water phantom. Finally, only three patients showed low-grade skin reactions 1 week after IORT. A review of the related literature also revealed the incidence of lower skin complications among patients treated via Intrabeam™ compared with MammoSite™ machine.ConclusionsThe Intrabeam™ TPS did not seem to be very reliable for accurate skin dosimetry. However, breast cancer treatment using Intrabeam™ could result in fewer incidences of skin reactions than MammoSite™ machine.
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Dosimetric characterization and commissioning of a superficial electronic brachytherapy device for skin cancer treatment. NUCLEAR ENGINEERING AND TECHNOLOGY 2018. [DOI: 10.1016/j.net.2018.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Schneider F, Bludau F, Clausen S, Fleckenstein J, Obertacke U, Wenz F. Precision IORT – Image guided intraoperative radiation therapy (igIORT) using online treatment planning including tissue heterogeneity correction. Phys Med 2017; 37:82-87. [DOI: 10.1016/j.ejmp.2017.04.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/17/2017] [Accepted: 04/14/2017] [Indexed: 12/30/2022] Open
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Herskind C, Ma L, Liu Q, Zhang B, Schneider F, Veldwijk MR, Wenz F. Biology of high single doses of IORT: RBE, 5 R's, and other biological aspects. Radiat Oncol 2017; 12:24. [PMID: 28107823 PMCID: PMC5251326 DOI: 10.1186/s13014-016-0750-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 12/21/2016] [Indexed: 01/14/2023] Open
Abstract
Intraoperative radiotherapy differs from conventional, fractionated radiotherapy in several aspects that may influence its biological effect. The radiation quality influences the relative biologic effectiveness (RBE), and the role of the five R’s of radiotherapy (reassortment, repair, reoxygenation, repopulation, radiosensitivity) is different. Furthermore, putative special biological effects and the small volume receiving a high single dose may be important. The present review focuses on RBE, repair, and repopulation, and gives an overview of the other factors that potentially contribute to the efficacy. The increased RBE should be taken into account for low-energy X-rays while evidence of RBE < 1 for high-energy electrons at higher doses is presented. Various evidence supports a hypothesis that saturation of the primary DNA double-strand break (DSB) repair mechanisms leads to increasing use of an error-prone backup repair system leading to genomic instability that may contribute to inactivate tumour cells at high single doses. Furthermore, the elimination of repopulation of residual tumour cells in the tumour bed implies that some patients are likely to have very few residual tumour cells which may be cured even by low doses to the tumour bed. The highly localised dose distribution of IORT has the potential to inactivate tumour cells while sparing normal tissue by minimising the volume exposed to high doses. Whether special effects of high single doses also contribute to the efficacy will require further experimental and clinical studies.
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Affiliation(s)
- Carsten Herskind
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Lin Ma
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,Present Address: Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Qi Liu
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,Present Address: Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Bo Zhang
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,Present Address: Department of Oncology at No. 2 Hospital Anhui Medical University, and School of Life Sciences, Anhui Medical University, Hefei, Anhui, China
| | - Frank Schneider
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Marlon R Veldwijk
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Frederik Wenz
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Eaton DJ. Electronic brachytherapy--current status and future directions. Br J Radiol 2015; 88:20150002. [PMID: 25748070 PMCID: PMC4628482 DOI: 10.1259/bjr.20150002] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 02/28/2015] [Accepted: 03/05/2015] [Indexed: 12/17/2022] Open
Abstract
In the past decade, electronic brachytherapy (EB) has emerged as an attractive modality for the treatment of skin lesions and intraoperative partial breast irradiation, as well as finding wider applications in intracavitary and interstitial sites. These miniature X-ray sources, which operate at low kilovoltage energies (<100 kV), have reduced shielding requirements and inherent portability, therefore can be used outside the traditional realms of the radiotherapy department. However, steep dose gradients and increased sensitivity to inhomogeneities challenge accurate dosimetry. Secondly, ease of use does not mitigate the need for close involvement by medical physics experts and consultant oncologists. Finally, further studies are needed to relate the more heterogeneous dose distributions to clinical outcomes. With these provisos, the practical convenience of EB strongly suggests that it will become an established option for selected patients, not only in radiotherapy departments but also in a range of operating theatres and clinics around the world.
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Affiliation(s)
- D J Eaton
- NCRI Radiotherapy Trials Quality Assurance Group, Mount Vernon Hospital, London, UK
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Pan L, Zheng W, Ye X, Chen L, Ke Y, Wan M, Tang W, Gao J, Zhang X. A novel approach of INTRABEAM intraoperative radiotherapy for nipple-sparing mastectomy with breast reconstruction. Clin Breast Cancer 2014; 14:435-41. [PMID: 24985074 DOI: 10.1016/j.clbc.2014.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 03/31/2014] [Accepted: 04/23/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite the advancement and increasing use of breast-conserving surgery, mastectomies, including nipple-sparing mastectomy (NSM), are still carried out in a portion of breast cancer patients. However, the role of NSM is still controversial, mainly because of concern about the oncologic safety of the nipple-areola complex (NAC). INTRABEAM (Carl Zeiss, Oberkochen, Germany) is the most widely used mobile intraoperative radiotherapy (IORT) device to date. This pilot study aims to broaden the application of the INTRABEAM system for breast cancer, investigating the feasibility of INTRABEAM IORT in NSM with breast reconstruction. PATIENTS AND METHODS From December 2012 to June 2013, 7 female patients with breast cancer were enrolled in the study. NSM with or without axillary dissection was performed first. After confirming negative retroareolar frozen section results and no poor local bleeding in the NAC, INTRABEAM IORT was carried out with a single dose of 16 Gy, followed by breast reconstruction. The complications and short-term outcomes were assessed. RESULTS The median radiation time was 13 minutes 14 seconds in the 7 cases. One patient complained of mild pain in the radiation field on the skin in the first 2 weeks. All 7 patients were followed for a median of 7 months. No acute radiation injury with symptoms (heart, lung, or hematologic system), NAC necrosis, local recurrence, or metastasis was observed. Although every patient had reduction in NAC sensitivity, the contours of the breasts (including the NAC) were satisfactory. CONCLUSIONS INTRABEAM IORT may be a feasible and convenient approach for NSM with breast reconstruction in patients with breast cancer.
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Affiliation(s)
- Lingxiao Pan
- Department of Breast Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Wenbo Zheng
- Department of Breast Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China.
| | - Xigang Ye
- Department of Breast Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Lun Chen
- Department of Breast Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Yaohua Ke
- Metabolic Bone Disease and Genetic Research Unit, Department of Osteoporosis and Bone Diseases, Shanghai Jiao Tong University, Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Minghui Wan
- Department of Radiation Oncology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Wei Tang
- Department of Breast Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Jin Gao
- Department of Breast Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Xiaoshen Zhang
- Department of Breast Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
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Williams NR, Pigott KH, Brew-Graves C, Keshtgar MRS. Intraoperative radiotherapy for breast cancer. Gland Surg 2014; 3:109-19. [PMID: 25083504 PMCID: PMC4115764 DOI: 10.3978/j.issn.2227-684x.2014.03.03] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/19/2014] [Indexed: 12/19/2022]
Abstract
Intra-operative radiotherapy (IORT) as a treatment for breast cancer is a relatively new technique that is designed to be a replacement for whole breast external beam radiotherapy (EBRT) in selected women suitable for breast-conserving therapy. This article reviews twelve reasons for the use of the technique, with a particular emphasis on targeted intra-operative radiotherapy (TARGIT) which uses X-rays generated from a portable device within the operating theatre immediately after the breast tumour (and surrounding margin of healthy tissue) has been removed. The delivery of a single fraction of radiotherapy directly to the tumour bed at the time of surgery, with the capability of adding EBRT at a later date if required (risk-adaptive technique) is discussed in light of recent results from a large multinational randomised controlled trial comparing TARGIT with EBRT. The technique avoids irradiation of normal tissues such as skin, heart, lungs, ribs and spine, and has been shown to improve cosmetic outcome when compared with EBRT. Beneficial aspects to both institutional and societal economics are discussed, together with evidence demonstrating excellent patient satisfaction and quality of life. There is a discussion of the published evidence regarding the use of IORT twice in the same breast (for new primary cancers) and in patients who would never be considered for EBRT because of their special circumstances (such as the frail, the elderly, or those with collagen vascular disease). Finally, there is a discussion of the role of the TARGIT Academy in developing and sustaining high standards in the use of the technique.
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Hill R, Healy B, Holloway L, Kuncic Z, Thwaites D, Baldock C. Advances in kilovoltage x-ray beam dosimetry. Phys Med Biol 2014; 59:R183-231. [DOI: 10.1088/0031-9155/59/6/r183] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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21
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Gérard JP, Myint AS, Croce O, Lindegaard J, Jensen A, Myerson R, Hannoun-Lévi JM, Marcie S. Renaissance of contact x-ray therapy for treating rectal cancer. Expert Rev Med Devices 2014; 8:483-92. [DOI: 10.1586/erd.11.28] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Schneider F, Clausen S, Thölking J, Wenz F, Abo-Madyan Y. A novel approach for superficial intraoperative radiotherapy (IORT) using a 50 kV X-ray source: a technical and case report. J Appl Clin Med Phys 2014; 15:4502. [PMID: 24423847 PMCID: PMC5711231 DOI: 10.1120/jacmp.v15i1.4502] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 08/01/2013] [Accepted: 07/30/2013] [Indexed: 12/28/2022] Open
Abstract
The use of IORT as a treatment modality for patients with close or positive margins has increased over the past decade. For situations where a flat area (up to 6 cm in diameter) has to be treated intraoperatively, new applicators for superficial treatment with a miniature X‐ray source (INTRABEAM system) were developed. Here we report our evaluation of the dosimetric characteristics of these new applicators and their first clinical use. Each of these flat and surface applicators consists of a radiation protective metal tube and a flattening filter, which converts the spherical dose distribution of the X‐ray source into a flat one. The homogeneity of each dose distribution and depth‐dose measurements were evaluated using film dosimetry in a solid water phantom and a soft X‐ray ionization chamber in a water tank. The first patient was treated with 5 Gy delivered in 5 mm using a 4 cm FLAT applicator over 21 minutes. The flat applicators show the maximum homogeneity, with a uniformity ratio of 1.02‐1.08 in certain depths. In 1 mm depth surface applicators show a uniformity ratio of 1.15‐1.28. They also show a higher dose rate and a steeper dose gradient compared to the flat applicators. The results of this investigation demonstrated that the flat and surface applicators have unique dosimetric characteristics that need to be considered during the treatment planning stages. This work also showed that it is possible to perform a superficial localized IORT which provides new application possibilities for use of the INTRABEAM system. PACS number: 87.55.ne
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Bocharov GS, Eletskii AV. Theory of Carbon Nanotube (CNT)-Based Electron Field Emitters. NANOMATERIALS (BASEL, SWITZERLAND) 2013; 3:393-442. [PMID: 28348342 PMCID: PMC5304654 DOI: 10.3390/nano3030393] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 06/24/2013] [Accepted: 06/27/2013] [Indexed: 11/17/2022]
Abstract
Theoretical problems arising in connection with development and operation of electron field emitters on the basis of carbon nanotubes are reviewed. The physical aspects of electron field emission that underlie the unique emission properties of carbon nanotubes (CNTs) are considered. Physical effects and phenomena affecting the emission characteristics of CNT cathodes are analyzed. Effects given particular attention include: the electric field amplification near a CNT tip with taking into account the shape of the tip, the deviation from the vertical orientation of nanotubes and electrical field-induced alignment of those; electric field screening by neighboring nanotubes; statistical spread of the parameters of the individual CNTs comprising the cathode; the thermal effects resulting in degradation of nanotubes during emission. Simultaneous consideration of the above-listed effects permitted the development of the optimization procedure for CNT array in terms of the maximum reachable emission current density. In accordance with this procedure, the optimum inter-tube distance in the array depends on the region of the external voltage applied. The phenomenon of self-misalignment of nanotubes in an array has been predicted and analyzed in terms of the recent experiments performed. A mechanism of degradation of CNT-based electron field emitters has been analyzed consisting of the bombardment of the emitters by ions formed as a result of electron impact ionization of the residual gas molecules.
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Affiliation(s)
- Grigory S Bocharov
- Moscow Power Engineering Institute, Technical University, Krasnokazarmennaya 14, Moscow 111250, Russia.
| | - Alexander V Eletskii
- National Research Center, Kurchatov Institute, Kurchatov sq. 1, Moscow 123182, Russia.
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Nwankwo O, Clausen S, Schneider F, Wenz F. A virtual source model of a kilo-voltage radiotherapy device. Phys Med Biol 2013; 58:2363-75. [DOI: 10.1088/0031-9155/58/7/2363] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Eaton DJ. Quality assurance and independent dosimetry for an intraoperative x-ray device. Med Phys 2012; 39:6908-20. [DOI: 10.1118/1.4761865] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Clausen S, Schneider F, Jahnke L, Fleckenstein J, Hesser J, Glatting G, Wenz F. A Monte Carlo based source model for dose calculation of endovaginal TARGIT brachytherapy with INTRABEAM and a cylindrical applicator. Z Med Phys 2012; 22:197-204. [DOI: 10.1016/j.zemedi.2012.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 06/05/2012] [Accepted: 06/05/2012] [Indexed: 10/27/2022]
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Heo SH, Kim HJ, Ha JM, Cho SO. A vacuum-sealed miniature X-ray tube based on carbon nanotube field emitters. NANOSCALE RESEARCH LETTERS 2012; 7:258. [PMID: 22594627 PMCID: PMC3494558 DOI: 10.1186/1556-276x-7-258] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Accepted: 02/21/2012] [Indexed: 05/31/2023]
Abstract
A vacuum-sealed miniature X-ray tube based on a carbon nanotube field-emission electron source has been demonstrated. The diameter of the X-ray tube is 10 mm; the total length of the tube is 50 mm, and no external vacuum pump is required for the operation. The maximum tube voltage reaches up to 70 kV, and the X-ray tube generates intense X-rays with the air kerma strength of 108 Gy·cm2 min-1. In addition, X-rays produced from the miniature X-ray tube have a comparatively uniform spatial dose distribution.
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Affiliation(s)
- Sung Hwan Heo
- Department of Nuclear and Quantum Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 305-701, Republic of Korea
- Particla Co., Ltd, Daejeon, 305-701, Republic of Korea
| | - Hyun Jin Kim
- Department of Nuclear and Quantum Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 305-701, Republic of Korea
| | - Jun Mok Ha
- Department of Nuclear and Quantum Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 305-701, Republic of Korea
| | - Sung Oh Cho
- Department of Nuclear and Quantum Engineering, Korea Advanced Institute of Science and Technology, Daejeon, 305-701, Republic of Korea
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Schneider F, Greineck F, Clausen S, Mai S, Obertacke U, Reis T, Wenz F. Development of a Novel Method for Intraoperative Radiotherapy During Kyphoplasty for Spinal Metastases (Kypho-IORT). Int J Radiat Oncol Biol Phys 2011; 81:1114-9. [PMID: 20934272 DOI: 10.1016/j.ijrobp.2010.07.1985] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 07/05/2010] [Accepted: 07/09/2010] [Indexed: 11/30/2022]
Affiliation(s)
- Frank Schneider
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Germany.
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Rava P, Dvorak T, Markelewicz RJ, Hiatt JR, Sternick ES, MacAusland SG, Huber K, Wazer DE, Hepel JT. A comparison of the biological effective dose of 50-kV electronic brachytherapy with (192)Ir high-dose-rate brachytherapy for vaginal cuff irradiation. Brachytherapy 2011; 11:402-7. [PMID: 21996539 DOI: 10.1016/j.brachy.2011.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 07/28/2011] [Accepted: 08/17/2011] [Indexed: 10/16/2022]
Abstract
PURPOSE Advantages for electronic brachytherapy (EBT) of the vaginal cuff include decreased physical dose to the bladder and rectum. Here we compare (192)Ir with EBT using biological effective dose (BED) to account for the different radiobiological effectiveness (RBE) predicted for low-energy x-rays. METHODS AND MATERIALS Fifteen data sets from five consecutive postoperative endometrial cancer patients treated with EBT were analyzed. Treatment planning was performed using PLATO software. The dose was prescribed as 21Gy in three fractions to a depth of 0.5cm. Physical dose, BED(3), and BED(10) were evaluated for the mucosa, bladder, and rectum. An RBE value of 1.5 was used for BED calculations. RESULTS Mucosal physical dose is 28.4% greater with EBT (36.6 vs. 28.5Gy, p<0.05). However, the BED(10) is increased by 79.1% (55.6 vs. 99.6Gy, p<0.05) and the BED(3) by 71.5% (118.8 vs. 203.7Gy, p<0.05). The physical dose (dose to 50% volume of the organ) to the bladder (9.3 vs. 6.6Gy, p<0.05) and rectum (7.2 vs. 4.2Gy, p<0.05) are reduced with EBT. BED(3) to the rectum and bladder are also reduced but to a lesser extent (13 vs. 8.3Gy, p<0.05; 18.9 vs. 14.7Gy, p=0.06, respectively). CONCLUSIONS BED takes into account the higher RBE of low-energy photons generated with EBT and provides a more accurate estimate of the biological effect. When using EBT, physical dose may underestimate the biological effect on the vaginal mucosa and overestimate the benefit for the bladder and rectum. Dose adjustment for EBT based on BED should be considered.
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Affiliation(s)
- Paul Rava
- Department of Radiation Oncology, Tufts Medical Center, Boston, MA 02111, USA.
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