A technique for inguinal node boost using photon fields defined by asymmetric collimator jaws

Technical aspects of radiation therapy for anal cancer

Historically treated with surgery, current practice recommends anal carcinoma to be treated with a combination of chemotherapy and radiation. This review will examine the anatomy, modes of disease spread and recurrence, and evaluate the existing evidence for treatment options for these tumors. An in-depth examination of specific radiation therapy (RT) techniques-such as conventional 3D-conformal RT and intensity-modulated RT-will be discussed along with modern dose constraints. RT field arrangement, patient setup, and recommended gross and clinical target volume (CTV) contours will be considered. Areas in need of further investigation, such as the role in treatment for positron emission tomography (PET) will be explored.

A study on beam homogeneity for a Siemens Primus linac

Asymmetric offset fields are an important tool for radiotherapy and their suitability for treatment should be assessed. Dose homogeneity for highly asymmetric fields has been studied for a Siemens PRIMUS clinical linear accelerator. Profiles and absolute dose have been measured in fields with two jaws at maximal position (20 cm) and the other two at maximal overtravel (10 cm), corresponding to 10 cm x 10 cm fields with extreme offset. Measured profiles have a marked decreasing gradient towards the beam edge, making these fields unsuitable for treatments. The flattening filter radius is smaller than the primary collimator aperture, and this creates beam inhomogeneities that affect large fields in areas far from the collimator axis, and asymmetric fields with large offset. The results presented assess the effect that the design of the primary collimator and flattening filter assembly has on beam homogeneity. This can have clinical consequences for treatments involving fields that include these inhomogeneous areas. Comparison with calculations from a treatment planning system, Philips Pinnacle v6.3, which computes under the hypotheses of a uniformly flattened beam, results in severe discrepancies.

Irradiating the groin nodes without breaking a leg: A comparison of techniques for groin node irradiation

The purpose of this study was to determine the optimal technique for delivering postoperative radiotherapy for vulvar cancer and other tumors requiring treatment of the inguinal nodes. This project compared tumor coverage and normal tissue sparing for the 5 main radiotherapy techniques that are used to treat vulvar cancer. The intensity-modulated radiation therapy (IMRT) plan was undesirable because it resulted in an excessive dose to portions of the central pelvic structures. The photon thunderbird with skin match was unacceptable because it underdosed a portion of the groin region. The electron thunderbird was ideal for thin patients but was not applicable for most patients because of excessive dose to the skin and subcutaneous tissues. The photon through-and-through and the photon thunderbird with deep match were acceptable in most situations. In thin patients, where the depth of the inguinal vessels is less than 3 cm, the electron thunderbird is the technique of choice. In the average-sized patient, both the photon through-and-through and the photon thunderbird with deep match are reasonable options. The available literature suggests that the risk of femoral neck fracture or necrosis of the femoral head is approximately 11% at 5 years using the photon through-and-through technique. In our opinion, this is an acceptable price to pay for reliable node coverage, setup simplicity, and zero risk of overdose at field junctions.