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Liang Y, Xu H, Tang W, Du X. The impact of metal implants on the dose and clinical outcome of radiotherapy (Review). Mol Clin Oncol 2024; 21:66. [PMID: 39091418 PMCID: PMC11289751 DOI: 10.3892/mco.2024.2764] [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: 02/19/2024] [Accepted: 06/27/2024] [Indexed: 08/04/2024] Open
Abstract
Radiotherapy (RT) is one of the most widely used and effective cancer treatments. With the increasing need for organ reconstruction and advancements in material technology, an increasing number of patients with cancer have metallic implants. These implants can affect RT dosage and clinical outcomes, warranting careful consideration by oncologists. The present review discussed the mechanisms by which different types of metallic implants impact various stages of the RT process, examined methods to mitigate these effects during treatment, and discussed the clinical implications of metallic implants on RT outcomes. In summary, when metallic implants are present within the RT field, oncologists should carefully assess their impact on the treatment.
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Affiliation(s)
- Yuwen Liang
- Department of Oncology, Mianyang Central Hospital, Mianyang, Sichuan 621000, P.R. China
- Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637100, P.R. China
- Sichuan Clinical Research Center for Radiation and Therapy, Mianyang, Sichuan 621000, P.R. China
| | - Haonan Xu
- Department of Oncology, Mianyang Central Hospital, Mianyang, Sichuan 621000, P.R. China
- Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637100, P.R. China
- Sichuan Clinical Research Center for Radiation and Therapy, Mianyang, Sichuan 621000, P.R. China
| | - Wenqiang Tang
- Department of Oncology, Mianyang Central Hospital, Mianyang, Sichuan 621000, P.R. China
- Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637100, P.R. China
- Sichuan Clinical Research Center for Radiation and Therapy, Mianyang, Sichuan 621000, P.R. China
| | - Xiaobo Du
- Department of Oncology, Mianyang Central Hospital, Mianyang, Sichuan 621000, P.R. China
- Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637100, P.R. China
- Sichuan Clinical Research Center for Radiation and Therapy, Mianyang, Sichuan 621000, P.R. China
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Singh PK, Verma R, Tripathi D, Singh S, Bhushan M, Kumar L, Barik S, Gairola M. Evaluation of the Treatment Planning and Delivery for Hip Implant Cases on Tomotherapy. J Med Phys 2024; 49:270-278. [PMID: 39131420 PMCID: PMC11309148 DOI: 10.4103/jmp.jmp_182_23] [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: 12/26/2023] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 08/13/2024] Open
Abstract
Purpose The metal present in the implant creates artifacts during the treatment simulation, which impacts the treatment planning and delivery of the prescribed dose to the target and sparing normal tissues. This retrospective study evaluated the uncertainties in the planning and delivery of doses for prosthesis cases with dedicated phantom. Materials and Methods In this retrospective study, 11 patients with a hip prosthesis having cervix carcinoma were selected. Two treatment plans were generated on treatment planning system (TPS) for each case. Plan_No_Res was without any beam restriction, and Plan_exit_only was the plan with restricted beam entry through the metallic implant. An indigenous phantom was utilized to verify the accuracy of the treatment. In the phantom, some groves were present, which could be filled by implants that mimic the patient's geometries, like left, right and bilateral femur implants. The delivered doses were recorded using optically stimulated luminescence dosimeters (OSLDs), which were placed at different positions in the phantom. The plans were further calculated using megavoltage computed tomography (MVCT) scans acquired during treatment. Results The patient data showed no significant dose changes between the two planning methods. The treatment time increases from 412.18 ± 86.65 to 427.36 ± 104.80 with P = 0.03 for Plan_No_Res and Plan_exit_only, respectively. The difference between planned and delivered doses of various points across phantom geometries was within ± 9.5% in each case as left, right, and bilateral implant. The variations between OSLDs and MVCT calculated doses were also within ± 10.8%. Conclusion The study showed the competency of tomotherapy planning for hip prosthesis cases. The phantom measurements demonstrate the errors in dosimetry near the implant material, suggesting the need for precise methods to deal with artifact-related issues.
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Affiliation(s)
- Pawan Kumar Singh
- Department of Physics, Amity Institute of Applied Sciences, Amity University (AUUP), Noida, India
- Department of Radiation Oncology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
| | - Rohit Verma
- Department of Physics, Amity Institute of Applied Sciences, Amity University (AUUP), Noida, India
| | - Deepak Tripathi
- Department of Physics, USAR, Guru Gobind Singh Indraprastha University, East Campus, Delhi, India
| | - Sukhvir Singh
- Radiation Safety Group, Institute of Nuclear Medicine and Allied Sciences, Defence Research and Development Organisation, New Delhi, India
| | - Manindra Bhushan
- Department of Radiation Oncology and Division of Medical Physics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Lalit Kumar
- Department of Radiation Oncology, Max Super Speciality Hospital, New Delhi, India
| | - Soumitra Barik
- Department of Radiation Oncology and Division of Medical Physics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Munish Gairola
- Department of Radiation Oncology and Division of Medical Physics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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Prostate radiotherapy in the setting of bilateral hip prostheses: All commonly used photon-based radiation approaches are feasible. Med Dosim 2021; 46:404-410. [PMID: 34175156 DOI: 10.1016/j.meddos.2021.05.003] [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: 02/05/2021] [Revised: 03/02/2021] [Accepted: 05/11/2021] [Indexed: 11/22/2022]
Abstract
The prevalence of hip prostheses is increasing. Prostate radiation delivery in the setting of hip prostheses is complicated by both imaging artifacts that interfere with volume delineation and dosimetric effects that must be addressed in the planning process. We hypothesized that with specialized planning, any photon-based definitive prostate radiotherapy approach may be utilized in patients with bilateral hip prostheses. Imaging data from sequential patients with prostate cancer and bilateral hip prostheses treated definitively with radiation were retrospectively reviewed. Bimodality imaging was used to define targets and organs at risk (OARs) along with specialized MRI sequences and/or orthopedic metal artifact reduction (OMAR) for MRI and CT artifact suppression, respectively. Multiple VMAT plans were generated for each set of patient images to include three fractionation schemes (conventional, hypofractionated, and SBRT), each with hip avoidance and with simulated normal hip. The ability to meet standard dose constraints was assessed for each plan type. Differences in target and OAR dosing between plans accounting for prosthetic hips via avoidance vs plans with simulated absence of prosthetic hip were also assessed. T-tests were used to compare dosimetric parameters. Ten patients with bilateral hip prostheses were identified, and 6 plans were created for each patient for a total of 60 radiation plans. Prosthetic hip avoidance did not result in failure to meet dose constraints for any patient. Hip avoidance resulted in minimal increases in high dose to the rectum and bladder (increases in mean V80%, V90%, and V95% ranged from 0.1% to 2.4%). Larger increases were seen at lower dose levels, with rectal V50% significantly increased in all three plan types with hip avoidance (conventional: 26.0% [standard deviation, SD 13.9] vs 16.9% [SD 10.2, p = 0.003]; hypofractionation: 26.4% [SD 13.3] vs 17.1% [SD 10.1, p = 0.002]; SBRT: 18.3% [SD 10.7] vs 10.5% [SD 6.9, p = 0.008]). Similarly, hip avoidance resulted in increases in bladder V50% to 31.7% (SD 16.8) vs 23.3% (SD 14.0, p = 0.001), 31.3% (SD 17.0) vs 23.3% (SD 13.8, p = 0.002), and 22.7% (SD 12.3) vs 16.5% (SD 12.6, p < 0.001) for conventional, hypofractionated, and SBRT plans, respectively. Hydrogel spacer resulted in reductions in rectal dose. For example, V70% for hip avoidance plans decreased with spacer presence to 8.3% (SD 6.7) vs 21.1% (SD 5.8, p = 0.021), 8.6% (SD 6.5) vs 21% (SD 5.7, p = 0.022), and 3.7% (SD 3.2) vs 15% (SD 8.2, p = 0.010) for conventional, hypofractionated, and SBRT plans, respectively. Any photon-based definitive prostate radiotherapy approach can be used with bimodality imaging for target and OAR definition and planning techniques to avoid dose attenuation effects of hip prostheses. Hydrogel spacer is a useful adjunct.
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Kouloulias V, Protopapa M, Zygogianni A, Patatoukas G, Kougioumtzopoulou A, Savvidou O, Platoni K. The need for a dose constraint in hip prosthesis to minimize later hip dysfunction. A retrospective analysis of relevant cases. Med Dosim 2021; 46:279-282. [PMID: 33741221 DOI: 10.1016/j.meddos.2021.02.004] [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: 10/28/2020] [Revised: 01/24/2021] [Accepted: 02/10/2021] [Indexed: 02/02/2023]
Abstract
Results from a single-institution study support the need of a dose constraint for patients who have previously undergone hip replacement surgery. Our study provides evidence that a dose above 30 Gy to the area of hip prosthesis is significantly correlated with later hip arthroplasty dysfunction as measured by the Harris Hip Score. As total hip arthroplasty becomes more and more common, it is urgent to further look into radiation therapy treatment parameters that can be modified to improve the quality of life of patients who receive pelvic irradiation after hip arthroplasty. Further prospective studies are needed to extract safe conclusions.
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Affiliation(s)
- Vassilis Kouloulias
- Radiotherapy Unit, Medical School, 2nd Department of Radiology, National and Kapodistrian University of Athens, ATTIKON University Hospital, Chaidari, 12462, Greece
| | - Maria Protopapa
- Mediterraneo Hospital, Radiotherapy Department, Glyfada, 16675, Greece.
| | - Anna Zygogianni
- Radiotherapy Unit, Medical School, 1st Department of Radiology, National and Kapodistrian University of Athens, Aretaieion University Hospital, Athens, 11528, Greece
| | - Georgios Patatoukas
- Radiotherapy Unit, Medical School, 2nd Department of Radiology, National and Kapodistrian University of Athens, ATTIKON University Hospital, Chaidari, 12462, Greece
| | - Andromachi Kougioumtzopoulou
- Radiotherapy Unit, Medical School, 2nd Department of Radiology, National and Kapodistrian University of Athens, ATTIKON University Hospital, Chaidari, 12462, Greece
| | - Olga Savvidou
- Medical School, 2nd Orthopaedic Clinic, National and Kapodistrian University of Athens, ATTIKON University Hospital, Chaidari, 12462, Greece
| | - Kalliopi Platoni
- Radiotherapy Unit, Medical School, 2nd Department of Radiology, National and Kapodistrian University of Athens, ATTIKON University Hospital, Chaidari, 12462, Greece
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Bhushan M, Tripathi D, Yadav G, Kumar L, Dewan A, Kumar G. Effect of Hip Prosthesis on Photon Beam Characteristics in Radiological Physics. Asian Pac J Cancer Prev 2020; 21:1731-1738. [PMID: 32592371 PMCID: PMC7568891 DOI: 10.31557/apjcp.2020.21.6.1731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction: Aim of study is to investigate the effect of hip prosthesis on 6 and 15 MV photon beam energies. Materials and Methods: Prosthesis was kept at the level of tray position. The measurements were done on Varian Clinac-iX linac. Customized prosthesis, termed as Prosthetic Metal Implant (PMI) was made up of wrought austenitic stainless steel rod and covered with paraffin-wax. ‘Standard prosthesis’ was made up of wrought titanium alloy. The dose profiles were measured for three field sizes i.e. 5, 10 and 20 cm at 100 cm SSD for 6 and 15 MV energies. The perturbation index (PI) was also calculated. Results: Perturbation caused by standard prosthesis was approximately 50% higher than that of PMI. This result may be due to difference in dimension and not because of material composition. Variation of central axis dose might be due to the dimensions of PMI used for experiment which gave intermediate response (e.g. 102.1%, 141.0% and 117.7% for Open, Standard and PMI respectively for 10x10 cm2 field size, 10 cm depth and 15MV photon beam setup )as compared to the ‘open’ and ‘standard’ prosthesis. Percentage dose at 10 cm for 6MV photon increased rapidly with field-size for PMI. But, for 15MV photon, difference was not significant. Surface dose (Ds) for PMI remains significantly higher for smaller field. Conclusion: The perturbation index varied from 0.05 to 0.22 for the measured energies and gave an idea to the planner to assess the behavior of the prosthesis. This range is applicable for both type of implants and for all clinical field-sizes. The attenuation caused by the prosthesis was significant and this effect should be considered in the treatment planning calculations.
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Affiliation(s)
- Manindra Bhushan
- Division of Medical Physics and Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi (India)-110085, India.,Amity School of Applied Sciences, Amity University (AUUP), NOIDA, India
| | - Deepak Tripathi
- Amity School of Applied Sciences, Amity University (AUUP), NOIDA, India
| | - Girigesh Yadav
- Division of Medical Physics and Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi (India)-110085, India
| | - Lalit Kumar
- Division of Medical Physics and Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi (India)-110085, India.,Dr. APJ Abdul Kalam Technical University, Lucknow (UP), India
| | - Abhinav Dewan
- Division of Medical Physics and Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi (India)-110085, India
| | - Gourav Kumar
- Division of Medical Physics and Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi (India)-110085, India
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