Permanent Breast Seed Implant Dosimetry Quality Assurance

被引:27
作者
Keller, Brian M. [1 ,3 ]
Ravi, Ananth [1 ]
Sankreacha, Raxa [2 ]
Pignol, Jean-Philippe [3 ]
机构
[1] Sunnybrook Hlth Sci Ctr, Dept Med Phys, Toronto, ON M4N 3M5, Canada
[2] Carlo Fidani Reg Canc Ctr, Mississauga, ON, Canada
[3] Univ Toronto, Sunnybrook Hlth Sci Ctr, Dept Radiat Oncol, Toronto, ON, Canada
来源
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS | 2012年 / 83卷 / 01期
关键词
Breast seed implant; Dosimetry; Partial breast irradiation; Pd-103; RADIATION-THERAPY; DOSE CALCULATIONS; MONTE-CARLO; CANCER; PD-103; BRACHYTHERAPY; LUMPECTOMY; I-125;
D O I
10.1016/j.ijrobp.2011.05.030
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: A permanent breast seed implant is a novel method of accelerated partial breast irradiation for women with early-stage breast cancer. This article presents pre- and post-implant dosimetric data, relates these data to clinical outcomes, and makes recommendations for those interested in starting a program. Methods and Materials: A total of 95 consecutive patients were accrued into one of three clinical trials after breast-conserving surgery: a Phase I/II trial (67 patients with infiltrating ductal carcinoma); a Phase II registry trial (25 patients with infiltrating ductal carcinoma); or a multi-center Phase II trial for patients with ductal carcinoma in situ (3 patients). Contouring of the planning target volume (PTV) was done on a Pinnacle workstation and dosimetry calculations, including dose-volume histograms, were done using a Variseed planning computer. Results: The mean pre-implant PTV coverage for the V-90, V-100, V-150, and V-200 were as follows: 98.8% +/- 1.2% (range, 94.5-100%); 97.3% +/- 2.1% (range, 90.3-99.9%), 68.8% +/- 14.3% (range, 32.7-91.5%); and 27.8% +/- 8.6% (range, 15.1-62.3%). The effect of seed motion was characterized by post-implant dosimetry performed immediately after the implantation (same day) and at 2 months after the implantation. The mean V100 changed from 85.6% to 88.4% (p = 0.004) and the mean V-200 changed from 36.2% to 48.3% (p < 0.001). Skin toxicity was associated with maximum skin dose (p = 0.014). Conclusions: Preplanning dosimetry should aim for a V90 of approximately 100%, a V-100 between 95% and 100%, and a V-200 between 20% and 30%, as these numbers are associated with no local recurrences to date and good patient tolerance. In general, the target volume coverage improved over the duration of the seed therapy. The maximum skin dose, defined as the average dose over the hottest 1 x 1-cm(2) surface area, should be limited to 90% of the prescription dose to minimize delayed skin toxicity. (C) 2012 Elsevier Inc.
引用
收藏
页码:84 / 92
页数:9
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