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Leakage dose reduction using modified midline block technique in the treatment of cervical cancer

  • Original Paper - Cross-Disciplinary Physics and Related Areas of Science and Technology
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Abstract

This study aimed to evaluate the usefulness of multileaf collimator (MLC) and jaw shielding in the midline block (MLB) plan for radiation treatment of cervical cancer. The shape of the MLC opening was considered in the MLB treatment plan to close the jaw in cases treated with the Varian linear accelerators (Linac) and to close the diaphragm in cases treated with the Elekta Linac. To evaluate the radiation dose to unintended areas, the Exradin A19 Ion Chamber was used to assess the calibrated EBT3 film. For the MLB treatment plan, approximately 60% of the applied dose was received at unintended locations due to the gap of leaf in the Elekta Linac. Approximately 30% dose leakage was measured with the Varian Linac. Comparing the treatment plans, the mean dose to the rectum is reduced by roughly 30%, and that to the bladder is reduced by approximately 4% when shielded fields are used for both Elekta and Varian Linac. In MLB boost treatment, the plan needs to consider using a shield in accordance with the characteristics of the Linac to reduce unintended radiation to the central block.

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References

  1. H. Sung, J. Ferlay, R.L. Siegel, M. Laversanne, I. Soerjomataram, A. Jemal et al., Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J. Clin. 71(3), 209–249 (2021)

    Article  Google Scholar 

  2. P.J. Eifel, K. Winter, M. Morris, C. Levenback, P.W. Grigsby, J. Cooper et al., Pelvic irradiation with concurrent chemotherapy versus pelvic and para-aortic irradiation for high-risk cervical cancer: an update of radiation therapy oncology group trial (RTOG) 90–01. J. Clin. Oncol. 22(5), 872–880 (2004)

    Article  Google Scholar 

  3. P.G. Rose, B.N. Bundy, E.B. Watkins, J.T. Thigpen, G. Deppe, M.A. Maiman et al., Concurrent cisplatin-based radiotherapy and chemotherapy for locally advanced cervical cancer. N. Engl. J. Med. 340(15), 1144–1153 (1999)

    Article  Google Scholar 

  4. E.M. Horwitz, B.S. American, ABS brachytherapy consensus guidelines. Brachytherapy 11(1), 4–5 (2012)

    Article  Google Scholar 

  5. T. Toita, S. Kato, Y. Niibe, T. Ohno, T. Kazumoto, T. Kodaira et al., Prospective multi-institutional study of definitive radiotherapy with high-dose-rate intracavitary brachytherapy in patients with nonbulky (<4-cm) stage I and II uterine cervical cancer (JAROG0401/JROSG04-2). Int. J. Radiat. Oncol. Biol. Phys. 82(1), e49-56 (2012)

    Article  Google Scholar 

  6. K.H. Kim, S. Kim, G.E. Kim, W.S. Koom, S.W. Kim, E.J. Nam et al., De-escalation of the cumulative central radiation dose according to the tumor response can reduce rectal toxicity without compromising the treatment outcome in patients with uterine cervical cancer. Gynecol. Oncol. 139(3), 439–446 (2015)

    Article  Google Scholar 

  7. O.A. Garcia-Garduno, M.A. Celis, J.M. Larraga-Gutierrez, S. Moreno-Jimenez, A. Martinez-Davalos, M. Rodriguez-Villafuerte, Radiation transmission, leakage and beam penumbra measurements of a micro-multileaf collimator using GafChromic EBT film. J. Appl. Clin. Med. Phys. 9(3), 90–98 (2008)

    Article  Google Scholar 

  8. W.E. Powers, J.J. Kinzie, A.J. Demidecki, J.S. Bradfield, A. Feldman, A new system of field shaping for external-beam radiation therapy. Radiology 108(2), 407–411 (1973)

    Article  Google Scholar 

  9. J.P. Balog, T.R. Mackie, D.L. Wenman, M. Glass, G. Fang, D. Pearson, Multileaf collimator interleaf transmission. Med. Phys. 26(2), 176–186 (1999)

    Article  Google Scholar 

  10. J. Deng, T. Pawlicki, Y. Chen, J. Li, S.B. Jiang, C.M. Ma, The MLC tongue-and-groove effect on IMRT dose distributions. Phys. Med. Biol. 46(4), 1039–1060 (2001)

    Article  Google Scholar 

  11. X.G. Xu, B. Bednarz, H. Paganetti, A review of dosimetry studies on external-beam radiation treatment with respect to second cancer induction. Phys. Med. Biol. 53(13), R193-241 (2008)

    Article  ADS  Google Scholar 

  12. C.B. Dracham, A. Shankar, R. Madan, Radiation induced secondary malignancies: a review article. Radiat. Oncol. J. 36(2), 85–94 (2018)

    Article  Google Scholar 

  13. M.S. Huq, I.J. Das, T. Steinberg, J.M. Galvin, A dosimetric comparison of various multileaf collimators. Phys. Med. Biol. 47(12), N159–N170 (2002)

    Article  ADS  Google Scholar 

  14. A. Leal, F. Sanchez-Doblado, R. Arrans, R. Capote, J.I. Lagares, E.C. Pavon et al., MLC leaf width impact on the clinical dose distribution: a Monte Carlo approach. Int. J. Radiat. Oncol. Biol. Phys. 59(5), 1548–1559 (2004)

    Article  Google Scholar 

  15. T.H. Kim, J.Y. Kim, D.K. Sohn, Y.J. Kim, Y.S. Lee, S.H. Moon et al., A prospective observational study with dose volume parameters predicting rectosigmoidoscopic findings and late rectosigmoid bleeding in patients with uterine cervical cancer treated by definitive radiotherapy. Radiat. Oncol. 8, 28 (2013)

    Article  Google Scholar 

  16. W. Shaw, W.I. Rae, M.L. Alber, Equivalence of Gyn GEC-ESTRO guidelines for image guided cervical brachytherapy with EUD-based dose prescription. Radiat. Oncol. 8, 266 (2013)

    Article  Google Scholar 

  17. M. Pasquino, V.C. Borca, P. Catuzzo, F. Ozzello, S. Tofani, Transmission, penumbra and leaf positional accuracy in commissioning and quality assurance program of a multileaf collimator for step-and-shoot IMRT treatments. Tumori 92(6), 511–516 (2006)

    Article  Google Scholar 

  18. M. Roche, R. Crane, M. Powers, T. Crabtree, Agility MLC transmission optimization in the Monaco treatment planning system. J. Appl. Clin. Med. Phys. 19(5), 473–482 (2018)

    Article  Google Scholar 

  19. J.M. Galvin, A.R. Smith, B. Lally, Characterization of a multi-leaf collimator system. Int. J. Radiat. Oncol. Biol. Phys. 25(2), 181–192 (1993)

    Article  Google Scholar 

  20. E.E. Klein, W.B. Harms, D.A. Low, V. Willcut, J.A. Purdy, Clinical implementation of a commercial multileaf collimator: dosimetry, networking, simulation, and quality assurance. Int. J. Radiat. Oncol. Biol. Phys. 33(5), 1195–1208 (1995)

    Article  Google Scholar 

  21. Galvin JM. The multileaf collimator: a complete guide. Proceedings of AAPM annual meeting ;1999 July; Nashville, TN

  22. Y. Liu, C. Shi, P. Tynan, N. Papanikolaou, Dosimetric characteristics of dual-layer multileaf collimation for small-field and intensity-modulated radiation therapy applications. J. Appl. Clin. Med. Phys. 9(2), 15–29 (2008)

    Article  Google Scholar 

  23. J.S. Wieder, T. Schneider, N.E. Martinez, The three R’s of reasonable in radiological protection: relationships, rationale, and resources. J. Radiol. Prot. 42(2), 021513 (2022)

    Article  Google Scholar 

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Acknowledgements

This work was supported by the National Research Foundation of Korea(NRF) grant funded by the Korea government(MSIT) (No.2021R1F1A1050932).

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Authors and Affiliations

  1. Department of Radiation Oncology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea

    Me Young Kim, Jai-Woong Yoon, Kwang-Ho Cheong, Sei-Kwon Kang, Taeryool Koo, Kyoung Ju Kim & Soah Park

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  1. Me Young Kim
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  2. Jai-Woong Yoon
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  4. Sei-Kwon Kang
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Correspondence to Soah Park.

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Kim, M.Y., Yoon, JW., Cheong, KH. et al. Leakage dose reduction using modified midline block technique in the treatment of cervical cancer. J. Korean Phys. Soc. 83, 563–571 (2023). https://doi.org/10.1007/s40042-023-00886-8

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  • DOI: https://doi.org/10.1007/s40042-023-00886-8

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