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Intensity Modulated Proton Therapy Treatment Planning for Postmastectomy Patients with Metallic Port Tissue Expanders.
Zhu, Mingyao; Langen, Katja; Nichols, Elizabeth M; Lin, Yuting; Flampouri, Stella; Godette, Karen D; Dutta, Sunil W; McDonald, Mark W; Patel, Sagar A.
Afiliação
  • Zhu M; Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia.
  • Langen K; Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia.
  • Nichols EM; Department of Radiation Oncology, Maryland University School of Medicine, Baltimore, Maryland.
  • Lin Y; Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia.
  • Flampouri S; Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia.
  • Godette KD; Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia.
  • Dutta SW; Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia.
  • McDonald MW; Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia.
  • Patel SA; Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia.
Adv Radiat Oncol ; 7(1): 100825, 2022.
Article em En | MEDLINE | ID: mdl-34805622
ABSTRACT

PURPOSE:

Proton beam therapy can significantly reduce cardiopulmonary radiation exposure compared with photon-based techniques in the postmastectomy setting for locally advanced breast cancer. For patients with metallic port tissue expanders, which are commonly placed in patients undergoing a staged breast reconstruction, dose uncertainties introduced by the high-density material pose challenges for proton therapy. In this report, we describe an intensity modulated proton therapy planning technique for port avoidance through a hybrid single-field optimization/multifield optimization approach. METHODS AND MATERIALS In this planning technique, 3 beams are utilized. For each beam, no proton spot is placed within or distal to the metal port plus a 5 mm margin. Therefore, precise modeling of the metal port is not required, and various tissue expander manufacturers/models are eligible. The blocked area of 1 beam is dosimetrically covered by 1 or 2 of the remaining beams. Multifield optimization is used in the chest wall target region with blockage of any beam, while single-field optimization is used for remainder of chest wall superior/inferior to the port.

RESULTS:

Using this technique, clinical plans were created for 6 patients. Satisfactory plans were achieved in the 5 patients with port-to-posterior chest wall separations of 1.5 cm or greater, but not in the sixth patient with a 0.7 cm separation.

CONCLUSIONS:

We described a planning technique and the results suggest that the metallic port-to-chest wall distance may be a key parameter for optimal plan design.

Texto completo: 1 Coleções: 01-internacional Temas: Geral Base de dados: MEDLINE Idioma: En Revista: Adv Radiat Oncol Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Geórgia

Texto completo: 1 Coleções: 01-internacional Temas: Geral Base de dados: MEDLINE Idioma: En Revista: Adv Radiat Oncol Ano de publicação: 2022 Tipo de documento: Article País de afiliação: Geórgia