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A radiotherapy technique to improve dose homogeneity around bone prostheses.


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Authors

Williams, MV 
Burnet, NG 
Sherwin, E 
Kestelman, R 
Geater, AR 

Abstract

Purpose. Following limb conserving surgery for bone or soft tissue sarcoma, patients may require post-operative radiotherapy to minimise the risk of local recurrence. In such circumstances the metal prosthesis reduces the dose in its shadow by approximately 10% when using opposed fields. We describe a technique to boost the underdosed area to overcome this problem.Patients or subjects. Seven sequential patients presenting between 1995 and 2001 had their treatment individualised because they had metal prosthesis in the treatment volume.Methods. To improve the target dose homogeneity we used a custom-made keyhole cutout to boost the area in the shadow of the prosthesis. The degree of attenuation caused by the metal prosthesis was estimated and a boost dose calculated. Exit thermoluminescent dosimetry (TLD) was used to confirm the estimates made.Results and discussion. Variation between patients was seen, demonstrating the need for exit TLD to individualise the treatment plan. The use of a boost field provides a method to overcome under-dosage in the shadow of a metal prosthesis. It improves dose homogeneity throughout the target volume and ensures adequate dose intensity around the prosthesis, the site most at risk of local recurrence.

Description

Keywords

1103 Clinical Sciences, Clinical, Clinical Medicine and Science, Clinical Research, Musculoskeletal

Journal Title

Sarcoma

Conference Name

Journal ISSN

1357-714X
1369-1643

Volume Title

Publisher

Wiley