A Radiotherapy Technique to Improve Dose Homogeneity Around Bone Prostheses

[摘要] Purpose. Following limb conserving surgery for bone or soft tissue sarcoma, patients may require post-operative radiotherapyto minimise the risk of local recurrence. In such circumstances the metal prosthesis reduces the dose in its shadow byapproximately 10% when using opposed fields. We describe a technique to boost the underdosed area to overcome thisproblem.Patients or subjects. Seven sequential patients presenting between 1995 and 2001 had their treatment individualised becausethey 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 ofthe prosthesis. The degree of attenuation caused by the metal prosthesis was estimated and a boost dose calculated. Exitthermoluminescent 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 thetreatment plan. The use of a boost field provides a method to overcome under-dosage in the shadow of a metal prosthesis. Itimproves dose homogeneity throughout the target volume and ensures adequate dose intensity around the prosthesis, the sitemost at risk of local recurrence.

[学科分类] 肿瘤学