Assessment of Field-in-Field, 3-Field, and 4-Field Treatment Planning Methods for Radiotherapy of Gastro-Esophageal Junction Cancer.

Background: Gastro-esophageal (GE) junction cancer is the fastest-growing tumor, particularly in the United States (US). Objective: This study aimed to compare dosimetric and radiobiological factors among field-in-field (FIF), three-field (3F), and four-field box (4FB) radiotherapy planning techniques for gastro-esophageal junction cancer. Material and Methods: In this experimental study, thirty patients with GE junction cancer were evaluated, and three planning techniques (field-in-field (FIF), three-field (3F), and four-field box (4FB)) were performed for each patient for a 6-MV photon beam. Dose distribution in the target volume, the monitor units (MUs) required, and the dose delivered to organs at risk (OARs) were compared for these techniques using the paired-sample t-test. Results: A significant difference was measured between the FIF and 3F techniques with respect to conformity index (CI), dose homogeneity index (HI), and tumor control probability (TCP) for the target organ, as well as the Dmean for the heart, kidneys, and liver. For the spinal cord, the FIF technique showed a slight reduction in the maximum dose compared to the other two techniques. In addition, the V20 Gy of the lungs and the normal tissue complication probability (NTCP) of all OARs were reduced with FIF method. Conclusion: The FIF technique showed better performance for treating patients with gastro-esophageal junction tumors, in terms of dose homogeneity in the target, conformity of the radiation field with the target volume, TCP, less dose to healthy organs, and fewer MU.

Developing a Treatment Planning Software Based on TG-43U1 Formalism for Cs-137 LDR Brachytherapy.

BACKGROUND: The old Treatment Planning Systems (TPSs) used for intracavitary brachytherapy with Cs-137 Selectron source utilize traditional dose calculation methods, considering each source as a point source. Using such methods introduces significant errors in dose estimation. As of 1995, TG-43 is used as the main dose calculation formalism in treatment TPSs. OBJECTIVES: The purpose of this study is to design and establish a treatment planning software for Cs-137 Solectron brachytherapy source, based on TG-43U1 formalism by applying the effects of the applicator and dummy spacers. MATERIALS AND METHODS: Two softwares used for treatment planning of Cs-137 sources in Iran (STPS and PLATO), are based on old formalisms. The purpose of this work is to establish and develop a TPS for Selectron source based on TG-43 formalism. In this planning system, the dosimetry parameters of each pellet in different places inside applicators were obtained by MCNP4c code. Then the dose distribution around every combination of active and inactive pellets was obtained by summing the doses. The accuracy of this algorithm was checked by comparing its results for special combination of active and inactive pellets with MC simulations. Finally, the uncertainty of old dose calculation formalism was investigated by comparing the results of STPS and PLATO softwares with those obtained by the new algorithm. RESULTS: For a typical arrangement of 10 active pellets in the applicator, the percentage difference between doses obtained by the new algorithm at 1cm distance from the tip of the applicator and those obtained by old formalisms is about 30%, while the difference between the results of MCNP and the new algorithm is less than 5%. CONCLUSIONS: According to the results, the old dosimetry formalisms, overestimate the dose especially towards the applicator's tip. While the TG-43U1 based software perform the calculations more accurately.

A Monte Carlo study on tissue dose enhancement in brachytherapy: a comparison between gadolinium and gold nanoparticles.

The aim of this study was to quantify the dose enhancement by gadolinium and gold nanoparticles in brachytherapy. MCNPX Monte Carlo code was used to simulate four brachytherapy sources: (60)Co, (198)Au, (192)Ir, (169)Yb. To verify the accuracy of our simulations, the obtained values of dose rate constants and radial dose functions were compared with corresponding published values for these sources. To study dose enhancements, a spherical soft tissue phantom with 15 cm in radius was simulated. Gadolinium and gold nanoparticles at 10, 20 and 30 mg/ml concentrations were separately assumed in a 1 × 1 × 1 cm(3) volume simulating tumour. The simulated dose to the tumour with the impurity was compared to the dose without impurity, as a function of radial distance and concentration of the impurity, to determine the enhancement of dose due to the presence of the impurity. Dose enhancements in the tumour obtained in the presence of gadolinium and gold nanoparticles with concentration of 30 mg/ml, were found to be in the range of -0.5-106.1 and 0.4-153.1 % respectively. In addition, at higher radial distances from the source center, higher dose enhancements were observed. GdNPs can be used as a high atomic number material to enhance dose in tumour volume with dose enhancements up to 106.1 % when used in brachytherapy. Regardless considering the clinical limitations of the here-in presented model, for a similar source and concentration of nanoparticles, gold nanoparticles show higher dose enhancement than gadolinium nanoparticles and can have more clinical usefulness as dose enhancer material.

A retrospective analysis of rectal and bladder dose for gynecological brachytherapy treatments with GZP6 HDR afterloading system.

AIM: The aim of this work is to evaluate rectal and bladder dose for the patients treated for gynecological cancers. BACKGROUND: The GZP6 high dose rate brachytherapy system has been recently introduced to a number of radiation therapy departments in Iran, for treatment of various tumor sites such as cervix and vagina. MATERIALS AND METHODS: Our analysis was based on dose measurements for 40 insertions in 28 patients, treated by a GZP6 unit between June 2009 and November 2010. Treatments consisted of combined teletherapy and intracavitary brachytherapy. In vivo dosimetry was performed with TLD-400 chips and TLD-100 microcubes in the rectum and bladder. RESULTS: The average of maximum rectal and bladder dose values were found to be 7.62 Gy (range 1.72-18.55 Gy) and 5.17 Gy (range 0.72-15.85 Gy), respectively. It has been recommended by the ICRU that the maximum dose to the rectum and bladder in intracavitary treatment of vaginal or cervical cancer should be lower than 80% of the prescribed dose to point A in the Manchester system. In this study, of the total number of 40 insertions, maximum rectal dose in 29 insertions (72.5% of treatment sessions) and maximum bladder dose in 18 insertions (45% of treatments sessions) were higher than 80% of the prescribed dose to the point of dose prescription. CONCLUSION: In vivo dosimetry for patients undergoing treatment by GZP6 brachytherapy system can be used for evaluation of the quality of brachytherapy treatments by this system. This information could be used as a base for developing the strategy for treatment of patients treated with GZP6 system.