RESUMEN
PURPOSE: The delivery of the therapeutic radiation dose to the tumour in photon radiotherapy, also implies dose deposition in distant organs (peripheral dose) related to secondary cancers induction (Hall and Wuu, Int J Radiat Oncol Biol Phys 56:83-88, 2003). Therefore, peripheral dose estimation in MU-demanding techniques, such as Helical TomoTherapy (HT), becomes relevant. TLD measurements and Monte Carlo modelling were compared by D'Agostino (Strahlenther Onkol 187:693, 2011). The purpose of this work was to find out experimental models predicting the equivalent photon dose as a function of the distance to the isocenter for different treatment types. The prostate case is presented here. METHODS: A HT prostate plan was delivered to an anthropomorphic phantom mimicking a male adult. The phantom was made of polyethylene blocks whereas light wood was used for lungs. 16 points distributed along the phantom, covering different depths, were selected (Sánchez-Doblado IFMBE, World Congress Med Phys & Biomed Eng, 259-261, 2009). Additionally, a polyethylene sheet was inserted in the phantom to measure the off-axis dose profile at midplane depth. Measurements were carried out with standard TLD-100 pairs of dosimeters (calibrated in a 137Cs source). RESULTS: Two-exponential-terms curve fitting was carried out to model separately the scatter and leakage contribution (f=a*exp(-b*x)+c*exp(-d*x)). The former resulted predominant in the proximal region (10=x=14cm) and the latter in the distal re gion (x=14cm). Both components equate at 18cm. Scatter contribution becomes negligible for x=23cm. Points at 5cm were not used for the model as they are too close to the isocenter to be considered as peripheral dose. Model fits well experimental data (13% mean deviation). Only depths behind the build-up region could be properly modelled. CONCLUSIONS: Peripheral photon dose profiles in HT treatments have been modelled by a two-exponential-terms curve modelling separately scatter and leakage.
RESUMEN
PURPOSE: Concerns about the secondary cancer risks associated to the peripheral neutron and photon contamination in photon modern radiotherapy (RT) techniques (e.g., Intensity Modulated RT -IMRT- or Intensity Modulated Arc Therapy -IMAT) have been widely raised. Benefits in terms of better tumor coverage have to be balanced against the drawbacks of poorer organ at risk sparing and secondary cancer risk in order to make the decision on the optimum treatment technique. The aim of this study was to develop a tool which estimates treatment success taking into consideration the neutron secondary cancer probability. METHODS: A methodology and benchmark dataset for radiotherapy real time assessment of patient neutron dose and application to a novel digital detector (DD) has been carried out (submitted to PMB, 2011). Our DD provides real time neutron equivalent dose distribution in relevant organs along the patient. This information, together with TCP and NTCP estimated from the DVH of target and organs at risks, respectively, have been built into a general biological model which allows us to evaluate the success of the treatments (Sánchez-Nieto et al., ESTRO meeting 2012). This model has been applied to make estimation of treatment success in a variety of treatment techniques (3DCRT, forward and inverse IMRT, RapidArc, Volumetric Modulated Arc Therapy and Helical Tomotherapy) to low and high energy. RESULTS: MU-demanding techniques at high energies were able to deliver treatment plans with the highest complicated-free tumour control. Nevertheless, neutron peripheral dose must be taken into consideration as the associated risk could be of the same order of magnitude than the usually considered NTCPs. CONCLUSIONS: The methodology developed to provide an online organ neutron peripheral dose can be successfully combined with biological models to make predictions on treatment success taking into consideration secondary cancer risks.