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Title: Impact of Internal Metallic Ports in Temporary Tissue Expanders on Postmastectomy Radiation Dose Distribution

Abstract

Purpose: Temporary tissue expanders (TTE) with an internal magnetic metal port (IMP) have been increasingly used for breast reconstruction in post-mastectomy patients who receive radiation therapy (XRT). We evaluated XRT plans of patients with IMP to determine its effect on XRT dose distribution. Methods and Materials: Original treatment plans with CT simulation scans of 24 consecutive patients who received XRT (ORI), planned without heterogeneity corrections, to a reconstructed breast containing an IMP were used. Two additional treatment plans were then generated: one treatment plan with the IMP assigned the electron density of the rare earth magnet, nickel plated neodymium-iron-boron (HET), and a second treatment plan with the IMP assigned a CT value of 1 to simulate a homogeneous breast without an IMP (BRS). All plans were prescribed 50 Gy to the reconstructed breast (CTV). Results: CTV coverage by 50 Gy was significantly lower in the HET (mean 87.7% CTV) than in either the ORI (mean 99.7% CTV, P<.001) or BRS plans (mean 95.0% CTV, P<.001). The effect of the port was more pronounced on CT slices containing the IMP with prescription dose coverage of the CTV being less in the HET than in either ORI (mean difference 33.6%, P<.01) ormore » BRS plans (mean difference 30.1%, P<.001). HET had a less homogeneous and conformal dose distribution than BRS or ORI. Conclusion: IMPs increase dose heterogeneity and reduce dose to the breast CTV through attenuation of the beam. For optimal XRT treatment, heterogeneity corrections should be used in XRT planning for patients with TTE with IMP, as the IMP impacts dose distribution.« less

Authors:
; ;  [1];  [2];  [3];  [4];  [1];  [1]
  1. Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (United States)
  2. North Coast Cancer Care, Sandusky, Ohio (United States)
  3. Division of Plastic Surgery and Reconstructive Surgery, Department of Surgery, Emory University, Atlanta, Georgia (United States)
  4. Division of Surgical Oncology, Department of Surgery, Emory University, Atlanta, Georgia (United States)
Publication Date:
OSTI Identifier:
22224353
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 85; Journal Issue: 3; Other Information: Copyright (c) 2013 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ANIMAL TISSUES; ATTENUATION; CORRECTIONS; ELECTRON DENSITY; IRON; MAGNETS; MAMMARY GLANDS; NEODYMIUM; NICKEL; PATIENTS; RADIATION DOSE DISTRIBUTIONS; RADIOTHERAPY; SIMULATION

Citation Formats

Chen, Susie A., Ogunleye, Tomiwa, Dhabbaan, Anees, Huang, Eugene H., Losken, Albert, Gabram, Sheryl, Davis, Lawrence, and Torres, Mylin A., E-mail: matorre@emory.edu. Impact of Internal Metallic Ports in Temporary Tissue Expanders on Postmastectomy Radiation Dose Distribution. United States: N. p., 2013. Web. doi:10.1016/J.IJROBP.2012.06.046.
Chen, Susie A., Ogunleye, Tomiwa, Dhabbaan, Anees, Huang, Eugene H., Losken, Albert, Gabram, Sheryl, Davis, Lawrence, & Torres, Mylin A., E-mail: matorre@emory.edu. Impact of Internal Metallic Ports in Temporary Tissue Expanders on Postmastectomy Radiation Dose Distribution. United States. doi:10.1016/J.IJROBP.2012.06.046.
Chen, Susie A., Ogunleye, Tomiwa, Dhabbaan, Anees, Huang, Eugene H., Losken, Albert, Gabram, Sheryl, Davis, Lawrence, and Torres, Mylin A., E-mail: matorre@emory.edu. Fri . "Impact of Internal Metallic Ports in Temporary Tissue Expanders on Postmastectomy Radiation Dose Distribution". United States. doi:10.1016/J.IJROBP.2012.06.046.
@article{osti_22224353,
title = {Impact of Internal Metallic Ports in Temporary Tissue Expanders on Postmastectomy Radiation Dose Distribution},
author = {Chen, Susie A. and Ogunleye, Tomiwa and Dhabbaan, Anees and Huang, Eugene H. and Losken, Albert and Gabram, Sheryl and Davis, Lawrence and Torres, Mylin A., E-mail: matorre@emory.edu},
abstractNote = {Purpose: Temporary tissue expanders (TTE) with an internal magnetic metal port (IMP) have been increasingly used for breast reconstruction in post-mastectomy patients who receive radiation therapy (XRT). We evaluated XRT plans of patients with IMP to determine its effect on XRT dose distribution. Methods and Materials: Original treatment plans with CT simulation scans of 24 consecutive patients who received XRT (ORI), planned without heterogeneity corrections, to a reconstructed breast containing an IMP were used. Two additional treatment plans were then generated: one treatment plan with the IMP assigned the electron density of the rare earth magnet, nickel plated neodymium-iron-boron (HET), and a second treatment plan with the IMP assigned a CT value of 1 to simulate a homogeneous breast without an IMP (BRS). All plans were prescribed 50 Gy to the reconstructed breast (CTV). Results: CTV coverage by 50 Gy was significantly lower in the HET (mean 87.7% CTV) than in either the ORI (mean 99.7% CTV, P<.001) or BRS plans (mean 95.0% CTV, P<.001). The effect of the port was more pronounced on CT slices containing the IMP with prescription dose coverage of the CTV being less in the HET than in either ORI (mean difference 33.6%, P<.01) or BRS plans (mean difference 30.1%, P<.001). HET had a less homogeneous and conformal dose distribution than BRS or ORI. Conclusion: IMPs increase dose heterogeneity and reduce dose to the breast CTV through attenuation of the beam. For optimal XRT treatment, heterogeneity corrections should be used in XRT planning for patients with TTE with IMP, as the IMP impacts dose distribution.},
doi = {10.1016/J.IJROBP.2012.06.046},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 3,
volume = 85,
place = {United States},
year = {Fri Mar 01 00:00:00 EST 2013},
month = {Fri Mar 01 00:00:00 EST 2013}
}