Abstract
Purpose. To assess differences in dose distribution of a vertebral body injected with bone cement as calculated by radiation treatment planning system (RTPS) and actual dose distribution. Methods. We prepared two water-equivalent phantoms with cement, and the other two phantoms without cement. The bulk density of the bone cement was imported into RTPS to reduce error from high CT values. A dose distribution map for the phantoms with and without cement was calculated using RTPS with clinical setting and with the bulk density importing. Actual dose distribution was measured by the film density. Dose distribution as calculated by RTPS was compared to the dose distribution measured by the film dosimetry. Results. For the phantom with cement, dose distribution was distorted for the areas corresponding to inside the cement and on the ventral side of the cement. However, dose distribution based on film dosimetry was undistorted behind the cement and dose increases were seen inside cement and around the cement. With the equivalent phantom with bone cement, differences were seen between dose distribution calculated by RTPS and that measured by the film dosimetry. Conclusion. The dose distribution of an area containing bone cement calculated using RTPS differs from actual dose distribution.
Highlights
Pain due to bone metastasis is one of the prevalent complications of cancer [1,2,3,4,5]
Three-dimensional radiotherapy planning is based on CT, but when performing radiotherapy following percutaneous vertebroplasty, bone cement containing barium in vertebral bodies can affect the dose distribution of radiotherapy
The present basic study using water-equivalent phantoms was performed to clarify the effects of bone cement containing barium in vertebral bodies by percutaneous vertebroplasty on dose distribution during radiotherapy and to ascertain differences between dose distribution calculated by radiation treatment planning system (RTPS) and actual dose distribution
Summary
Pain due to bone metastasis is one of the prevalent complications of cancer [1,2,3,4,5]. Radiotherapy is gold standard treatment for pain associated with metastatic bone tumor. The National Comprehensive Cancer Network guidelines [16] and Ontario guidelines [17] recommend radiotherapy for alleviating the pain associated with bone metastasis. In the treatment of metastatic spinal bone tumor, combination therapy consisting of vertebroplasty and radiotherapy has been performed [18, 19]. Radiotherapy combined with percutaneous vertebroplasty is expected to be performed more frequently
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