Abstract
Cancer patients undergoing therapeutic radiation routinely develop injury of the adjacent gastrointestinal (GI) tract mucosa due to treatment. To reduce radiation dose to critical GI structures including the rectum and oral mucosa, 3D‐printed GI radioprotective devices composed of high‐Z materials are generated from patient CT scans. In a radiation proctitis rat model, a significant reduction in crypt injury is demonstrated with the device compared to without (p < 0.0087). Optimal device placement for radiation attenuation is further confirmed in a swine model. Dosimetric modeling in oral cavity cancer patients demonstrates a 30% radiation dose reduction to the normal buccal mucosa and a 15.2% dose reduction in the rectum for prostate cancer patients with the radioprotectant material in place compared to without. Finally, it is found that the rectal radioprotectant device is more cost‐effective compared to a hydrogel rectal spacer. Taken together, these data suggest that personalized radioprotectant devices may be used to reduce GI tissue injury in cancer patients undergoing therapeutic radiation.
Highlights
Radiation attenuating materials are integral to the safety of all diagnostic radiology and radiation oncology practices worldwide
Based upon the burden of radiation-induced GI toxicities in these areas, we wanted to focus on the following organs at risk: buccal mucosa in oral cavity cancer patients, esophagus in lung cancer patients, and rectum in prostate cancer patients.[5,6,17]
To determine the degree of radioprotection expected in patients treated with the current standard-of-care radiation delivery method, known as intensity-modulated radiation therapy (IMRT), we modeled the attenuating devices in our radiation treatment planning software in both prostate cancer patients and head and neck cancer patients
Summary
Radiation attenuating materials are integral to the safety of all diagnostic radiology and radiation oncology practices worldwide These materials traditionally have a high atomic number (high-Z), such as lead, and are capable of reducing ionizing radiation exposure.[1] Despite their ability to mitigate radiation exposure, these materials have not been directly integrated into patient treatments due to the inability to rapidly generate personalized attenuating devices. K. Edgington Division of Medical Physics Department of Radiation Oncology Massachusetts General Hospital 450 Brookline Avenue, Boston, MA 02115, USA. We conceptualize that due to their personalized manufacturing, these devices can enable improved dosimetric advantage and compliance compared to generic systems These devices have the potential to shift the paradigm of clinical management of patients receiving radiation therapy for cancer; by reducing radiation-associated morbidity and improving treatment adherence, they have the potential to improve survival
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