Abstract
Purpose: Large superficial (skin, soft tissue sarcoma) lesions located on curved areas are hard to treat with electrons. The Freiburg Flap (Nucletron, Netherlands) is a flexible mesh style surface which can be easily shaped to fit curved surfaces for reproducible HDR fraction delivery. To understand the fundamental dosimetric differences, a dosimetric comparison was made between HDR plesiotherapy (Freiburg applicator for lesions over 4cm) and external electron beam radiotherapy over cases with varying target curvature (both stylized and clinical cases). Methods: Four stylized cases with variable complexity were created using artificial DICOM axial CT slices and RT structures (a square and three curved structures on a 4.5cm radius cylinder). They were planned using Oncentra v4.3 and exported to Pinnacle v9.6 for electrons planning. The HDR source dwell positions were optimized for the best coverage of the targets using graphical optimization. Electron treatment plans were created in Pinnacle using the same CT and RT structures of three HDR cases with surface lesions previously treated with the Freiburg flap. The En face electron plans used 6-12 MeV electrons and 0.5–1 cm bolus was added to increase surface dose. The electron plans were prescribed to an isodose line to conform to the target. Results:more » For all lesions, the average target dose coverage was similar (D90ave of 100% for HDR vs 101% for electrons). For lesions with high curvature, the HDR coverage was better (D90 102% vs D90 97% for electron). For all cases, adjacent structures high dose region was lower for HDR than electrons (D1cc 100% for HDR vs D1cc 111% for electrons). Conclusion: HDR plesiotherapy offers excellent target conformity for superficial targets similar to electrons. However, for lesions with complex curved surfaces, HDR has the advantage to achieve better dose distributions using graphical optimization to spare adjacent normal tissue while maximizing target coverage.« less
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