Abstract
To introduce a new 3D printed individualized bolus system for superficial lesions with irregular surface. Instead of the flat bolus, a new 3D printed individualized bolus system is used for patients of superficial lesions with irregular surface in Peking University First Hospital. The electron density of the 3D printed bolus is 1.00-1.01, which is close to water. Pre-clinical evaluations were done by using Alderson RANDO anthropomorphic phantom in three different modes: A) with no bolus; B) with a flat bolus; C) with a 3D printed bolus. Inverse Intensity modulated radiation therapy (IMRT) plans were designed for all modes respectively. For clinical evaluation, dosimetric parameters of 25 patients (28 IMRT plans) were analyzed. Daily kV-CBCT was used to assure the consistency of position. Acute and late toxicity, according to toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC), were record. The radiation dose prescribed to the PTV for the Alderson RANDO anthropomorphic phantom was 2Gy delivered in 1 fraction. Dmax of PTV of mode A, B, and C were 182.9cGY, 118.9cGY and 114.8cGY, respectively. Dmean of PTV of mode A, B, and C were 146.2cGY, 107.7cGY and 104.1cGY, respectively. HI (homogeneity index) in the IMRT plans of mode A, B, and C were 0.56, 0.15 and 0.11, respectively. 25 cases of superficial lesions with irregular surface were included. The primary lesions of 17 cases were on the penis and scrotum, 6 cases were on the head and face, and the last 2 cases were on the vulva. The dosimetric parameters of these 25 cases (28 IMRT plans) showed that all patients benefit from the 3D printed individualized bolus for its high conformity and dose uniformity (HImedian=0.09, range 0.03-0.29). 6 cases of Paget's disease of penis and scrotum benefit for their support and fixation. 3 cases had not finished the treatment.11 cases felt pain. 8 cases had edema. Serious treatment-related toxicity occurred (>G2) were seen in 4 cases. No recurrence was observed. The 3D-printed bolus can effectively improve the radiation dose of body surface for its high conformity and its function of support and fixation.
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