Purpose/Objective: To describe a novel, yet simple modified segmental boost technique (MSBT) for treatment of malignancies requiring irradiation of the pelvis and inguinal nodes. We also compare the dose inhomogeneity of our technique with other traditional methods of treatment for an extended pelvic/winged radiation field. Materials/Methods: A modification of a previously described segmental boost technique (SBT)(1) was developed to decrease “hot spots” that are commonly present at the matchline between the pelvic and inguinal boost fields. At our institution, patients have been simulated and treated in the following manner: The patient is placed supine with the isocenter at midline (Fig 1). Initially, the superior, inferior, and lateral borders of the posterior field are defined by the clinician and resemble a standard pelvic field (PA). The anterior field (AP) is then defined using the same superior/inferior borders and opening the lateral jaws wider to encompass the inguinal/femoral nodes. Two additional anterior inguinal fields, right anterior oblique (RAO) and left anterior oblique (LAO), are added for treating the inguinal nodes. The RAO and LAO are shaped by moving the multileaf collimators (MLC) across the central axis to the lateral edge of the exiting PA field (SBT). The dose inhomogeneity can be significantly reduced by simply angling the gantry for the inguinal fields so that the medial borders match the divergence of the lateral borders of the PA field (determined through field geometry or CT based treatment planning). Film dosimetry using Ready Pack Kodak EDR2 film was performed using our MSBT as well as other traditional techniques including: 1. Segmental boost technique (SBT) 2. Partial transmission block/compensator (PTB) 3. Photon pelvis with electron tags (P-E) Both vertical and horizontal films were exposed in a Virtual WaterTM phantom using beam arrangements specific to each technique. The films were scanned to produce isodose curves and computerized dose distributions were determined for each technique to allow for comparative dosimetry. Results: A comparison of the variation of dose inhomogeneity with depth and location within the treatment volume for SBT and MSBT is shown in Table 1. Data analysis of the techniques showed comparable maximum doses (115-122%), within the target volume for MSBT, PTB, and P-E while the maximum dose for the SBT was 146%. The maximum dose occurred at a depth of 1.5 cm along the matchline between the inguinal fields and the posterior pelvic field. Conclusions: The MSBT significantly improved the dose homogeneity at the matchline in comparison to the SBT. The PTB and P-E techniques have comparable dose homogeneity but are technically more complicated and in our clinical experience, require more time for both simulation and daily set up. Our MSBT proves to be technically simple while optimizing dose homogeneity and allows for maximal utilization of the features of modern linear accelerators. 1. Watson, Barbara; et al. Use of Segmental Boost Fields in the Irradiation of Inguinal Lymphatic Nodes. Medical Dosimetry 24(1): 27-32;1999. Tabled 1Depth (cm)Segmental Boost (SBT)Modified Segmental Boost (MSBT)Average Dose (%)Matchline Dose (%)Dose InhomogeneityAverage Dose (%)Matchline Dose (%)Dose Inhomogeneity1.5 (inguinal field)1181461.241161231.065.0 (inguinal field)1001321.321001121.1210.0 (pelvic field)100N/AN/A100N/AN/A Open table in a new tab
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