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Radiation treatment planning and delivery strategies for a pregnant brain tumor patient.

Publication ,  Journal Article
Labby, ZE; Barraclough, B; Bayliss, RA; Besemer, AE; Dunkerley, DAP; Howard, SP
Published in: J Appl Clin Med Phys
September 2018

The management of a pregnant patient in radiation oncology is an infrequent event requiring careful consideration by both the physician and physicist. The aim of this manuscript was to highlight treatment planning techniques and detail measurements of fetal dose for a pregnant patient recently requiring treatment for a brain cancer. A 27-year-old woman was treated during gestational weeks 19-25 for a resected grade 3 astrocytoma to 50.4 Gy in 28 fractions, followed by an additional 9 Gy boost in five fractions. Four potential plans were developed for the patient: a 6 MV 3D-conformal treatment plan with enhanced dynamic wedges, a 6 MV step-and-shoot (SnS) intensity-modulated radiation therapy (IMRT) plan, an unflattened 6 MV SnS IMRT plan, and an Accuray TomoTherapy HDA helical IMRT treatment plan. All treatment plans used strategies to reduce peripheral dose. Fetal dose was estimated for each treatment plan using available literature references, and measurements were made using thermoluminescent dosimeters (TLDs) and an ionization chamber with an anthropomorphic phantom. TLD measurements from a full-course radiation delivery ranged from 1.0 to 1.6 cGy for the 3D-conformal treatment plan, from 1.0 to 1.5 cGy for the 6 MV SnS IMRT plan, from 0.6 to 1.0 cGy for the unflattened 6 MV SnS IMRT plan, and from 1.9 to 2.6 cGy for the TomoTherapy treatment plan. The unflattened 6 MV SnS IMRT treatment plan was selected for treatment for this particular patient, though the fetal doses from all treatment plans were deemed acceptable. The cumulative dose to the patient's unshielded fetus is estimated to be 1.0 cGy at most. The planning technique and distance between the treatment target and fetus both contributed to this relatively low fetal dose. Relevant treatment planning strategies and treatment delivery considerations are discussed to aid radiation oncologists and medical physicists in the management of pregnant patients.

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Published In

J Appl Clin Med Phys

DOI

EISSN

1526-9914

Publication Date

September 2018

Volume

19

Issue

5

Start / End Page

368 / 374

Location

United States

Related Subject Headings

  • Radiotherapy, Intensity-Modulated
  • Radiotherapy, Conformal
  • Radiotherapy Planning, Computer-Assisted
  • Radiotherapy Dosage
  • Pregnancy
  • Phantoms, Imaging
  • Nuclear Medicine & Medical Imaging
  • Humans
  • Female
  • Brain Neoplasms
 

Citation

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ICMJE
MLA
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Labby, Z. E., Barraclough, B., Bayliss, R. A., Besemer, A. E., Dunkerley, D. A. P., & Howard, S. P. (2018). Radiation treatment planning and delivery strategies for a pregnant brain tumor patient. J Appl Clin Med Phys, 19(5), 368–374. https://doi.org/10.1002/acm2.12262
Labby, Zacariah E., Brendan Barraclough, R Adam Bayliss, Abigail E. Besemer, David A. P. Dunkerley, and Steven P. Howard. “Radiation treatment planning and delivery strategies for a pregnant brain tumor patient.J Appl Clin Med Phys 19, no. 5 (September 2018): 368–74. https://doi.org/10.1002/acm2.12262.
Labby ZE, Barraclough B, Bayliss RA, Besemer AE, Dunkerley DAP, Howard SP. Radiation treatment planning and delivery strategies for a pregnant brain tumor patient. J Appl Clin Med Phys. 2018 Sep;19(5):368–74.
Labby, Zacariah E., et al. “Radiation treatment planning and delivery strategies for a pregnant brain tumor patient.J Appl Clin Med Phys, vol. 19, no. 5, Sept. 2018, pp. 368–74. Pubmed, doi:10.1002/acm2.12262.
Labby ZE, Barraclough B, Bayliss RA, Besemer AE, Dunkerley DAP, Howard SP. Radiation treatment planning and delivery strategies for a pregnant brain tumor patient. J Appl Clin Med Phys. 2018 Sep;19(5):368–374.

Published In

J Appl Clin Med Phys

DOI

EISSN

1526-9914

Publication Date

September 2018

Volume

19

Issue

5

Start / End Page

368 / 374

Location

United States

Related Subject Headings

  • Radiotherapy, Intensity-Modulated
  • Radiotherapy, Conformal
  • Radiotherapy Planning, Computer-Assisted
  • Radiotherapy Dosage
  • Pregnancy
  • Phantoms, Imaging
  • Nuclear Medicine & Medical Imaging
  • Humans
  • Female
  • Brain Neoplasms