IMRT treatment of anal cancer with a scrotal shield.

Journal Article (Journal Article)

The risk of sterility in males undergoing radiotherapy in the pelvic region indicates the use of a shielding device, which offers protection to the testes for patients wishing to maintain fertility. The use of such devices in the realm of intensity-modulated radiotherapy (IMRT) in the pelvic region can pose many obstacles during simulation, treatment planning, and delivery of radiotherapy. This work focuses on the development and execution of an IMRT plan for the treatment of anal cancer using a scrotal shielding device on a clinical patient. An IMRT plan was developed using Eclipse treatment planning system (Varian Medical Systems, Palo Alto, CA), using a wide array of gantry angles as well as fixed jaw and fluence editing techniques. When possible, the entire target volume was encompassed by the treatment field. When the beam was incident on the scrotal shield, the jaw was fixed to avoid the device and the collimator rotation optimized to irradiate as much of the target as possible. This technique maximizes genital sparing and allows minimal irradiation of the gonads. When this fixed-jaw technique was found to compromise adequate coverage of the target, manual fluence editing techniques were used to avoid the shielding device. Special procedures for simulation, imaging, and treatment verification were also developed. In vivo dosimetry was used to verify and ensure acceptable dose to the gonads. The combination of these techniques resulted in a highly conformal plan that spares organs and risk and avoids the genitals as well as entrance of primary radiation onto the shielding device.

Full Text

Duke Authors

Cited Authors

  • Hood, RC; Wu, QJ; McMahon, R; Czito, B; Willett, C

Published Date

  • 2012

Published In

Volume / Issue

  • 37 / 4

Start / End Page

  • 432 - 435

PubMed ID

  • 22538113

Electronic International Standard Serial Number (EISSN)

  • 1873-4022

Digital Object Identifier (DOI)

  • 10.1016/j.meddos.2012.03.007


  • eng

Conference Location

  • United States