Dosimetric evaluation of multilumen intracavitary balloon applicator rotation in high‐dose‐rate brachytherapy for breast cancer

The objective of this work is to evaluate dosimetric impact of multilumen balloon applicator rotation in high‐dose‐rate (HDR) brachytherapy for breast cancer. Highly asymmetrical dose distribution was generated for patients A and B, depending upon applicator proximity to skin and rib. Both skin and rib spacing was for A; only rib spacing was for B. Thirty‐five rotation scenarios were simulated for each patient by rotating outer lumens every 10° over range with respect to central lumen using mathematically calculated rotational matrix. Thirty‐five rotated plans were compared with three plans: 1) original multidwell multilumen (MDML) plan, 2) multidwell single‐lumen (MDSL) plan, and 3) singledwell single‐lumen (SDSL) plan. For plan comparison, planning target volume for evaluation (PTV_EVAL) coverage (dose to 95% and 90% volume of PTV_EVAL) (D95 and D90), skin and rib maximal dose (Dmax), and normal breast tissue volume receiving 150% (V150) and 200% (V200) of prescribed dose (PD) were evaluated. Dose variation due to device rotation ranged from to 0.8% (A) and to 0.2% (B) for PTV_EVAL D95; to 0.4% (A) and to 0.7% (B) for PTV_EVAL D90; to 18.4% (A) and to 17.5% (B) for skin Dmax; to 22.8% (A) and to 55.1% (B) of PD for rib Dmax, respectively. Normal breast tissue V150 and V200 variation was , except for to 2.5 cc (B) of V200. Furthermore, 30° device rotation increased rib Dmax over 145% of PD: 152.9% (A) by clockwise 30° rotation and 152.5% (B) by counterclockwise 30° rotation. For a highly asymmetric dose distribution, device rotation can outweigh the potential benefit of improved dose shaping capability afforded by multilumen and make dosimetric data worse than single‐lumen plans unless it is properly corrected.PACS number: 87.53.Jw

Duke Scholars

Author Yongbok Kim Radiation Oncology