Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-10T08:22:01.145Z Has data issue: false hasContentIssue false
  • English
  • Français

A dosimetric study of skin toxicity induced by 3-D conventional and intensity-modulated radiotherapy techniques using immobilization mask for treatment of head-and-neck (nasopharyngeal cancer) carcinoma: a prospective study

Published online by Cambridge University Press:  26 October 2018

Khaldoon Mahmoud Radaideh
Khaldoon Mahmoud Radaideh*
Affiliation:
Radiological Technology Department, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia
*
Author for correspondence: Khaldoon Mahmoud Radaideh, PhD, Qassim University, Buraidah, Saudi Arabia. E-mail: khaldoonmah1@yahoo.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The purpose of this study was to investigate variations in surface dose, with and without the use of a Klarity® Mask (Orfit Industries America, Wijnegem, Belgium), using intensity-modulated radiotherapy (IMRT) and 3-D conventional radiotherapy (3D-CRT).

Materials and methods

Thermoluminescent dosimeters (TLDs) together with a phantom were used to examine acute skin toxicity during nasopharyngeal cancer treatment. These plans were sequentially delivered to the perspex phantom. Dosimeters were placed in five fixed regions over the skin. A Klarity mask for immobilization was used for covering the head, neck, and shoulder. The phantom was irradiated with and without a Klarity Mask, using IMRT and 3D-CRT, respectively.

Results

The Klarity mask increased the skin doses for IMRT and 3D-CRT approximately 18·6% and 8·6%, respectively, from the prescribed maximum skin dose using treatment planning system (TPS). Additionally, the average percentage dose between IMRT and 3D-CRT received on the surface region was 30·9%, 24·9% with and without Klarity mask respectively. The average percentage dose received on surfaces from the total therapeutic dose 70 Gy, without using the mask was 7·7% and 5·7%, for IMRT and 3D-CRT, respectively. The TPS overestimated the skin dose for IMRT planning by 20%, and for 3D-CRT by 16·6%, compared with TLD measurements.

Conclusions

The results of this study revealed that IMRT significantly increases acute skin toxicity, compared with CRT. Although it is recommended to use Klarity mask as a sparing tool of normal tissue, it increases the risk of skin toxicity. In conclusion, skin dose is an important issue of focus during radiotherapy.

Keywords

thermoluminescent dosimetry (TLD)thermoplastic masktreatment planning systemradiation doseskin toxicity
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 18 , Issue 2 , June 2019 , pp. 132 - 137
Check for updates
Copyright
© Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Cite this article: Radaideh KM. (2019) A dosimetric study of skin toxicity induced by 3-D conventional and intensity-modulated radiotherapy techniques using immobilization mask for treatment of head-and-neck (nasopharyngeal cancer) carcinoma: a prospective study. Journal of Radiotherapy in Practice18: 132–137. doi: 10.1017/S1460396918000523

References

1. Cox, J D, Stetz, J, Pajak, T F. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European organization for research and treatment of cancer (EORTC). Int J Radiat Oncol Biol Phys 1995; 31 (5): 1341–1346.Google Scholar
2. Lee, N, Pfister, D G, Zhang, Q et al. Phase II study of concurrent and adjuvant chemotherapy with intensity modulated radiation therapy (IMRT) or three-dimensional conformal radiotherapy (3D-CRT)+ Bevacizumab (BV) for locally or regionally advanced nasopharyngeal cancer (NPC)[RTOG 0615]: preliminary toxicity report. Int J Radiat Oncol Biol Phys 2010; 78 (3): S103–S104.Google Scholar
3. Faithfull, S, Wells, M. Randomized trial, a method of comparison: a study of supportive care in radiotherapy. Eur J Oncol Nurs 1999; 3 (3): 176–184.Google Scholar
4. Elliott, E A, Wright, J R, Swann, R S et al. Phase III trial of an emulsion containing trolamine for the prevention of radiation dermatitis in patients with advanced squamous cell carcinoma of the head and neck: results of Radiation Therapy Oncology Group Trial 99-13. J Clin Oncol 2006; 24 (13): 2092–2097.Google Scholar
5. Ezzell, G A. Genetic and geometric optimization of three-dimensional radiation therapy treatment planning. Med Phys 1996; 23 (3): 293–305.Google Scholar
6. Keirim Markus, I. On the choice of the skin sensitive layer related to the routine exposure effects. Radiat Prot Dosim 1991; 39: 29–32.Google Scholar
7. International Commission on Radiation Units and Measurements. Determination of Dose Equivalents Resulting from External Radiation Sources (Report 39). ICRU, 2016; 20 (2).Google Scholar
8. Radaideh, K M, Malatqah, L M. Predictors of radiation-induced skin toxicity in nasopharyngeal cancer patients treated by intensity-modulated radiation therapy: a prospective study. J Radiother Pract 2016; 15 (3): 276–282.Google Scholar
9. Radaideh, K M. Evaluation of thermoplastic Klarity mask use during intensity-modulated radiation therapy for head and neck carcinoma. J Radiother in Pract 2018; 17 (2): 171–178.Google Scholar
10. Bhandare, M M W. A literature review of late complications of radiation therapy for head and neck cancers: incidence and dose response. S 2:009. J Nucl Med Radiat Ther 2012; 2: 9 DOI: 10.4172/2155-9619.S2-009.Google Scholar
11. Koenig, T R, Mettler, F A, Wagner, L K. Skin injuries from fluoroscopically guided procedures: part 2, review of 73 cases and recommendations for minimizing dose delivered to patient. Am J Roentgenol 2001; 177 (1): 13–20.Google Scholar
12. Rosenthal, L S, Williams, J, Mahesh, M et al. Acute radiation dermatitis following radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia. Pacing Clin Electrophysiol 1997; 20 (7): 1834–1839.Google Scholar
13. Mettler, F, Koenig, T, Wagner, L, Kelsey, C. Radiation injuries after fluoroscopic procedures. Sem Ultrasound Ct MRI 2002; 23 (5): 428–442.Google Scholar
14. Bahl, A, Ghosal, S, Kapoor, R, Bhattacharya, T, Sharma, S C. Clinical implications of thermoplastic mask immobilization on acute effects of radiotherapy in head and neck cancers. J Postgrad Med Edu Res 2012; 46: 187–189.Google Scholar
15. Norbash, A, Busick, D, Marks, M. Techniques for reducing interventional neuro radiologic skin dose: tube position rotation and supplemental beam filtration. Am J Neuroradiol 1996; 17: 41–49.Google Scholar
16. Bredfeldt, J, Sapir, E, Masi, K, Schipper, M, Eisbruch, A, Matuszak, M. Clinical skin toxicity comparison and phantom dose measurements for head and neck patients treated with IMRT vs. VMAT. Med Phys 2015; 42 (6): 3742–3742.Google Scholar
17. Radaideh, K M, Matalqah, L M, Tajuddin, A A, Fabian, L, Bauk, S. Preliminary dosimetric evaluation of a designed head and neck phantom for intensity modulated radiation therapy (IMRT). Int J Med Med Sci 2012; 11 (2): 236–244.Google Scholar
18. Radaideh, K M, Matalqah, L M, Tajuddin, A A, Fabian Lee, W I, Bauk, S, Eid Abdel Munem, E. M. Development and evaluation of a Perspex anthropomorphic head and neck phantom for three dimensional conformal radiation therapy (3D-CRT). J Radiother Pract 2013; 12 (3): 272–280.Google Scholar
19. Radaideh, K M, AlZoubi, A. Factors impacting the dose at maximum depth dose (dmax) for 6 MV high-energy photon beams using different dosimetric detectors. Biohealth Sci Bull 2010; 2 (2): 38–42.Google Scholar
20. ICRP (International Commission on Radiation Units and Measurements). Conversion coefficients for use in radiological protection against external radiation. Report 74, Ann. ICRP 26, 3. Report 74. Ann ICRP 1997; 26: 3.Google Scholar
21. Chung, H, Jin, H, Dempsey, J F et al. Evaluation of surface and build-up region dose for intensity-modulated radiation therapy in head and neck cancer. Med Phys 2005; 32 (8): 2682–2689.Google Scholar
22. Cherpak, A, Studinski, R C, Cygler, J E. MOSFET detectors in quality assurance of tomotherapy treatments. Radiother Oncol 2008; 86 (2): 242–250.Google Scholar
23. Kinhikar, R A, Murthy, V, Goel, V, Tambe, C M, Dhote, D. S, Deshpande, D D. Skin dose measurements using MOSFET and TLD for head and neck patients treated with tomotherapy. Appl Radiat Isotop 2009; 67 (9): 1683–1685.Google Scholar
24. Stathakis, S, Li, J S, Paskalev, K, Yang, J, Wang, L, Ma, C. Ultra-thin TLDs for skin dose determination in high energy photon beams. Phys Med Biol 2006; 51 (14): 3549–3567.Google Scholar
25. Olko, P. Thermoluminescence dosimetry materials: properties and uses Stephen W.S. Mckeever, Marko Moskovitch And Peter D. Townsend. Nuclear Technology Publishing, Ashford, Kent TN3 1YW, U.K., 1995. ISBN: 1-870965-19-1, 204 pp. Radiat Phys Chem 1997; 50 (3): 313–314.Google Scholar
26. Radaideh, K M, Matalqah, L M, Tajuddin, A A, Luen, L F W, Bauk, S, Moneim, E A. A custom made phantom for dosimetric audit and quality assurance of three-dimensional conformal radiotherapy. Jurnal Sains Nuklear Malaysia 2012; 24 (1): 48–58.Google Scholar
27. Harris, C K, Elson, H R, Lamba, M A S, Foster, A E. A comparison of the effectiveness of thermoluminescent crystals LiF:Mg,Ti, and LiF:Mg,Cu,P for clinical dosimetry. Med Phys 1997; 24 (9): 1527–1529.Google Scholar
28. Nutting, C M, Morden, J P, Harrington, K J et al. Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol 2011; 12 (2): 127–136.Google Scholar
29. Xia, P, Fu, K K, Wong, G W, Akazawa, C, Verhey, L J. Comparison of treatment plans involving intensity-modulated radiotherapy for nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2000; 48 (2): 329–337.Google Scholar
30. Kam, M K M, Leung, S, Zee, B et al. Prospective randomized study of intensity-modulated radiotherapy on salivary gland function in early-stage nasopharyngeal carcinoma patients. J Clin Oncol 2007; 25 (31): 4873–4879.Google Scholar
31. Chau, R M C, Teo, P M L, Kam, M K M, Leung, S F, Cheung, K Y, Chan, A T C. Dosimetric comparison between 2-dimensional radiation therapy and intensity modulated radiation therapy in treatment of advanced T-stage nasopharyngeal carcinoma: to treat less or more in the planning organ-at-risk volume of the brainstem and spinal cord. Med Dosimet 2007; 32 (4): 263–270.Google Scholar
32. Lee, N, Xia, P, Quivey, J M et al. Intensity-modulated radiotherapy in the treatment of nasopharyngeal carcinoma: an update of the UCSF experience. Int J Radiat Oncol Biol Phys 2002; 53 (1): 12–22.Google Scholar
33. Lee, N, Chuang, C, Quivey, J M et al. Skin toxicity due to intensity-modulated radiotherapy for head-and-neck carcinoma. Int J Radiat Oncol Biol Phys 2002; 53 (3): 630–637.Google Scholar
34. Półtorak, M, Fujak, E, Kukołowicz, P. Effect of the thermoplastic masks on dose distribution in the build-up region for photon beams. Polish J Med Phys Eng 2016; 22 (1): 1–4.Google Scholar
35. Nilsson, B, Brahme, A. Electron contamination from photon beam collimators. Radiother Oncol 1986; 5 (3): 235–244.Google Scholar
36. Vano, E, Prieto, C, Fernandez, J M, Gonzalez, L, Sabate, M, Galvan, C. Skin dose and dose-area product values in patients undergoing intracoronary brachytherapy. Br J Radiol 2003; 76 (901): 32–38.Google Scholar
37. Porock, D. Factors influencing the severity of radiation skin and oral mucosal reactions: development of a conceptual framework. Eur J Cancer Care 2002; 11 (1): 33–43.Google Scholar
38. Chung, H, Jin, H, Dempsey, J F et al. Evaluation of surface and build-up region dose for intensity-modulated radiation therapy in head and neck cancer. Med Phys 2005; 32 (8): 2682–2689.Google Scholar
39. Kry, S F, Smith, S A, Weathers, R, Stovall, M. Skin dose during radiotherapy: a summary and general estimation technique. J Appl Clin Med Phys/Am Coll Med Phys 2012; 13 (3): 20–34.Google Scholar