MR-guided breast radiotherapy: feasibility and magnetic-field impact on skin dose.
The UMC Utrecht MRI/linac (MRL) design provides image guidance with high soft-tissue contrast, directly during radiotherapy (RT). Breast cancer patients are a potential group to benefit from better guidance in the MRL. However, due to the electron return effect, the skin dose can be increased in presence of a magnetic field. Since large skin areas are generally involved in breast RT, the purpose of this study is to investigate the effects on the skin dose, for whole-breast irradiation (WBI) and accelerated partial-breast irradiation (APBI). In ten patients with early-stage breast cancer, targets and organs at risk (OARs) were delineated on postoperative CT scans co-registered with MRI. The OARs included the skin, comprising the first 5 mm of ipsilateral-breast tissue, plus extensions. Three intensity-modulated RT techniques were considered (2× WBI, 1× APBI). Individual beam geometries were used for all patients. Specially developed MRL treatment-planning software was used. Acceptable plans were generated for 0 T, 0.35 T and 1.5 T, using a class solution. The skin dose was augmented in WBI in the presence of a magnetic field, which is a potential drawback, whereas in APBI the induced effects were negligible. This opens possibilities for developing MR-guided partial-breast treatments in the MRL.
Department of Radiotherapy, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. T.C.F.vanHeijst@umcutrecht.nl
Tristan C F
TC
van Heijst
Mariska D
MD
den Hartogh
Jan J W
JJ
Lagendijk
H J G Desirée
HJ
van den Bongard
Bram
B
van Asselen
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000532:radiotherapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D060526:Magnetic Fields; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D058958:Organs at Risk / Q000528:radiation effects; D011829:Radiation Dosage; D061089:Radiotherapy, Image-Guided / Q000009:adverse effects* / Q000379:methods*; D012867:Skin / Q000528:radiation effects*