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

Zacariah E. Labby, Brendan Barraclough, R. Adam Bayliss, Abigail E Besemer, David A.P. Dunkerley, Steven P. Howard

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)368-374
Number of pages7
JournalJournal of Applied Clinical Medical Physics
Volume19
Issue number5
DOIs
StatePublished - Sep 1 2018

Fingerprint

Radiotherapy
Brain Neoplasms
brain
planning
Tumors
Brain
delivery
tumors
Radiation
Planning
radiation
Dosimeters
radiation therapy
dosage
Therapeutics
Planning Techniques
Ionization chambers
Oncology
fetuses
dosimeters

Keywords

  • astrocytoma
  • fetal dose
  • pregnant patient
  • radiation therapy

ASJC Scopus subject areas

  • Radiation
  • Instrumentation
  • Radiology Nuclear Medicine and imaging

Cite this

Radiation treatment planning and delivery strategies for a pregnant brain tumor patient. / Labby, Zacariah E.; Barraclough, Brendan; Bayliss, R. Adam; Besemer, Abigail E; Dunkerley, David A.P.; Howard, Steven P.

In: Journal of Applied Clinical Medical Physics, Vol. 19, No. 5, 01.09.2018, p. 368-374.

Research output: Contribution to journalArticle

Labby, Zacariah E. ; Barraclough, Brendan ; Bayliss, R. Adam ; Besemer, Abigail E ; Dunkerley, David A.P. ; Howard, Steven P. / Radiation treatment planning and delivery strategies for a pregnant brain tumor patient. In: Journal of Applied Clinical Medical Physics. 2018 ; Vol. 19, No. 5. pp. 368-374.
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