Fetal dose measurements and shielding efficiency assessment in a custom setup of Ir-192 brachytherapy for a pregnant woman with breast cancer

Autores de IIS La Fe

• Cristian Candela Juan

  Autor

• José Gimeno Olmos

  Autor

• Vicente Carmona Meseguer

  Autor

• Françoise Lliso Valverde

  Autor

• Francisco Javier Celada Álvarez

  Autor

• Alejandro Tormo Mico

  Autor

• José Pérez Calatayud

  Autor

Participantes ajenos a IIS La Fe

• Pujades, MC
• Rivard, MJ
• Ramirez-Coves, JL
• Ballester, F

Grupos

• Unidad Mixta de Investigación en Radiofísica e Instrumentación nuclear en medicina

  Leader

  Facundo Ballester Pallares

Abstract

Purpose: To assess the radiation dose to the fetus of a pregnant patient undergoing high-dose-rate (HDR) Ir-192 interstitial breast brachytherapy, and to design a new patient setup and lead shielding technique that minimizes the fetal dose. Methods: Radiochromic films were placed between the slices of an anthropomorphic phantom modeling the patient. The pregnant woman was seated in a chair with the breast over a table and inside a leaded box. Dose variation as a function of distance from the implant volume as well as dose homogeneity within a representative slice of the fetal position was evaluated without and with shielding. Results: With shielding, the peripheral dose after a complete treatment ranged from 50 cGy at 5 cm from the caudal edge of the breast to <0.1 cGy at 30 cm. The shielding reduces absorbed dose by a factor of two near the breast and more than an order of magnitude beyond 20 cm. The dose is heterogeneous within a given axial plane, with variations from the central region within 50%. Interstitial HDR Ir-192 brachytherapy with breast shielding can be more advantageous than external-beam radiotherapy (EBRT) from a radiation protection point of view, as long as the distance to the uterine fundus is higher than about 10 cm. Furthermore, the weight of the shielding here proposed is notably lower than that needed in EBRT. Conclusions: Shielded breast brachytherapy may benefit pregnant patients needing localized radiotherapy, especially during the early gestational ages when the fetus is more sensitive to ionizing radiation. (C) 2015 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Keywords

• Brachytherapy; Breast cancer; Pregnant; Fetal dose