Patient-specific Monte Carlo dose calculations for high-dose-rate endorectal brachytherapy with shielded intracavitary applicator.

PURPOSE: An integrated software platform was developed to perform a patient-specific dosimetric study on high-dose-rate (192)Ir endorectal brachytherapy. Monte Carlo techniques were used to examine the perturbation effects of an eight-channel intracavitary applicator with shielding and a liquid-inflatable balloon. Such effects are ignored in conventional treatment planning systems that assume water-equivalent geometries. METHODS AND MATERIALS: A total of 40 Task Group 43-based rectal patient plans were calculated using the PTRAN_CT Monte Carlo photon transport code. The silicone applicator, tungsten or lead shielding, contrast solution-filled balloon, and patient anatomy were included in the simulations. The dose to water and dose to medium were scored separately. The effects of heterogeneities and uncertainties in source positioning were examined. A superposition calculation method using pregenerated Monte Carlo dose distributions about the shielded applicator in water was developed and validated for efficient treatment planning purposes.
RESULTS: On average, metal shielding decreases the mean dose to the contralateral normal tissues by 24% and reduces the target volume covered by the prescribed dose from 97% to 94%. Tissue heterogeneities contribute to dose differences of <1% relative to the prescribed dose. The differences in the dose volume indices between dose to water and dose to medium-based calculations were <1% for soft tissues, <2% for bone marrow, and >20% for cortical bone. A longitudinal shift of +/-2.5 mm and a rotational shift of +/-15 degrees in applicator insertion reduced the target volume receiving the prescribed dose by </=4%.
CONCLUSION: The shielded applicator improved dose conformity and normal tissue sparing; however, Task Group 43-based treatment planning might compromise target coverage by not accounting for shielding.