Brandon S Imber1, Suzanne L Wolden2, Hilda E Stambuk3, Evan Matros4, Leonard H Wexler5, Alexander S Drew6, Evan B Rosen7, Ian Ganly8, Gil'ad N Cohen9, Antonio L Damato9. 1. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY. 2. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: woldens@mskcc.org. 3. Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, NY. 4. Department of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. 5. Department of Pediatrics, Memorial Sloan Kettering Cancer Center, Weill Cornell College of Medicine, New York, NY. 6. Division of Prosthodontics, Columbia University College of Dental Medicine, New York, NY. 7. Department of Surgery, Dental Service, Memorial Sloan Kettering Cancer Center, New York, NY. 8. Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY. 9. Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY.
Abstract
BACKGROUND: Intraoperative radiotherapy (IORT) is an effective strategy for the delivery of high doses of radiotherapy to a residual tumor or resection cavity with relative sparing of nearby healthy tissues. This strategy is an important component of the multimodality management of pediatric soft tissue sarcomas, particularly in cases where patients have received prior courses of external beam radiotherapy. PURPOSE: Tumor beds with significant topographic irregularity remain a therapeutic challenge because existing IORT technologies are typically most reliable with flat surfaces. To address this limitation, we have developed a novel strategy to create custom, prefabricated high-dose-rate (HDR)-IORT applicators designed to match the shape of an anticipated surgical cavity. METHODS AND MATERIALS: Silastic applicators are constructed using three-dimensional (3D) printing and are derived from volumetric segmentation of preoperative imaging. RESULTS: HDR preplanning with the applicators improves dosimetric accuracy and minimizes incremental operative time. In this report, we describe the fabrication process for the 3D-printed applicators and detail our experience utilizing this strategy in two pediatric patients who underwent HDR-IORT as part of complex base of skull sarcoma resections. CONCLUSIONS: Early experience suggests that usage of the custom applicators is feasible, versatile for a variety of clinical situations, and enables the uniform delivery of high superficial doses of radiotherapy to irregularly shaped surgical cavities.
BACKGROUND: Intraoperative radiotherapy (IORT) is an effective strategy for the delivery of high doses of radiotherapy to a residual tumor or resection cavity with relative sparing of nearby healthy tissues. This strategy is an important component of the multimodality management of pediatric soft tissue sarcomas, particularly in cases where patients have received prior courses of external beam radiotherapy. PURPOSE:Tumor beds with significant topographic irregularity remain a therapeutic challenge because existing IORT technologies are typically most reliable with flat surfaces. To address this limitation, we have developed a novel strategy to create custom, prefabricated high-dose-rate (HDR)-IORT applicators designed to match the shape of an anticipated surgical cavity. METHODS AND MATERIALS: Silastic applicators are constructed using three-dimensional (3D) printing and are derived from volumetric segmentation of preoperative imaging. RESULTS: HDR preplanning with the applicators improves dosimetric accuracy and minimizes incremental operative time. In this report, we describe the fabrication process for the 3D-printed applicators and detail our experience utilizing this strategy in two pediatric patients who underwent HDR-IORT as part of complex base of skull sarcoma resections. CONCLUSIONS: Early experience suggests that usage of the custom applicators is feasible, versatile for a variety of clinical situations, and enables the uniform delivery of high superficial doses of radiotherapy to irregularly shaped surgical cavities.
Authors: Emma-Louise Jones; Anna Tonino Baldion; Christopher Thomas; Tom Burrows; Nick Byrne; Victoria Newton; Sarah Aldridge Journal: Brachytherapy Date: 2016-12-10 Impact factor: 2.362
Authors: Richard A Canters; Irene M Lips; Markus Wendling; Martijn Kusters; Marianne van Zeeland; Rianne M Gerritsen; Philip Poortmans; Cornelia G Verhoef Journal: Radiother Oncol Date: 2016-07-27 Impact factor: 6.280
Authors: Kwangwoo Park; Sungjin Park; Mi-Jin Jeon; Jinhyun Choi; Jun Won Kim; Yoon Jin Cho; Won-Seok Jang; Yo Sup Keum; Ik Jae Lee Journal: Oncotarget Date: 2017-04-11