Skip to main content
PMC home page
Sarcoma logoLink to Sarcoma
. 2004 Mar;8(1):37–42. doi: 10.1080/13577140410001679248

A Radiotherapy Technique to Improve Dose Homogeneity Around Bone Prostheses

M V Williams 1,✉, N G Burnet 1,2, E Sherwin 1,4, R Kestelman 3, A R Geater 3, S J Thomas 3, C B Wilson 1
PMCID: PMC2395598  PMID: 18521392

Abstract

Purpose. Following limb conserving surgery for bone or soft tissue sarcoma, patients may require post-operative radiotherapy to minimise the risk of local recurrence. In such circumstances the metal prosthesis reduces the dose in its shadow by approximately 10% when using opposed fields. We describe a technique to boost the underdosed area to overcome this problem.

Patients or subjects. Seven sequential patients presenting between 1995 and 2001 had their treatment individualised because they had metal prosthesis in the treatment volume.

Methods. To improve the target dose homogeneity we used a custom-made keyhole cutout to boost the area in the shadow of the prosthesis. The degree of attenuation caused by the metal prosthesis was estimated and a boost dose calculated. Exit thermoluminescent dosimetry (TLD) was used to confirm the estimates made.

Results and discussion. Variation between patients was seen, demonstrating the need for exit TLD to individualise the treatment plan. The use of a boost field provides a method to overcome under-dosage in the shadow of a metal prosthesis. It improves dose homogeneity throughout the target volume and ensures adequate dose intensity around the prosthesis, the site most at risk of local recurrence.

Full Text

The Full Text of this article is available as a PDF (163.1 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abudu A., Sferopoulos N. K., Tillman R. M., Carter S. R., Grimer R. J. The surgical treatment and outcome of pathological fractures in localised osteosarcoma. J Bone Joint Surg Br. 1996 Sep;78(5):694–698. [PubMed] [Google Scholar]
  2. Bacci G., Ferrari S., Bertoni F., Ruggieri P., Picci P., Longhi A., Casadei R., Fabbri N., Forni C., Versari M. Long-term outcome for patients with nonmetastatic osteosarcoma of the extremity treated at the istituto ortopedico rizzoli according to the istituto ortopedico rizzoli/osteosarcoma-2 protocol: an updated report. J Clin Oncol. 2000 Dec 15;18(24):4016–4027. doi: 10.1200/JCO.2000.18.24.4016. [DOI] [PubMed] [Google Scholar]
  3. Bacci G., Picci P., Ruggieri P., Mercuri M., Avella M., Capanna R., Brach Del Prever A., Mancini A., Gherlinzoni F., Padovani G. Primary chemotherapy and delayed surgery (neoadjuvant chemotherapy) for osteosarcoma of the extremities. The Istituto Rizzoli Experience in 127 patients treated preoperatively with intravenous methotrexate (high versus moderate doses) and intraarterial cisplatin. Cancer. 1990 Jun 1;65(11):2539–2553. doi: 10.1002/1097-0142(19900601)65:11<2539::aid-cncr2820651125>3.0.co;2-m. [DOI] [PubMed] [Google Scholar]
  4. CADE S. Osteogenic sarcoma; a study based on 133 patients. J R Coll Surg Edinb. 1955 Dec;1(2):79–111. [PubMed] [Google Scholar]
  5. Deacon J., Peckham M. J., Steel G. G. The radioresponsiveness of human tumours and the initial slope of the cell survival curve. Radiother Oncol. 1984 Dec;2(4):317–323. doi: 10.1016/s0167-8140(84)80074-2. [DOI] [PubMed] [Google Scholar]
  6. Erlanson M., Franzén L., Henriksson R., Littbrand B., Löfroth P. O. Planning of radiotherapy for patients with hip prosthesis. Int J Radiat Oncol Biol Phys. 1991 May;20(5):1093–1098. doi: 10.1016/0360-3016(91)90210-u. [DOI] [PubMed] [Google Scholar]
  7. Fuks Z., Leibel S. A., Wallner K. E., Begg C. B., Fair W. R., Anderson L. L., Hilaris B. S., Whitmore W. F. The effect of local control on metastatic dissemination in carcinoma of the prostate: long-term results in patients treated with 125I implantation. Int J Radiat Oncol Biol Phys. 1991 Aug;21(3):537–547. doi: 10.1016/0360-3016(91)90668-t. [DOI] [PubMed] [Google Scholar]
  8. Gaitán-Yanguas M. A study of the response of osteogenic sarcoma and adjacent normal tissues to radiation. Int J Radiat Oncol Biol Phys. 1981 May;7(5):593–595. doi: 10.1016/0360-3016(81)90371-0. [DOI] [PubMed] [Google Scholar]
  9. Hazuka M. B., Ibbott G. S., Kinzie J. J. Hip prostheses during pelvic irradiation: effects and corrections. Int J Radiat Oncol Biol Phys. 1988 Jun;14(6):1311–1317. doi: 10.1016/0360-3016(88)90412-9. [DOI] [PubMed] [Google Scholar]
  10. Hudson F. R., Crawley M. T., Samarasekera M. Radiotherapy treatment planning for patients fitted with prostheses. Br J Radiol. 1984 Jul;57(679):603–608. doi: 10.1259/0007-1285-57-679-603. [DOI] [PubMed] [Google Scholar]
  11. Jenkin R. D., Allt W. E., Fitzpatrick P. J. Osteosarcoma. An assessment of management with particular reference to primary irradiation and selective delayed amputation. Cancer. 1972 Aug;30(2):393–400. doi: 10.1002/1097-0142(197208)30:2<393::aid-cncr2820300215>3.0.co;2-2. [DOI] [PubMed] [Google Scholar]
  12. Ozaki Toshifumi, Flege Silke, Kevric Matthias, Lindner Norbert, Maas Rainer, Delling Günter, Schwarz Rudolf, von Hochstetter Arthur R., Salzer-Kuntschik Mechthild, Berdel Wolfgang E. Osteosarcoma of the pelvis: experience of the Cooperative Osteosarcoma Study Group. J Clin Oncol. 2003 Jan 15;21(2):334–341. doi: 10.1200/JCO.2003.01.142. [DOI] [PubMed] [Google Scholar]
  13. Provisor A. J., Ettinger L. J., Nachman J. B., Krailo M. D., Makley J. T., Yunis E. J., Huvos A. G., Betcher D. L., Baum E. S., Kisker C. T. Treatment of nonmetastatic osteosarcoma of the extremity with preoperative and postoperative chemotherapy: a report from the Children's Cancer Group. J Clin Oncol. 1997 Jan;15(1):76–84. doi: 10.1200/JCO.1997.15.1.76. [DOI] [PubMed] [Google Scholar]
  14. Reft Chester, Alecu Rodica, Das Indra J., Gerbi Bruce J., Keall Paul, Lief Eugene, Mijnheer Ben J., Papanikolaou Nikos, Sibata Claudio, Van Dyk Jake. Dosimetric considerations for patients with HIP prostheses undergoing pelvic irradiation. Report of the AAPM Radiation Therapy Committee Task Group 63. Med Phys. 2003 Jun;30(6):1162–1182. doi: 10.1118/1.1565113. [DOI] [PubMed] [Google Scholar]
  15. Rosen G., Marcove R. C., Caparros B., Nirenberg A., Kosloff C., Huvos A. G. Primary osteogenic sarcoma: the rationale for preoperative chemotherapy and delayed surgery. Cancer. 1979 Jun;43(6):2163–2177. doi: 10.1002/1097-0142(197906)43:6<2163::aid-cncr2820430602>3.0.co;2-s. [DOI] [PubMed] [Google Scholar]
  16. Suit H. D. The American Society of Therapeutic Radiologists Presidential Address: October 1981. Potential for improving survival rates for the cancer patient by increasing the efficacy of treatment of the primary lesion. Cancer. 1982 Oct 1;50(7):1227–1234. doi: 10.1002/1097-0142(19821001)50:7<1227::aid-cncr2820500702>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  17. Weeden S., Grimer R. J., Cannon S. R., Taminiau A. H., Uscinska B. M., European Osteosarcoma Intergroup The effect of local recurrence on survival in resected osteosarcoma. Eur J Cancer. 2001 Jan;37(1):39–46. doi: 10.1016/s0959-8049(00)00362-2. [DOI] [PubMed] [Google Scholar]

Articles from Sarcoma are provided here courtesy of Wiley

RESOURCES