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Fetal radiation monitoring and dose minimization during intensity modulated radiation therapy for glioblastoma in pregnancy

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Abstract

We examined the fetal dose from irradiation of glioblastoma during pregnancy using intensity modulated radiation therapy (IMRT), and describe fetal dose minimization using mobile shielding devices. A case report is described of a pregnant woman with glioblastoma who was treated during the third trimester of gestation with 60 Gy of radiation delivered via a 6 MV photon IMRT plan. Fetal dose without shielding was estimated using an anthropomorphic phantom with ion chamber and diode measurements. Clinical fetal dose with shielding was determined with optically stimulated luminescent dosimeters and ion chamber. Clinical target volume (CTV) and planning target volume (PTV) coverage was 100 and 98 % receiving 95 % of the prescription dose, respectively. Normal tissue tolerances were kept below quantitative analysis of normal tissue effects in the clinic (QUANTEC) recommendations. Without shielding, anthropomorphic phantom measurements showed a cumulative fetal dose of 0.024 Gy. In vivo measurements with shielding in place demonstrated a cumulative fetal dose of 0.016 Gy. The fetal dose estimated without shielding was 0.04 % and with shielding was 0.026 % of the target dose. In vivo estimation of dose equivalent received by the fetus was 24.21 mSv. Using modern techniques, brain irradiation can be delivered to pregnant patients in the third trimester with very low measured doses to the fetus, without compromising target coverage or normal tissue dose constraints. Fetal dose can further be reduced with the use of shielding devices, in keeping with the principle of as low as reasonably achievable.

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Conflict of interest

The authors declare that they have no relevant conflict of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA

    David P. Horowitz, Tony J. C. Wang, Cheng-Shie Wuu, Wenzheng Feng, Simon Cheng & Eileen P. Connolly

  2. Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA

    Daphnie Drassinower & Anita Lasala

  3. Center for Radiological Research, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA

    Radoslaw Pieniazek

  4. Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA

    Andrew B. Lassman

Authors
  1. David P. Horowitz
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  2. Tony J. C. Wang
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  3. Cheng-Shie Wuu
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  4. Wenzheng Feng
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  5. Daphnie Drassinower
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  6. Anita Lasala
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  7. Radoslaw Pieniazek
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  8. Simon Cheng
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  9. Eileen P. Connolly
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  10. Andrew B. Lassman
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Corresponding author

Correspondence to David P. Horowitz.

Additional information

David P. Horowitz and Tony J. C. Wang have contributed equally to this study.

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Horowitz, D.P., Wang, T.J.C., Wuu, CS. et al. Fetal radiation monitoring and dose minimization during intensity modulated radiation therapy for glioblastoma in pregnancy. J Neurooncol 120, 405–409 (2014). https://doi.org/10.1007/s11060-014-1565-4

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  • DOI: https://doi.org/10.1007/s11060-014-1565-4

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