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Dose perturbation by metallic biliary stent in external beam radiotherapy of pancreato-biliary cancers

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Abstract

This study aims to investigate dose perturbations caused by a metallic biliary stent (MBS) in patients undergoing external beam radiotherapy for cancers in the pancreato-biliary region. Four MBSs with nitinol mesh were examined in the EasyCube® phantom including a custom stent holder fabricated by a 3D printer. For experimental models, three-dimensional conformal radiotherapy plans using a single anterior–posterior (AP) and four-field box (4FB) as well as volumetric modulated arc therapy (VMAT) plan were prepared to deliver the photon beam of 8 Gy to the stent holder. EBT3 film was used to measure dose distributions at four sides surrounding MBS. All MBSs in the AP beam demonstrated mean dose enhancements of 2.3–8.2% at the proximal, left, and right sides. Maximum dose enhancements of 12.3–19.5% appeared at regions surrounding the radiopaque markers. At the location distal to the source, there were mean dose reductions of − 3.6 to − 10.9% and minimum doses of − 11.1 to − 9.5%. The mean and maximum doses with the 4FB plan were in the ranges of − 0.1 to 3.6% and 6.7–14.9%, respectively. The VMAT produced mean doses of − 0.9 to 4.8% and maximum doses of 6.0–15.3%. Dose perturbations were observed with maximum and minimum spots near the stent surface. The use of multiple beams including parallel-opposed pairs reduced dose perturbations caused by the nitinol and radiopaque components within the stent. Special attention is required for patients in whom the radiopaque markers are closely located near critical structures or the target volume.

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Funding

This research was supported by a Grant of the Radiation Technology R&D program through the National Research Foundation of Korea funded by the Ministry of Science, ICT & Future Planning (2017M2A2A6A01070330).

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Authors and Affiliations

  1. Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea

    Ho Lee

  2. Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Jeongmin Yoon, Kwangwoo Park, Chai Hong Rim & Jinsil Seong

  3. Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Moon Jae Chung

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  1. Ho Lee
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Correspondence to Jinsil Seong.

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Lee, H., Yoon, J., Park, K. et al. Dose perturbation by metallic biliary stent in external beam radiotherapy of pancreato-biliary cancers. Australas Phys Eng Sci Med 42, 745–756 (2019). https://doi.org/10.1007/s13246-019-00774-1

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  • DOI: https://doi.org/10.1007/s13246-019-00774-1

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