The Clinical Application of 3D-Printed Boluses in Superficial Tumor Radiotherapy

Wang, Xiran; Wang, Xuetao; Zeng, Yuanyuan; Liu, Fang; Shao, Bianfei; He, Tao; Ma, Jiang; Yu, Shaoming; Liu, Lei

doi:10.3389/fonc.2021.698773

Cited by 15 publications

(13 citation statements)

References 53 publications

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“…The 3D-printed plastic plates enable the peak dose in the mini-beam dose profile. Thanks to the fast prototyping of the 3D-printing technology, [22][23][24] it was not only possible to create several plastic plates with different thicknesses and angles to change FWHM and ctc as well as compensate for beam divergence but also to design mounting setups for reproducible positioning of the mini-beam collimator in the MultiRad. The relevance of aligning the mini-beam collimator properly in the center of the X-ray radiation field is illustrated in Figure S7.…”

Section: Discussionmentioning

confidence: 99%

Development and characterization of a versatile mini‐beam collimator for pre‐clinical photon beam irradiation

et al. 2023

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BackgroundInterest in spatial fractionation radiotherapy has exponentially increased over the last decade as a significant reduction of healthy tissue toxicity was observed by mini‐beam irradiation. Published studies, however, mostly use rigid mini‐beam collimators dedicated to their exact experimental arrangement such that changing the setup or testing new mini‐beam collimator configurations becomes challenging and expensive.PurposeIn this work, a versatile, low‐cost mini‐beam collimator was designed and manufactured for pre‐clinical applications with X‐ray beams. The mini‐beam collimator enables variability of the full width at half maximum (FWHM), the center‐to‐center distance (ctc), the peak‐to‐valley dose ratio (PVDR), and the source‐to‐collimator distance (SCD).MethodsThe mini‐beam collimator is an in‐house development, which was constructed of 10 × 40 mm2 tungsten or brass plates. These metal plates were combined with 3D‐printed plastic plates that can be stacked together in the desired order. A standard X‐ray source was used for the dosimetric characterization of four different configurations of the collimator, including a combination of plastic plates of 0.5, 1, or 2 mm width, assembled with 1 or 2 mm thick metal plates. Irradiations were done at three different SCDs for characterizing the performance of the collimator. For the SCDs closer to the radiation source, the plastic plates were 3D‐printed with a dedicated angle to compensate for the X‐ray beam divergence, making it possible to study ultra‐high dose rates of around 40 Gy/s. All dosimetric quantifications were performed using EBT‐XD films. Additionally, in vitro studies with H460 cells were carried out.ResultsCharacteristic mini‐beam dose distributions were obtained with the developed collimator using a conventional X‐ray source. With the exchangeable 3D‐printed plates, FWHM and ctc from 0.52 to 2.11 mm, and from 1.77 to 4.61 mm were achieved, with uncertainties ranging from 0.01% to 8.98%, respectively. The FWHM and ctc obtained with the EBT‐XD films are in agreement with the design of each mini‐beam collimator configuration. For dose rates in the order of several Gy/min, the highest PVDR of 10.09 ± 1.08 was achieved with a collimator configuration of 0.5 mm thick plastic plates and 2 mm thick metal plates. Exchanging the tungsten plates with the lower‐density metal brass reduced the PVDR by approximately 50%. Also, increasing the dose rate to ultra‐high dose rates was feasible with the mini‐beam collimator, where a PVDR of 24.26 ± 2.10 was achieved. Finally, it was possible to deliver and quantify mini‐beam dose distribution patterns in vitro.ConclusionsWith the developed collimator, we achieved various mini‐beam dose distributions that can be adjusted according to the needs of the user in regards to FWHM, ctc, PVDR and SCD, while accounting for beam divergence. Therefore, the designed mini‐beam collimator may enable low‐cost and versatile pre‐clinical research on mini‐beam irradiation.

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Section: Discussionmentioning

confidence: 99%

Development and characterization of a versatile mini‐beam collimator for pre‐clinical photon beam irradiation

et al. 2023

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“…The limitation of the present study is that we did not use 3D printed boluses when conducting radiotherapy for patients with superficial electron beam. The research of Wang X et al shows that 3D printed boluses can reduce the air gap between skin surface and bolus, improve the accuracy and uniformity of radiation dose, better protect normal tissues, and have obvious advantages in cost and time efficiency (17). In the course of radiotherapy for such patients in the future, 3D printed boluses can be considered to achieve better therapeutic effect.…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy for keratoacanthoma of facial skin: A case report and review of literature

Jia

Wang

et al. 2023

Front. Oncol.

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BackgroundKeratoacanthoma (KA) is a benign tumor that arises from the infundibulum of hair follicles. However, some researchers believe that KA is a subtype of squamous cell carcinoma (SCC) or a borderline tumor. There are two types of KA: single-type and multiple-type. Surgical resection is the first-line treatment for KA. The treatment options for patients with large lesions who are not surgical candidates are limited. We present a case of single-type KA patients with basic diseases and large lesions that were untreatable surgically, but the lesions essentially disappeared after radiotherapy. No recurrences were discovered during the two-year follow-up.Case DescriptionA 62-year-old male patient was admitted to the dermatology department of our hospital in June 2020 due to the discovery of a red papule on the right face two months prior, with occasional itching, which increased gradually. Pathological examination confirmed the diagnosis of KA. Due to the large lesions and underlying diseases, he was transferred to our radiotherapy department for radiotherapy after consultation. Since the surface of the lesion is uneven and close to the corner of the eye, we adopted intensity modulated radiation therapy (IMRT) at the beginning of radiotherapy. Following the reduction of the lesion, superficial electron beam and added a bolus with thickness of 5mm on the surface of the lesion was continued. The target dose: 42Gy/21 fractions (6MV X-ray, 22Gy; 2Gy/fraction; a total of 11 fractions, 6MeV electron beam, 20Gy; 2Gy/fraction; a total of 10 fractions). By the end of radiotherapy, the patient’s facial tumor was dry and subsided. The facial tumor subsided significantly two years after radiotherapy, and the damaged skin on the face recovered to a flat shape.ConclusionsThe treatment experience of this case shows that IMRT combined with superficial electron beam radiotherapy may be an effective treatment for single-type KA patients with basic diseases and large lesions that are not suitable for surgery, and it is worth further study.

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“…Many studies have consequently demonstrated a reduction in the air gap and an improvement in the accuracy of the dose build-up, while also reducing the time and money required. However, there have been few reports of these boluses being employed in clinical practice, and past research has rarely considered the characteristics of repetition of RT sessions [ 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Application of a Customized 3D-Printed Bolus in Radiation Therapy for Distal Extremities

Ahn

Choi

et al. 2023

Life

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In radiation therapy (RT) for skin cancer, tissue-equivalent substances called boluses are widely used to ensure the delivery of an adequate dose to the skin surface and to provide a radioprotective effect for normal tissue. The aim of this study was to develop a new type of three-dimensional (3D) bolus for RT involving body parts with irregular geometries and to evaluate its clinical feasibility. Two 3D-printed boluses were designed for two patients with squamous cell carcinoma (SCC) of their distal extremities based on computed tomography (CT) images and printed with polylactic acid (PLA). The clinical feasibility of the boluses was evaluated by measuring the in vivo skin dose at the tumor site with optically stimulated luminescence detectors (OSLDs) and comparing the results with the prescribed and calculated doses from the Eclipse treatment planning system (TPS). The average measured dose distribution for the two patients was 94.75% of the prescribed dose and 98.8% of the calculated dose. In addition, the average measured dose during repeated treatments was 189.5 ± 3.7 cGy, thus demonstrating the excellent reproducibility of the proposed approach. Overall, the customized 3D-printed boluses for the RT of distal extremities accurately delivered doses to skin tumors with improved reproducibility.

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The Clinical Application of 3D-Printed Boluses in Superficial Tumor Radiotherapy

Cited by 15 publications

References 53 publications

Development and characterization of a versatile mini‐beam collimator for pre‐clinical photon beam irradiation

Development and characterization of a versatile mini‐beam collimator for pre‐clinical photon beam irradiation

Radiotherapy for keratoacanthoma of facial skin: A case report and review of literature

Clinical Application of a Customized 3D-Printed Bolus in Radiation Therapy for Distal Extremities

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