MR-guided breast radiotherapy: feasibility and magnetic-field impact on skin dose

Phys Med Biol. 2013 Sep 7;58(17):5917-30. doi: 10.1088/0031-9155/58/17/5917. Epub 2013 Aug 6.

Abstract

The UMC Utrecht MRI/linac (MRL) design provides image guidance with high soft-tissue contrast, directly during radiotherapy (RT). Breast cancer patients are a potential group to benefit from better guidance in the MRL. However, due to the electron return effect, the skin dose can be increased in presence of a magnetic field. Since large skin areas are generally involved in breast RT, the purpose of this study is to investigate the effects on the skin dose, for whole-breast irradiation (WBI) and accelerated partial-breast irradiation (APBI). In ten patients with early-stage breast cancer, targets and organs at risk (OARs) were delineated on postoperative CT scans co-registered with MRI. The OARs included the skin, comprising the first 5 mm of ipsilateral-breast tissue, plus extensions. Three intensity-modulated RT techniques were considered (2× WBI, 1× APBI). Individual beam geometries were used for all patients. Specially developed MRL treatment-planning software was used. Acceptable plans were generated for 0 T, 0.35 T and 1.5 T, using a class solution. The skin dose was augmented in WBI in the presence of a magnetic field, which is a potential drawback, whereas in APBI the induced effects were negligible. This opens possibilities for developing MR-guided partial-breast treatments in the MRL.

MeSH terms

  • Adult
  • Aged
  • Breast Neoplasms / radiotherapy*
  • Feasibility Studies
  • Female
  • Humans
  • Magnetic Fields*
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Organs at Risk / radiation effects
  • Radiation Dosage*
  • Radiotherapy, Image-Guided / adverse effects*
  • Radiotherapy, Image-Guided / methods*
  • Skin / radiation effects*