Reliable Radiation Technique to Minimize Ovarian Dose During Radiation Prophylaxis of Heterotopic Ossification

Waleed Fouad Mourad, Satyaseelan Packianathan, Weisi Yan, Mahboubeh Pishgou, John K. Ma, Sherif G. Shaaban, Edward M. Marchan, Rui He, Paul N. Mobit, Chunli Claus Yang, Srinivasan Vijayakumar

Research output: Contribution to journalArticle

Abstract

BACKGROUND/AIM: Scattered radiation during radiotherapy (RT) directed at the hip joint poses concerns about ovarian function in patients of reproductive age. Here, we report the impact of using a split-beam technique (SBT) and different photon energies on the total ovary dose during radiation prophylaxis of heterotopic ossification (HO).

PATIENTS AND METHODS: This was a single-institution, retrospective study of 32-patients with traumatic acetabular fractures (TAF). All underwent surgery followed by CT-based-RT within 72 h in a single fraction of 700 cGy. Ipsilateral (IL) and contralateral (CL) ovaries (OV) were contoured separately and dose volume histograms (DVH) generated. Additional planning trials were created for each patient by utilizing a SBT medially and by using different photon energies (6-18 MV) to investigate the difference in ovary dose among these maneuvers.

RESULTS: The median Mean-dose delivered to ILOV was 59 cGy and the median Max-dose was 177 cGy. CLOV median Mean-dose was 6 cGy and median Max-dose was 10 cGy. SBT at the medial edge of the field led to a 27% and 22% dose reduction in the median Mean and Max. doses, respectively, to ILOV; 9% and 5% reduction was seen in the median Mean and Max. doses, respectively, to CLOV. Higher photon energies (10-18 MV) led to an additional 28% and 16 % reduction in median Mean and Max. doses, respectively, to ILOV when compared to those from 6 MV. The CLOV median Mean dose was reduced by 18% and the Max. dose was reduced by 12%.

CONCLUSION: A biologically significant radiation dose is delivered to the ovaries during HO radiation prophylaxis at the hip joints. Ipsilateral ovarian dose could be reduced by half and contralateral by one-quarter by using CT-based treatment planning with a medial SBT and photon energies above 6 MV. We suggest using no more than 10 MV to minimize neutron contamination. Those techniques should be the standard of care as it provides a reliable method for minimizing the radiation dose to the ovaries, consequently, maximizing female fertility preservation during HO radiation prophylaxis. All female patients in childbearing age should be fully informed about ovarian radiation exposure and possible temporary alteration in ova production and morphology.

Original languageEnglish (US)
Pages (from-to)6929-6935
Number of pages7
JournalAnticancer research
Volume37
Issue number12
StatePublished - Dec 1 2017

Fingerprint

Heterotopic Ossification
Ovary
Radiation
Photons
Hip Joint
Radiotherapy
Fertility Preservation
Neutrons
Standard of Care
Ovum
Retrospective Studies

Keywords

  • Radiation therapy (RT)
  • acetabular fracture
  • heterotopic ossification (HO)
  • indomethacin
  • megavoltage photon
  • ovarian dose
  • radiation prophylaxis
  • split-beam technique

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Mourad, W. F., Packianathan, S., Yan, W., Pishgou, M., Ma, J. K., Shaaban, S. G., ... Vijayakumar, S. (2017). Reliable Radiation Technique to Minimize Ovarian Dose During Radiation Prophylaxis of Heterotopic Ossification. Anticancer research, 37(12), 6929-6935.

Reliable Radiation Technique to Minimize Ovarian Dose During Radiation Prophylaxis of Heterotopic Ossification. / Mourad, Waleed Fouad; Packianathan, Satyaseelan; Yan, Weisi; Pishgou, Mahboubeh; Ma, John K.; Shaaban, Sherif G.; Marchan, Edward M.; He, Rui; Mobit, Paul N.; Yang, Chunli Claus; Vijayakumar, Srinivasan.

In: Anticancer research, Vol. 37, No. 12, 01.12.2017, p. 6929-6935.

Research output: Contribution to journalArticle

Mourad, WF, Packianathan, S, Yan, W, Pishgou, M, Ma, JK, Shaaban, SG, Marchan, EM, He, R, Mobit, PN, Yang, CC & Vijayakumar, S 2017, 'Reliable Radiation Technique to Minimize Ovarian Dose During Radiation Prophylaxis of Heterotopic Ossification', Anticancer research, vol. 37, no. 12, pp. 6929-6935.
Mourad WF, Packianathan S, Yan W, Pishgou M, Ma JK, Shaaban SG et al. Reliable Radiation Technique to Minimize Ovarian Dose During Radiation Prophylaxis of Heterotopic Ossification. Anticancer research. 2017 Dec 1;37(12):6929-6935.
Mourad, Waleed Fouad ; Packianathan, Satyaseelan ; Yan, Weisi ; Pishgou, Mahboubeh ; Ma, John K. ; Shaaban, Sherif G. ; Marchan, Edward M. ; He, Rui ; Mobit, Paul N. ; Yang, Chunli Claus ; Vijayakumar, Srinivasan. / Reliable Radiation Technique to Minimize Ovarian Dose During Radiation Prophylaxis of Heterotopic Ossification. In: Anticancer research. 2017 ; Vol. 37, No. 12. pp. 6929-6935.
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abstract = "BACKGROUND/AIM: Scattered radiation during radiotherapy (RT) directed at the hip joint poses concerns about ovarian function in patients of reproductive age. Here, we report the impact of using a split-beam technique (SBT) and different photon energies on the total ovary dose during radiation prophylaxis of heterotopic ossification (HO).PATIENTS AND METHODS: This was a single-institution, retrospective study of 32-patients with traumatic acetabular fractures (TAF). All underwent surgery followed by CT-based-RT within 72 h in a single fraction of 700 cGy. Ipsilateral (IL) and contralateral (CL) ovaries (OV) were contoured separately and dose volume histograms (DVH) generated. Additional planning trials were created for each patient by utilizing a SBT medially and by using different photon energies (6-18 MV) to investigate the difference in ovary dose among these maneuvers.RESULTS: The median Mean-dose delivered to ILOV was 59 cGy and the median Max-dose was 177 cGy. CLOV median Mean-dose was 6 cGy and median Max-dose was 10 cGy. SBT at the medial edge of the field led to a 27{\%} and 22{\%} dose reduction in the median Mean and Max. doses, respectively, to ILOV; 9{\%} and 5{\%} reduction was seen in the median Mean and Max. doses, respectively, to CLOV. Higher photon energies (10-18 MV) led to an additional 28{\%} and 16 {\%} reduction in median Mean and Max. doses, respectively, to ILOV when compared to those from 6 MV. The CLOV median Mean dose was reduced by 18{\%} and the Max. dose was reduced by 12{\%}.CONCLUSION: A biologically significant radiation dose is delivered to the ovaries during HO radiation prophylaxis at the hip joints. Ipsilateral ovarian dose could be reduced by half and contralateral by one-quarter by using CT-based treatment planning with a medial SBT and photon energies above 6 MV. We suggest using no more than 10 MV to minimize neutron contamination. Those techniques should be the standard of care as it provides a reliable method for minimizing the radiation dose to the ovaries, consequently, maximizing female fertility preservation during HO radiation prophylaxis. All female patients in childbearing age should be fully informed about ovarian radiation exposure and possible temporary alteration in ova production and morphology.",
keywords = "Radiation therapy (RT), acetabular fracture, heterotopic ossification (HO), indomethacin, megavoltage photon, ovarian dose, radiation prophylaxis, split-beam technique",
author = "Mourad, {Waleed Fouad} and Satyaseelan Packianathan and Weisi Yan and Mahboubeh Pishgou and Ma, {John K.} and Shaaban, {Sherif G.} and Marchan, {Edward M.} and Rui He and Mobit, {Paul N.} and Yang, {Chunli Claus} and Srinivasan Vijayakumar",
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AU - Mourad, Waleed Fouad

AU - Packianathan, Satyaseelan

AU - Yan, Weisi

AU - Pishgou, Mahboubeh

AU - Ma, John K.

AU - Shaaban, Sherif G.

AU - Marchan, Edward M.

AU - He, Rui

AU - Mobit, Paul N.

AU - Yang, Chunli Claus

AU - Vijayakumar, Srinivasan

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N2 - BACKGROUND/AIM: Scattered radiation during radiotherapy (RT) directed at the hip joint poses concerns about ovarian function in patients of reproductive age. Here, we report the impact of using a split-beam technique (SBT) and different photon energies on the total ovary dose during radiation prophylaxis of heterotopic ossification (HO).PATIENTS AND METHODS: This was a single-institution, retrospective study of 32-patients with traumatic acetabular fractures (TAF). All underwent surgery followed by CT-based-RT within 72 h in a single fraction of 700 cGy. Ipsilateral (IL) and contralateral (CL) ovaries (OV) were contoured separately and dose volume histograms (DVH) generated. Additional planning trials were created for each patient by utilizing a SBT medially and by using different photon energies (6-18 MV) to investigate the difference in ovary dose among these maneuvers.RESULTS: The median Mean-dose delivered to ILOV was 59 cGy and the median Max-dose was 177 cGy. CLOV median Mean-dose was 6 cGy and median Max-dose was 10 cGy. SBT at the medial edge of the field led to a 27% and 22% dose reduction in the median Mean and Max. doses, respectively, to ILOV; 9% and 5% reduction was seen in the median Mean and Max. doses, respectively, to CLOV. Higher photon energies (10-18 MV) led to an additional 28% and 16 % reduction in median Mean and Max. doses, respectively, to ILOV when compared to those from 6 MV. The CLOV median Mean dose was reduced by 18% and the Max. dose was reduced by 12%.CONCLUSION: A biologically significant radiation dose is delivered to the ovaries during HO radiation prophylaxis at the hip joints. Ipsilateral ovarian dose could be reduced by half and contralateral by one-quarter by using CT-based treatment planning with a medial SBT and photon energies above 6 MV. We suggest using no more than 10 MV to minimize neutron contamination. Those techniques should be the standard of care as it provides a reliable method for minimizing the radiation dose to the ovaries, consequently, maximizing female fertility preservation during HO radiation prophylaxis. All female patients in childbearing age should be fully informed about ovarian radiation exposure and possible temporary alteration in ova production and morphology.

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KW - indomethacin

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KW - radiation prophylaxis

KW - split-beam technique

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