Clinical modeling and validation of breast tissue expander metallic ports in a commercial treatment planning system for proton therapy.

Purpose To validate breast tissue expander metallic port (MP) models in a commercial treatment planning system (TPS) in proton pencil beam scanning (PBS) treatments for breast cancer patients with breast tissue expanders. Methods and materials Three types of MPs taken out of a Mentor CPX4, a Natrelle 133, and a PMT Integra breast tissue expanders and a 650cc saline filled Mentor CPX4 expander were placed on top of acrylic slabs, and scanned using a Siemens Somatom Definition AS Open RT CT scanner. Structure templates for each of the MPs were designed within Eclipse TPS. The CT numbers for the metallic parts were overridden to reflect measured or calculated relative proton stopping powers (RPSPs). Mock targets were contoured in acrylic to represent post-mastectomy chest-wall radiation therapy (PMRT) targets. Plans with different beam incident angles were optimized using the Eclipse TPS to deliver uniform prescription dose to the target using Hitachi Probeat-V PBS beams. Eclipse calculated doses and an in-house Monte Carlo (MC) code calculated doses were compared to the measured Gafchromic EBT3 film doses in acrylic. Results TPS/MC and film dose comparison results showed that: 1) 3%/2mm/10% threshold Gamma pass rates were better than 90.8% in the acrylic target region for all plans; 2) comparing TPS and film doses for the individual beam plans in the MP dose shadow areas, the area with dose difference above 5% ((ΔA)5%) ranged from 1.1cm2 to 5.0cm2 , and the maximum dose difference ((ΔD)0.01cm2 ) ranged from 12.5% to 25.0%; 3) comparing MC and film doses for the individual beam plans in the MP dose shadow areas, the (ΔA)5% varied from 1.1cm2 to 2.9cm2 and (ΔD)0.01cm2 varied from 8.5% to 24.2%; 4) for a plan composed of three individual beams treating through the Mentor CPX4 expander, the TPS (ΔA)5% was less than 0.13cm2 , and the (ΔD)0.01cm2 was less than 6% in the MP dose shadow areas. Conclusions It is feasible to treat patients with tissue expanders using multiple PBS beams using a structure template with CT number overridden to represent the measured/calculated RPSP for MPs for PBS treatment planning. MC dose was more accurate than analytical dose in the areas with high dose gradient caused by the density heterogeneity of the breast tissue expander MPs. This article is protected by copyright. All rights reserved.