The Evaluation of Skin Toxicity during Brain Tumor Irradiation Dose Calculation

Abstract

Background: Radiotherapy is the keystone in brain tumor treatment, including posterior fossa tumors, and can achieve better patient health-related quality of life. Radiation exposure can be associated with the risk of skin radiation injuries. Accurate tumor and critical structure delineations and precise dose planning may improve the outcomes and decrease radiation complications. The objective of this study was to compare the influence of the headrest and treatment couch during dose planning, on the dose distributions and skin injury post irradiation. Material and Methods: Treatment planning calculations were performed for 14 brain tumor patients using the volumetric modulated arc therapy (VMAT) to study the dose distribution and dose-volume histograms (DVH). We compared the following three cases of general patient contours: patient body contour alone, body contour including the headrest, and body contour with headrest, couch and immobilization mask. The same configuration beams were used in all these cases; general patient contours alone were altered. Results: For dose estimations, the skin was delineated as a 2 mm layer beneath the patient’s body contour. The comparisons showed that the average dose on the skin, among all the patients included in this study, in the case of body contour alone is 3.3 Gy, whereas in the case of body contour with headrest, it is 6.3 Gy and in the case of body contour with headrest, couch and immobilization mask it is 9.4 Gy. Conclusion: For brain tumors, located in the posterior fossa and near the patient’s skin, the skin needed to be included as a critical structure. The skin dose should be considered when evaluating treatment plans, taking into account the bolus effect of the headrest and couch.