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Open Access Research

Novel low-kVp beamlet system for choroidal melanoma

Carlos Esquivel12*, Clifton D Fuller23, Robert G Waggener23, Adrian Wong34, Martin Meltz23, Melissa Blough12, Tony Y Eng3 and Charles R Thomas5

Author Affiliations

1 Cancer Therapy and Research Center, San Antonio, TX, USA

2 Graduate Division of Radiological Sciences, Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

3 Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

4 Department of Diagnostic and Interventional Imaging, University of Texas Health Science at Houston, Houston, TX, USA

5 Department of Radiation Medicine, Oregon Health & Science University, Portland, OR, USA

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Radiation Oncology 2006, 1:36  doi:10.1186/1748-717X-1-36

Published: 11 September 2006

Abstract

Background

Treatment of choroidal melanoma with radiation often involves placement of customized brachytherapy eye-plaques. However, the dosimetric properties inherent in source-based radiotherapy preclude facile dose optimization to critical ocular structures. Consequently, we have constructed a novel system for utilizing small beam low-energy radiation delivery, the Beamlet Low-kVp X-ray, or "BLOKX" system. This technique relies on an isocentric rotational approach to deliver dose to target volumes within the eye, while potentially sparing normal structures.

Methods

Monte Carlo N-Particle (MCNP) transport code version 5.0(14) was used to simulate photon interaction with normal and tumor tissues within modeled right eye phantoms. Five modeled dome-shaped tumors with a diameter and apical height of 8 mm and 6 mm, respectively, were simulated distinct positions with respect to the macula iteratively. A single fixed 9 × 9 mm2 beamlet, and a comparison COMS protocol plaque containing eight I-125 seeds (apparent activity of 8 mCi) placed on the scleral surface of the eye adjacent to the tumor, were utilized to determine dosimetric parameters at tumor and adjacent tissues. After MCNP simulation, comparison of dose distribution at each of the 5 tumor positions for each modality (BLOKX vs. eye-plaque) was performed.

Results

Tumor-base doses ranged from 87.1–102.8 Gy for the BLOKX procedure, and from 335.3–338.6 Gy for the eye-plaque procedure. A reduction of dose of at least 69% to tumor base was noted when using the BLOKX. The BLOKX technique showed a significant reduction of dose, 89.8%, to the macula compared to the episcleral plaque. A minimum 71.0 % decrease in dose to the optic nerve occurred when the BLOKX was used.

Conclusion

The BLOKX technique allows more favorable dose distribution in comparison to standard COMS brachytherapy, as simulated using a Monte Carlo iterative mathematical modeling. Future series to determine clinical utility of such an approach are warranted.