The effect of metallic tracheal stents on radiation dose in the airway and surrounding tissues

Evans, Andrew; Lee, David Y.; Jain, Anudh K.; Razi, Syed S.; Park, Koji; Schwartz, Gary S.; Trichter, F.; Ostenson, Jason; Sasson, Jordan; Bhora, Faiz Y.

doi:10.1016/j.jss.2014.01.013

Cited by 9 publications

(8 citation statements)

References 19 publications

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“…Especially in cases of esophageal and thyroid cancer with immediate resolution of symptoms in 100% of patients with improvement in FEV1 by 10% compared to preoperative value, no intraoperative complications or death were reported, with good tumor within the stent and stent migration in 8.3% [10]. The effect on patients receiving radiotherapy is not well studied, however in porcine models the radiation dose to the airway and adjacent tissues is not affected [11].…”

Section: Use Of Metal Stentsmentioning

confidence: 99%

Emergency Surgical Treatment of Upper Airway Obstruction in Oncological Patients: Bibliographic Review and Proposal for Management Algorithm

J¹,

Gómez‐Pedraza²,

Granados-García³

et al. 2018

Head Neck Cancer Res

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Introduction:Tracheostomy is an emergency procedure; however, 85% of cases are due to malignant neoplasms. For different types of neoplasia, till date there are no algorithms in literatures for the management of airway obstruction. Objective of the study:To Generate an algorithm for the management of airway obstruction in head and neck cancer patients.Material and methods: An exhaustive bibliographical search was carried out in PubMed database with the MeSH terms "malignant airway obstruction/surgery", "airway obstruction/etiology", "airway management/ standards". Patients with airway obstruction and its management that included cancer were studied, the most outstanding authors in the subject were identified through the Science Citation Index and the exchange of information was carried out with specialists in the subject. A total of 344 articles were found to be reviewed, of which 11 articles addressing obstruction in the cancer patient were selected for review.Results: A management algorithm is created combining the oncological characteristics of the patient (type of tumor, clinical status, functional status, treatment) anesthetic management as well as surgical treatment.Patients with airway obstruction that can be intubated are preferred cytoreduction with CO 2 and biopsy in case of cancer of the larynx, oropharynx or oral cavity; if the patient cannot be intubated, supraglottic devices or facial mask can be used. In case of failure, cricothyrotomy is performed. Once the airway is controlled, the tracheostomy is performed; complementary treatment specifications are made in the different types of tumors (larynx, thyroid, oral cavity and oropharynx).Discussion: Creating a management algorithm is of vital importance since everything is not resolved with "tracheostomy". For decision making, there are no data available in other literature that groups all the oncological head and neck disorders. Therefore, a management algorithm is proposed based on the bibliographic review and the exchange of information with specialists in head and neck cancer. Conclusion:We propose a management algorithm based on the characteristics of the patients and tumor with the current anesthetic management.

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Section: Use Of Metal Stentsmentioning

confidence: 99%

Emergency Surgical Treatment of Upper Airway Obstruction in Oncological Patients: Bibliographic Review and Proposal for Management Algorithm

J¹,

Gómez‐Pedraza²,

Granados-García³

et al. 2018

Head Neck Cancer Res

View full text Add to dashboard Cite

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“…The dose perturbation for the photon beam is primarily due to secondary electrons and scattering caused by the metallic components within the stent [7]. Metal stents developed using nitinol, an alloy of nickel and titanium, have been clinically tested and are the most widely used [7,8,10,13,14]. Even in proton therapy, the dose perturbations caused by metal stents will result in underdose and overdose in that part of the target volume containing the metal stent due to secondary electrons and multi-scattering.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Dose Perturbations for Metal Stent in Photon and Proton Radiotherapy Plans for Hepatocellular Carcinoma

Lee

Cho

Park

et al. 2022

Preprint

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Background: The present study aimed to investigate the dosimetric impact of metal stent for photon and proton treatment plans in hepatocellular carcinoma.Methods: Dose perturbation caused by a metal stent included in the photon and proton treatment of hepatocellular carcinoma was evaluated with comparing Eclipse and RayStation treatment planning system (TPS) to Monte Carlo (MC). Photon and proton plans were created using anterior-posterior/posterior-anterior (AP/PA) fields using a 6 MV beam and AP/PA fields of a wobbling beam using 150 MeV and a 10 cm ridge filter. The difference in dose distributions and dosimetric parameters were compared depending on the stent's positions (the bile duct (GB) and the intestinal tract (GI)) and angles (0°, 45°, and 90°). In addition, the dose variation in the target volume including the stent was comparatively evaluated through dose volume histogram (DVH) analysis.Results: The percentage differences in the dosimetric parameters calculated by MC ranged from -7.0 to 3.9% for the photon beam and -33.7% to 4.3% for the proton beam, depending on the angle at which the GB and GI stents were placed. A maximum difference was observed at the minimum dose (Dmin), which was shown in both photon and proton plans in the GB and GI stents deployed at an incidence angle of 90°. The differences in these parameters were greater in the proton plan than in photon plan. The target volume showed various dose variations depending on positions and angles of stent for both beams. Compared with the no-stent, the doses within the target volume containing the GI and GB stents for the photon beam were overestimated in the high-dose area at 0°, nearly equal within 1% at 45°, and underestimated at 90°. These doses to the proton beam were underestimated at all angles, and the amount of underdose to the target volume increased with the increase of the stent’s angle. However, the difference was much greater with the proton plan than with the photon plan.Conclusions: Dose perturbations within the target volume due to the presence of the metal stent were not observed in the TPS calculations for photon and proton beams, but MC were used to confirm that there are the dose variation within the target volume. The MC results found that delivery of the treatment beam avoiding the stent was the best method to prevent underdose of the target volume.

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“…The dose perturbation for the photon beam is primarily due to secondary electrons and scattering caused by the metallic components within the stent [ 7 ]. Metal stents developed using nitinol, an alloy of nickel and titanium, have been clinically tested and are the most widely used [ 7 , 8 , 10 , 13 , 14 ]. Especially in proton therapy, the dose perturbations caused by metal stents will result in an underdose and overdose in that part of the target volume containing the metal stent due to secondary electrons and multi-scattering.…”

Section: Introductionmentioning

confidence: 99%

Assessment of dose perturbations for metal stent in photon and proton radiotherapy plans for hepatocellular carcinoma

et al. 2022

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Background The present study aimed to investigate the dosimetric impact of metal stent for photon and proton treatment plans in hepatocellular carcinoma. Methods With computed tomography data of a water-equivalent solid phantom, dose perturbation caused by a metal stent included in the photon and proton treatment of hepatocellular carcinoma was evaluated by comparing Eclipse and RayStation treatment planning system (TPS) to a Monte Carlo (MC) based dose calculator. Photon and proton plans were created with anterior–posterior/posterior-anterior (AP/PA) fields using a 6 MV beam and AP/PA fields of a wobbling beam using 150 MeV and a 10 cm ridge filter. The difference in dose distributions and dosimetric parameters were compared depending on the stent's positions (the bile duct (GB) and intestinal tract (GI)) and angles (0°, 45°, and 90°). Additionally, the dose variation in the target volume including the stent was comparatively evaluated through dose volume histogram (DVH) analysis. And the comparison of clinical cases was carried out in the same way. Results Percentage differences in the dosimetric parameters calculated by MC ranged from − 7.0 to 3.9% for the photon plan and − 33.7 to 4.3% for the proton plan, depending on the angle at which the GB and GI stents were placed, compared to those without the stent. The maximum difference was observed at the minimum dose (Dmin), which was observed in both photon and proton plans in the GB and GI stents deployed at a 90° incidence angle. The parameter differences were greater in the proton plan than in photon plan. The target volume showed various dose variations depending on positions and angles of stent for both beams. Compared with no-stent, the doses within the target volume containing the GI and GB stents for the photon beam were overestimated in the high-dose area at 0°, nearly equal within 1% at 45°, and underestimated at 90°. These doses to the proton beam were underestimated at all angles, and the amount of underdose to the target volume increased with an increase in the stent angle. However, the difference was significantly greater with the proton plan than the photon plan. Conclusions Dose perturbations within the target volume due to the presence of the metal stent were not observed in the TPS calculations for photon and proton beams, but MC was used to confirm that there are dose variations within the target volume. The MC results found that delivery of the treatment beam avoiding the stent was the best method to prevent target volume underdose.

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The effect of metallic tracheal stents on radiation dose in the airway and surrounding tissues

Cited by 9 publications

References 19 publications

Emergency Surgical Treatment of Upper Airway Obstruction in Oncological Patients: Bibliographic Review and Proposal for Management Algorithm

Emergency Surgical Treatment of Upper Airway Obstruction in Oncological Patients: Bibliographic Review and Proposal for Management Algorithm

Assessment of Dose Perturbations for Metal Stent in Photon and Proton Radiotherapy Plans for Hepatocellular Carcinoma

Assessment of dose perturbations for metal stent in photon and proton radiotherapy plans for hepatocellular carcinoma

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