MAASTRO applicator, a novel rectal applicator for contact brachytherapy with 192Ir HDR sources

Abstract

Purpose or Objective: The standard care for rectal cancer includes surgery, which may be avoided if complete response is achieved, e.g. with chemoradiotherapy (EBCRT) or external beam radiotherapy EBRT, adopting a watch and wait strategy. Studies report a local regrowth reduction from 30% (EBCRT alone) to 11% when EBCRT is associated with a radiation boost using 50 kV x-rays (CXB), technique that allows a high dose delivery to a highly selective volume, allowing preservation of organs at risk (OAR) and low toxicity. However, CXB is not widely adopted due to its low costeffectiveness. Hence, the MAASTRO applicator was developed to deliver a dose distribution similar to those generated by CXB devices, but using HDR 192Ir sources, as a cost-effective alternative to CXB, with possibility of integration to treatment planning systems (TPS). Material and Methods: Fig 1-a shows the applicator design, a cylindrical applicator with 5 channels and a slanted edge, using its tip. Results: Due to the applicator geometry, the most distal position of the source in each channel doesn’t reach the sharp edge of the applicator, resulting in an effective treatment surface (high dose region shown in Fig 1 a and b) of approximately 20 x 20 mm2, which is smaller than the contact surface. The resulting dose falloff is steeper than the one resulting from the P50 with a 22 mm applicator. With the dose falloff normalized at 2mm, the relative dose values delivered at depths of 0, 2, 5 and 10 mm are, respectively, 130, 100, 70 and 43% for the P50 and 140, 100, 67 and 38% for the applicator. The time required to deliver an average dose of 32 Gy to the treatment surface of the applicator is 5m30s for a 40700 U source (new source) and 8m30s for a 20350 U source (source to be replaced), including the time required to perform obstruction verification before irradiation. The applicator delivers a high dose to a small target volume while the lateral shielding spares normal tissues in all directions other than the contact surface. Conclusion: The MAASTRO applicator was designed to deliver dose distributions similar to those of CXB devices using 192Ir HDR sources. The applicator has the advantage of TPS integration, increasing the degrees of freedom to modulate the dose distribution.