Inverse planning of energy-modulated electron beams in radiotherapy

The use of megavoltage electron beams often poses a clinical challenge in that the planning target volume (PTV) is anterior to other radiosensitive structures and has variable depth. To ensure that skin as well as the deepest extent of the PTV receives the prescribed dose entails prescribing to a point beyond the depth of peak dose for a single electron energy. This causes dose inhomogeneities and heightened potential for tissue fibrosis, scarring, and possible soft tissue necrosis. Use of bolus on the skin improves the entrant dose at the cost of decreasing the therapeutic depth that can be treated. Selection of a higher energy to improve dose homogeneity results in increased dose to structures beyond the PTV, as well as enlargement of the volume receiving heightened dose. Measured electron data from a linear accelerator was used as input to create an inverse planning tool employing energy and intensity modulation using bolus (e-IMRT™). Using tools readily available in a radiotherapy department, the applications of energy and intensity modulation on the central axis makes it possible to remove hot spots of 115% or more over the depths clinically encountered. The e-IMRT™ algorithm enables the development of patient-specific dose distributions with user-defined positions of peak dose, range, and reduced dose to points beyond the prescription point.