An erratum to this article can be found at http://dx.doi.org/10.1186/s13014-015-0565-7.
An erratum to this article is available at http://dx.doi.org/10.1186/s13014-015-0565-7.
The authors report no conflicts of interest in this work.
LS conceived and organized the study, with some input from OS and JPS. SS, FC and AP carried out the measurements. SS, FC, AP, JL, AD and LC were responsible for data analysis and interpretation. FC, SS and LS reviewed the literature. SS and FC drafted the first version of the manuscript. AP, JL, AD, LC, OS, JPS and LS revised the manuscript critically for important intellectual content. All authors read and approved the final manuscript.
Surgery of locally advanced and/or recurrent rectal cancer can be complemented with intra-operative electron radiation therapy (IOERT) to deliver a single dose of radiation directly to the unresectable margins, while sparing nearby sensitive organs/structures. Haemorrhages may occur and can affect the dose distribution, leading to an incorrect target irradiation. The TachoSil (TS) surgical patch, when activated, creates a fibrin clot at the surgical site to achieve haemostasis. The aim of this work was to determine the effect of TS on the dose distribution, and ascertain whether it could be used in combination with IOERT. This characterization was extended to include high dose rate (HDR) intraoperative brachytherapy, which is sometimes used at other institutions instead of IOERT.
CT images of the TS patch were acquired for initial characterization. Dosimetric measurements were performed in a water tank phantom, using a conventional LINAC with a hard-docking system of cylindrical applicators. Percentage Depth Dose (PDD) curves were obtained, and measurements made at the depth of dose maximum for the three clinically used electron energies (6, 9 and 12MeV), first without any attenuator and then with the activated patch of TS completely covering the tip of the IOERT applicator. For HDR brachytherapy, a measurement setup was improvised using a solid water phantom and a Farmer ionization chamber.
Our measurements show that the attenuation of a TachoSil patch is negligible, both for high energy electron beams (6 to 12MeV), and for a HDR 192Ir brachytherapy source. Our results cannot be extrapolated to lower beam energies such as 50 kVp X-rays, which are sometimes used for breast IORT.
The TachoSil surgical patch can be used in IORT procedures using 6MeV electron energies or higher, or HDR 192Ir brachytherapy.
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Palta JR, Biggs PJ, Hazle JD, Huq MS, Dahl RA, Ochran TG, et al. Intraoperative electron beam radiation therapy: technique, dosimetry, and dose specification: report of task force 48 of the radiation therapy committee, american association of physicists in medicine. Int J Radiat Oncol Biol Phys. 1995;33:725–46. CrossRefPubMed
- Attenuation measurements show that the presence of a TachoSil surgical patch will not compromise target irradiation in intra-operative electron radiation therapy or high-dose-rate brachytherapy
José Pedro Silva
- BioMed Central
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