Dosimetric and treatment planning considerations for radiotherapy of the chest wall

Radiotherapy treatment planning calculations of the chest wall are complex due to missing tissue, the thin chest wall and the presence of lung. The accuracy of calculated dose is dependent on the type of algorithm employed. This work evaluates a collapsed cone (CC) and a pencil beam (PB) convolution model for radiotherapy planning of the chest wall. Various irradiation geometries simulating the chest wall have been examined and calculations were compared with measurements with an ionization chamber in epoxy resin water substitute and in low-density lung substitute blocks. A retrospective treatment planning study comprising 6 patients was carried out to evaluate the differences in the dose distributions and monitor units predicted by the two algorithms. The calculated dose in unit density medium was within +/-1% for the CC model and up to +/-2% for PB. In low density medium and under full scatter conditions, CC overestimated the dose by 1% whereas PB overestimated the dose by 9%. In the tangential irradiation geometry with water and lung media, the PB overestimated dose to the isocentre by up to 10%, whereas the dose from CC was within 3%. From the treatment planning study calculated monitor units (MU) and doses were consistent with the experimental findings. The CC model is more accurate for radiotherapy treatment planning of the chest wall and especially when there is significant involvement of lung tissue.