Inverse planning optimization with lead block effectively suppresses dose to the mandible in high-dose-rate brachytherapy for tongue cancer

PURPOSE: In this study, we developed in-house software to evaluate the effect of the lead block (LB)-inserted spacer on the mandibular dose in interstitial brachytherapy (ISBT) for tongue cancer. In addition, an inverse planning algorithm for LB attenuation was developed, and its performance in mandibular dose reduction was evaluated. METHODS: Treatment plans of 30 patients with tongue cancer treated with ISBT were evaluated. The prescribed dose was 54 Gy/9 fractions. An in-house software was developed to calculate the dose distribution based on the American Association of Physicists in Medicine (AAPM) Task Group No.43 (TG-43) formalism. The mandibular dose was calculated with consideration of the LB attenuation. The attenuation coefficient of the lead was computed using the PHITS Monte Carlo simulation. The software further optimized the treatment plans using an attraction–repulsion model (ARM) to account for the LB attenuation. RESULTS: Compared to the calculation in water, the D(2 cc) of the mandible changed by − 2.4 ± 2.3 Gy (range, − 8.6 to − 0.1 Gy) when the LB attenuation was considered. The ARM optimization with consideration of the LB resulted in a − 2.4 ± 2.4 Gy (range, − 8.2 to 0.0 Gy) change in mandibular D(2 cc). CONCLUSIONS: This study enabled the evaluation of the dose distribution with consideration of the LB attenuation. The ARM optimization with lead attenuation further reduced the mandibular dose.