3D printed integrated bolus/headrest for radiation therapy for malignancies involving the posterior scalp and neck

Eric J Hsu; David Parsons; Tsuicheng Chiu; Andrew R Godley; David J Sher; Dat T Vo

doi:10.1186/s41205-022-00152-w

3D printed integrated bolus/headrest for radiation therapy for malignancies involving the posterior scalp and neck

3D Print Med. 2022 Jul 18;8(1):22. doi: 10.1186/s41205-022-00152-w.

Authors

Eric J Hsu¹, David Parsons², Tsuicheng Chiu², Andrew R Godley², David J Sher¹, Dat T Vo³

Affiliations

¹ Department of Radiation Oncology, Division of Clinical Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 75390, USA.
² Department of Radiation Oncology, Division of Medical Physics and Engineering, UT Southwestern Medical Center, Dallas, TX, 75390, USA.
³ Department of Radiation Oncology, Division of Clinical Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, 75390, USA. Dat.Vo@UTSouthwestern.edu.

Abstract

Background: Malignancies of the head and neck region, encompassing cutaneous, mucosal, and sarcomatous histologies, are complex entities to manage, comprising of coordination between surgery, radiation therapy, and systemic therapy. Malignancies of the posterior scalp are particular challenging to treat with radiation therapy, given its irregular contours and anatomy as well as the superficial location of the target volume. Bolus material is commonly used in radiation therapy to ensure that the dose to the skin and subcutaneous tissue is appropriate and adequate, accounting for the buildup effect of megavoltage photon treatment. The use of commercially available bolus material on the posterior scalp potentially creates air gaps between the bolus and posterior scalp.

Case presentations: In this report, we created and utilized a custom 3D-printed integrated bolus and headrest for 5 patients to irradiate malignancies involving the posterior scalp, including those with cutaneous squamous cell carcinoma, melanoma, malignant peripheral nerve sheath tumor, and dermal sarcoma. Treatment setup was consistently reproducible, and patients tolerated treatment well without any unexpected adverse effects.

Conclusions: We found that the use of this custom 3D-printed integrated bolus/headrest allowed for comfortable, consistent, and reproducible treatment set up while minimizing the risk of creating significant air gaps and should be considered in the radiotherapeutic management of patients with posterior scalp malignancies.

Keywords: 3D Printing; Bolus; Neck Malignancy; Radiation therapy; Scalp malignancy.