Dosimetric properties of megavoltage grid therapy

Purpose: Grid therapy is a technique used to deliver a high dose of radiation (15-20 Gy) in a single fraction to many small volumes within a large treatment field. This treatment modality is used for the palliative treatment of large, deeply seated tumors, which have either been treated to tolerance with conventional radiation, or, due to massive tumor bulk, would most likely not benefit from a conventional course of radiation therapy. As the dose distribution from megavoltage grid therapy differs significantly from that of conventional radiation therapy (i.e., many large dose gradients exist within the tumor volume), we have measured various dosimetric properties inherent in this unique treatment modality. Methods and Materials: The grid is a 16 x 16 array of 1-cm diameter holes in a 7-cm thick piece of custom blocking material. The ratio of shielded to open surface area is 1:1. Depth dose, valley-to-peak ratios, and output factors for this square array grid were measured in a water phantom for several field sizes, as well as for a 1-cm diameter narrow beam using 6 MV and 25 MV photon beams. Results: The depth dose curves for the grid fields lie between those for an open portal and a narrow beam. For the 6-MV beam at dmax, the ratios of the doses delivered to the center of the shielded regions to that under the center of the holes, expressed as valley-to-peak ratios, range from 15 to 40%. At 10 cm, the ratios increase to between 25 and 45%. At 25 MV at both dmax and 10 cm, the valley-to-peak ratios are between 40 and 60%. The output factors, 0.89 for 6 MV and 0.77 for 25 MV, do not depend on field size. Conclusion: Megavoltage grid therapy is a unique treatment modality where the dose is delivered differentially to a large volume in one fraction. Characterization of the dosimetric properties has allowed clinical implementation of the grid