# Challenges in Radiotherapy for Mandibular Cancer With Titanium Implant Reconstruction: A Case Report

## TL;DR

This case report discusses the challenges and solutions in radiotherapy for a patient with mandibular cancer who had a 3D-printed titanium implant.

## Contribution

The paper highlights novel strategies for integrating 3D-printed titanium implants into radiotherapy treatment planning.

## Key findings

- Advanced techniques like VMAT and manual artifact correction helped manage imaging and dose issues from titanium implants.
- A multidisciplinary approach was essential for optimizing treatment and protecting healthy tissues.
- Combining new technology with collaborative care improves outcomes in complex head-and-neck cancer cases.

## Abstract

Mandibular cancer, a rare and aggressive malignancy, often requires extensive surgical resection followed by complex reconstruction. The advent of 3D-printed titanium implants has revolutionized mandibular reconstruction, offering precise anatomical restoration and improved functional outcomes. However, their integration into the radiotherapy workflow presents unique challenges, particularly in imaging and dose distribution.

This case report explores the management of a 71-year-old male with advanced mandibular squamous cell carcinoma, who underwent mandibular reconstruction using a custom 3D-printed titanium implant, followed by adjuvant radiotherapy. The challenges of imaging artifacts and dose perturbations caused by the titanium implant were addressed using advanced techniques, such as volumetric modulated arc therapy (VMAT) and manual artifact correction in the treatment planning system (TPS). A multidisciplinary approach, involving surgical, radiological, and radiotherapy teams, was crucial in optimizing treatment while minimizing damage to surrounding healthy tissues. This case underscores the importance of individualized treatment strategies and the need for ongoing research to refine protocols for integrating 3D-printed implants into radiotherapy. Ultimately, the combination of cutting-edge technology and collaborative care enhances patient outcomes and provides a model for managing complex head-and-neck oncology cases.