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Mirzaei M, Rowshanfarzad P, Gill S, Ebert MA, Dass J. Risk of cardiac implantable device malfunction in cancer patients receiving proton therapy: an overview. Front Oncol 2023; 13:1181450. [PMID: 37469405 PMCID: PMC10352826 DOI: 10.3389/fonc.2023.1181450] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/12/2023] [Indexed: 07/21/2023] Open
Abstract
Age is a risk factor for both cardiovascular disease and cancer, and as such radiation oncologists frequently see a number of patients with cardiac implantable electronic devices (CIEDs) receiving proton therapy (PT). CIED malfunctions induced by PT are nonnegligible and can occur in both passive scattering and pencil beam scanning modes. In the absence of an evidence-based protocol, the authors emphasise that this patient cohort should be managed differently to electron- and photon- external beam radiation therapy (EBRT) patients due to distinct properties of proton beams. Given the lack of a PT-specific guideline for managing this cohort and limited studies on this important topic; the process was initiated by evaluating all PT-related CIED malfunctions to provide a baseline for future reporting and research. In this review, different modes of PT and their interactions with a variety of CIEDs and pacing leads are discussed. Effects of PT on CIEDs were classified into a variety of hardware and software malfunctions. Apart from secondary neutrons, cumulative radiation dose, dose rate, CIED model/manufacturer, distance from CIED to proton field, and materials used in CIEDs/pacing leads were all evaluated to determine the probability of malfunctions. The importance of proton beam arrangements is highlighted in this study. Manufacturers should specify recommended dose limits for patients undergoing PT. The establishment of an international multidisciplinary team dedicated to CIED-bearing patients receiving PT may be beneficial.
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Affiliation(s)
- Milad Mirzaei
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- Department of Medical Imaging and Radiation Sciences, School of Biomedical Sciences, Monash University, Clayton, VIC, Australia
| | - Pejman Rowshanfarzad
- School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, WA, Australia
| | - Suki Gill
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, WA, Australia
| | - Martin A. Ebert
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- School of Physics, Mathematics and Computing, The University of Western Australia, Crawley, WA, Australia
| | - Joshua Dass
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
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2
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Griffin KT, Yeom YS, Mille MM, Lee C, Jung JW, Hertel NE, Lee C. Comparison of out-of-field normal tissue dose estimates for pencil beam scanning proton therapy: MCNP6, PHITS, and TOPAS. Biomed Phys Eng Express 2022; 9:10.1088/2057-1976/acaab1. [PMID: 36562506 PMCID: PMC10772933 DOI: 10.1088/2057-1976/acaab1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 12/12/2022] [Indexed: 12/14/2022]
Abstract
Monte Carlo (MC) methods are considered the gold-standard approach to dose estimation for normal tissues outside the treatment field (out-of-field) in proton therapy. However, the physics of secondary particle production from high-energy protons are uncertain, particularly for secondary neutrons, due to challenges in performing accurate measurements. Instead, various physics models have been developed over the years to reenact these high-energy interactions based on theory. It should thus be acknowledged that MC users must currently accept some unknown uncertainties in out-of-field dose estimates. In the present study, we compared three MC codes (MCNP6, PHITS, and TOPAS) and their available physics models to investigate the variation in out-of-field normal tissue dosimetry for pencil beam scanning proton therapy patients. Total yield and double-differential (energy and angle) production of two major secondary particles, neutrons and gammas, were determined through irradiation of a water phantom at six proton energies (80, 90, 100, 110, 150, and 200 MeV). Out-of-field normal tissue doses were estimated for intracranial irradiations of 1-, 5-, and 15-year-old patients using whole-body computational phantoms. Notably, the total dose estimates for each out-of-field organ varied by approximately 25% across the three codes, independent of its distance from the treatment volume. Dose discrepancies amongst the codes were linked to the utilized physics model, which impacts the characteristics of the secondary radiation field. Using developer-recommended physics, TOPAS produced both the highest neutron and gamma doses to all out-of-field organs from all examined conditions; this was linked to its highest yields of secondary particles and second hardest energy spectra. Subsequent results when using other physics models found reduced yields and energies, resulting in lower dose estimates. Neutron dose estimates were the most impacted by physics model choice, and thus the variation in out-of-field dose estimates may be even larger than 25% when considering biological effectiveness.
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Affiliation(s)
- Keith T. Griffin
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Yeon Soo Yeom
- Department of Radiation Convergence Engineering, Yonsei University, Wonju, South Korea
| | - Matthew M. Mille
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Choonik Lee
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Jae Won Jung
- Department of Physics, East Carolina University, Greenville, NC, USA
| | - Nolan E. Hertel
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
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Zorloni G, Bosmans G, Brall T, Caresana M, De Saint-Hubert M, Domingo C, Ferrante C, Ferrulli F, Kopec R, Leidner J, Mares V, Nabha R, Olko P, Caballero-Pacheco MA, Rühm W, Silari M, Stolarczyk L, Swakon J, Tisi M, Trinkl S, Van Hoey O, Vilches-Freixas G. EURADOS REM-COUNTER INTERCOMPARISON AT MAASTRO PROTON THERAPY CENTRE: COMPARISON WITH LITERATURE DATA. RADIATION PROTECTION DOSIMETRY 2022; 198:1471-1475. [PMID: 36138419 DOI: 10.1093/rpd/ncac189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 06/27/2022] [Accepted: 08/29/2022] [Indexed: 06/16/2023]
Abstract
The Maastro Proton Therapy Centre is the first European facility housing the Mevion S250i Hyperscan synchrocyclotron. The proximity of the accelerator to the patient, the presence of an active pencil beam delivery system downstream of a passive energy degrader and the pulsed structure of the beam make the Mevion stray neutron field unique amongst proton therapy facilities. This paper reviews the results of a rem-counter intercomparison experiment promoted by the European Radiation Dosimetry Group at Maastro and compares them with those at other proton therapy facilities. The Maastro neutron H*(10) in the room (100-200 μSv/Gy at about 2 m from the isocentre) is in line with accelerators using purely passive or wobbling beam delivery modalities, even though Maastro shows a dose gradient peaked near the accelerator. Unlike synchrotron- and cyclotron-based facilities, the pulsed beam at Maastro requires the employment of rem-counters specifically designed to withstand pulsed neutron fields.
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Affiliation(s)
| | - Geert Bosmans
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Thomas Brall
- Helmholtz Zentrum München, Institute of Radiation Medicine, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Marco Caresana
- Department of Energy, Polytechnic of Milan, via Lambruschini 4, 20156 Milan, Italy
| | | | - Carles Domingo
- Departament de Física, Universitat Autònoma de Barcelona, E-08193 Bellaterra, Spain
| | - Christian Ferrante
- Department of Energy, Polytechnic of Milan, via Lambruschini 4, 20156 Milan, Italy
| | - Francesca Ferrulli
- CERN, 1211 Geneva 23, Switzerland
- University of Caen Normandy, 14032 Caen-5, France
| | - Renata Kopec
- Institute of Nuclear Physics PAN, Radzikowskiego 152, 31-342 Krakow, Poland
| | | | - Vladimir Mares
- Helmholtz Zentrum München, Institute of Radiation Medicine, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Racell Nabha
- Belgian Nuclear Research Center SCK CEN, 2400 Mol, Belgium
| | - Pawel Olko
- Institute of Nuclear Physics PAN, Radzikowskiego 152, 31-342 Krakow, Poland
| | | | - Werner Rühm
- Helmholtz Zentrum München, Institute of Radiation Medicine, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | | | - Liliana Stolarczyk
- Institute of Nuclear Physics PAN, Radzikowskiego 152, 31-342 Krakow, Poland
- The Danish Centre for Particle Therapy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 25, DK-8200 Aarhus, Denmark
| | - Jan Swakon
- Institute of Nuclear Physics PAN, Radzikowskiego 152, 31-342 Krakow, Poland
| | - Marco Tisi
- Helmholtz Zentrum München, Institute of Radiation Medicine, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - Sebastian Trinkl
- Federal Office for Radiation Protection, Medical and Occupational Radiation Protection, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | | | - Gloria Vilches-Freixas
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
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4
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Štika J, Jelínek Michaelidesová A, Davídková M. MONTE CARLO SIMULATIONS OF OUT-OF-FIELD LET SPECTRA IN WATER PHANTOM IRRADIATED BY SCANNING PENCIL PROTON BEAM. RADIATION PROTECTION DOSIMETRY 2022; 198:573-579. [PMID: 36005973 DOI: 10.1093/rpd/ncac139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/11/2022] [Accepted: 05/22/2022] [Indexed: 06/15/2023]
Abstract
LET spectra can be measured by track-etched detectors. However, these detectors are not able to identify the type of interacting particles. Monte Carlo simulations can provide this missing information. In this work, Monte Carlo simulations based on the EURADOS Work Group 9 experiment consisting of systematic 3D mapping of out-of-field doses and LET spectra in a prototype water phantom were performed. The simulations aimed to identify the types of particles contributing to the out-of-field LET spectra. The total absorbed dose, LET and energy spectra were calculated. The calculated dose distributions and LET spectra were compared with the ones measured by radiophotoluminiscence and track-etched detectors. The out-of-field particles and their LET values were identified. No statistically significant differences between the measured and simulated spectra were revealed in the LET range of 100-2000 keV μm-1.
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Affiliation(s)
- Jan Štika
- Department of Dosimetry and Application of Ionising Radiation, Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University in Prague, Břehová 7, 110 00 Praha 1, Czech Republic
- General University Hospital in Prague, U Nemocnice 499/2, 128 08 Praha 2, Czech Republic
| | - Anna Jelínek Michaelidesová
- Department of Dosimetry and Application of Ionising Radiation, Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University in Prague, Břehová 7, 110 00 Praha 1, Czech Republic
- Department of Radiation Dosimetry, Nuclear Physics Institute of the CAS, Na Truhlářce 39/64, 180 00 Praha 8, Czech Republic
| | - Marie Davídková
- Department of Radiation Dosimetry, Nuclear Physics Institute of the CAS, Na Truhlářce 39/64, 180 00 Praha 8, Czech Republic
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5
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Zhou J, Di Fulvio A, Beyer KA, Ferrarini M, Pullia M, Donetti M, Clarke SD, Pozzi SA. Angular distribution of neutron production by proton and carbon-ion therapeutic beams. Phys Med Biol 2020; 65:155002. [PMID: 32197258 DOI: 10.1088/1361-6560/ab81ca] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Carbon-ion beams are increasingly used in the clinical practice for external radiotherapy treatments of deep-seated tumors. At therapeutic energies, carbon ions yield significant secondary products, including neutrons, which may be of concern for the radiation protection of the patient and personnel. We simulated the neutron yield produced by proton and carbon-ion pencil beams impinging on a clinical phantom at three different angles: 15°, 45° and 90°, with respect to the beam axis. We validated the simulated results using the measured response of organic scintillation detectors. We compared the results obtained with FLUKA 2011.2 and MCNPX 2.7.0 based on three different physics models: Bertini, Isabel, and CEM. Over the different ions, energies, and angles, the FLUKA simulation results agree better with the measured data, compared to the MCNPX results. Simulations of carbon ions at low angles exhibit both the highest deviation from measured data and inter-model discrepancy, which is probably due to the different treatment of the pre-equilibrium stage. The reported neutron yield results could help in the comparison of carbon-ion and proton treatments in terms of secondary neutron production for radiation protection applications.
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Affiliation(s)
- J Zhou
- Department of Nuclear, Plasma and Radiological Engineering, University of Illinois at Urbana-Champaign, 104 South Wright Street Urbana, IL 61801-2957, United States of America
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Komori M, Takeuchi A, Niwa M, Harada T, Oguchi H. OPTIMIZATION OF AN ADDITIONAL COLLIMATOR IN A BEAM DELIVERY SYSTEM FOR REDUCTION OF THE SECONDARY NEUTRON EXPOSURE IN PASSIVE CARBON-ION THERAPY. RADIATION PROTECTION DOSIMETRY 2019; 184:28-35. [PMID: 30339247 DOI: 10.1093/rpd/ncy182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/17/2018] [Accepted: 10/04/2018] [Indexed: 06/08/2023]
Abstract
The aim of this work is to optimize an additional collimator in a beam delivery system to reduce neutron exposure to patients in passive carbon-ion therapy. All studies were performed by Monte Carlo simulation assuming the beam delivery system at Heavy-Ion Medical Accelerator in Chiba. We calculated the neutron ambient dose equivalent at patient positions with an additional collimator, and optimized the position, aperture size and material of the collimator to reduce the neutron ambient dose equivalent. The collimator located 125 and 470 cm upstream from the isocenter could reduce the dose equivalent near the isocenter by 35%, while the collimator located 813 cm upstream from the isocenter was ineffective. As for the material of the collimator, iron and nickel could conduct reduction slightly better than aluminum and polymethyl methacrylate. The additional collimator is an effective method for the reduction of the neutron ambient dose equivalent near the isocenter.
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Affiliation(s)
- Masataka Komori
- Department of Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya, Japan
| | - Akihiko Takeuchi
- Department of Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya, Japan
| | - Maiko Niwa
- Department of Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya, Japan
| | - Takaomi Harada
- Department of Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya, Japan
| | - Hiroshi Oguchi
- Department of Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya, Japan
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7
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Chiriotti S, Parisi A, Vanhavere F, De Saint-Hubert M, Vandevoorde C, Slabbert J, Beukes P, de Kock E, Symons J. MICRODOSIMETRIC MEASUREMENT OF SECONDARY RADIATION IN THE PASSIVE SCATTERED PROTON THERAPY ROOM OF iTHEMBA LABS USING A TISSUE-EQUIVALENT PROPORTIONAL COUNTER. RADIATION PROTECTION DOSIMETRY 2018; 182:252-257. [PMID: 29669096 DOI: 10.1093/rpd/ncy056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 03/22/2018] [Indexed: 06/08/2023]
Abstract
Measurements of the dose equivalent at different distances from the isocenter of the proton therapy center at iThemba LABS were previously performed with a tissue-equivalent proportional counter (TEPC). These measurements showed that the scattered radiation levels were one or two orders of magnitude higher in comparison to other passive scattering delivery systems. In order to reduce these radiation levels, additional shielding was installed shortly after the measurements were done. Therefore, the aim of this work is to quantify and assess the reduction of the secondary doses delivered in the proton therapy room at iThemba LABS after the installation of the additional shielding. This has been performed by measuring microdosimetric spectra with a TEPC at 11 locations around the isocenter when a clinical modulated beam of 200 MeV proton was impinging onto a water phantom placed at the isocenter.
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Affiliation(s)
- S Chiriotti
- Belgian Nuclear Research Centre, SCK•CEN, Boeretang 200, Mol, Belgium
| | - A Parisi
- Belgian Nuclear Research Centre, SCK•CEN, Boeretang 200, Mol, Belgium
| | - F Vanhavere
- Belgian Nuclear Research Centre, SCK•CEN, Boeretang 200, Mol, Belgium
| | - M De Saint-Hubert
- Belgian Nuclear Research Centre, SCK•CEN, Boeretang 200, Mol, Belgium
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Kim DH, Park S, Jo K, Cho S, Shin E, Lim DH, Pyo H, Han Y, Suh TS. Investigations of line scanning proton therapy with dynamic multi-leaf collimator. Phys Med 2018; 55:47-55. [DOI: 10.1016/j.ejmp.2018.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/08/2018] [Accepted: 10/08/2018] [Indexed: 02/07/2023] Open
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Lee S, Lee C, Shin EH, Cho S, Kim DH, Han Y, Choi DH, Ye SJ, Kim JS. MEASUREMENT OF NEUTRON AMBIENT DOSE EQUIVALENT IN PROTON RADIOTHERAPY WITH LINE-SCANNING AND WOBBLING MODE TREATMENT SYSTEM. RADIATION PROTECTION DOSIMETRY 2017; 177:382-388. [PMID: 28444374 DOI: 10.1093/rpd/ncx056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 04/07/2017] [Indexed: 06/07/2023]
Abstract
The primary objective of this study was to measure secondary neutron dose during proton therapy using a detector that covers the entire neutron energy range produced in proton therapy. We analyzed and compared the neutron dose during proton treatment with passive scattering and line scanning. The neutron ambient dose equivalents were measured with a 190 MeV wobbling and line-scanning proton beam. The center of a plastic water phantom (30 × 30 × 60 cm3) was placed at the isocenter. A Wide-Energy Neutron Detection Instrument (WENDI-2) was located 1m from the isocenter at four different angles (0°, 45°, 90° and 135°). Both wobbling and line-scanning modes of a multipurpose and pencil beam scanning dedicated nozzles were used to obtain a spread-out Bragg peak with 10-cm-width for the measurements. The ambient dose equivalent H*(10) value was normalized by the proton therapeutic dose at the isocenter. For wobbling mode and line-scanning mode, the highest H*(10) values were 1.972 and 0.099 mSv/Gy, respectively. We successfully measured the neutron ambient dose equivalents at six positions generated by a 190 MeV proton beam using wobbling and line-scanning mode with the WENDI-2. These reference data could be used for neutron dose reduction methods and other analysis for advanced proton treatment in the near future.
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Affiliation(s)
- Sangmin Lee
- Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul 16229, Republic of Korea
| | - Chaeyeong Lee
- Department of Radiological Science, Yonsei University, Wonju 26493, Republic of Korea
| | - Eun Hyuk Shin
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Sungkoo Cho
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Dae-Hyun Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Youngyih Han
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Doo Ho Choi
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Sung-Joon Ye
- Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul 16229, Republic of Korea
| | - Jin Sung Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
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Nichols RC, Hu C, Bahary JP, Zeitzer KL, Souhami L, Leibenhaut MH, Rotman M, Gore EM, Balogh AG, McGowan D, Michalski J, Raben A, Rudoler S, Jones CU, Sandler H. Serum testosterone changes in patients treated with radiation therapy alone for prostate cancer on NRG oncology RTOG 9408. Adv Radiat Oncol 2017; 2:608-614. [PMID: 29204528 PMCID: PMC5707413 DOI: 10.1016/j.adro.2017.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/27/2017] [Accepted: 07/12/2017] [Indexed: 12/02/2022] Open
Abstract
Objectives We reviewed testosterone changes for patients who were treated with radiation therapy (RT) alone on NRG oncology RTOG 9408. Methods and materials Patients (T1b-T2b, prostate-specific antigen <20 ng/mL) were randomized between RT alone and RT plus 4 months of androgen ablation. Serum testosterone (ST) levels were investigated at enrollment, RT completion, and the first follow-up 3 months after RT. The Wilcoxon signed rank test was used to compare pre- and post-treatment ST levels in patients who were randomized to the RT-alone arm. Results Of 2028 patients enrolled, 992 patients were randomized to receive RT alone and 917 (92.4%) had baseline ST values available and completed RT. Of these 917 patients, immediate and 3-month post-RT testosterone levels were available for 447 and 373 patients, respectively. Excluding 2 patients who received hormonal therapy off protocol after RT, 447 and 371 patients, respectively, were analyzed. For all patients, the median change in ST values at completion of RT and at 3-month follow-up were −30.0 ng/dL (p5-p95; −270.0 to 162.0; P < .001) and −34.0 ng/dL (p5-p95, −228.0 to 160.0; P < .01), respectively. Conclusion RT for prostate cancer was associated with a median 9.2% decline in ST at completion of RT and a median 9.3% decline 3 months after RT. These changes were statistically significant.
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Affiliation(s)
| | - Chen Hu
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania.,Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jean-Paul Bahary
- Centre Hospitalier de l'Université de Montréal-Notre Dame, Montreal, Quebec, Canada
| | | | | | | | | | - Elizabeth M Gore
- Medical College of Wisconsin and Zablocki VA Medical Center, Milwaukee, Wisconsin
| | | | | | | | - Adam Raben
- Christiana Care Health Services, Inc. CCOP, Newark, Delaware
| | - Shari Rudoler
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Trinkl S, Mares V, Englbrecht FS, Wilkens JJ, Wielunski M, Parodi K, Rühm W, Hillbrand M. Systematic out-of-field secondary neutron spectrometry and dosimetry in pencil beam scanning proton therapy. Med Phys 2017; 44:1912-1920. [DOI: 10.1002/mp.12206] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/17/2016] [Accepted: 12/18/2016] [Indexed: 12/20/2022] Open
Affiliation(s)
- Sebastian Trinkl
- Institute of Radiation Protection; Helmholtz Zentrum München (HMGU); Neuherberg Germany
- Department of Physik; Technical University of Munich; Munich Germany
| | - Vladimir Mares
- Institute of Radiation Protection; Helmholtz Zentrum München (HMGU); Neuherberg Germany
| | | | - Jan Jakob Wilkens
- Department of Physik; Technical University of Munich; Munich Germany
- Department of Radiation Oncology; Technical University of Munich, Klinikum rechts der Isar; Munich Germany
| | - Marek Wielunski
- Institute of Radiation Protection; Helmholtz Zentrum München (HMGU); Neuherberg Germany
| | - Katia Parodi
- Department of Medical Physics; Ludwig-Maximilians-Universität München; Garching b. München Germany
| | - Werner Rühm
- Institute of Radiation Protection; Helmholtz Zentrum München (HMGU); Neuherberg Germany
| | - Martin Hillbrand
- Department of Medical Physics; Rinecker Proton Therapy Center; Munich Germany
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12
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Measurement of stray neutron doses inside the treatment room from a proton pencil beam scanning system. Phys Med 2017; 34:80-84. [DOI: 10.1016/j.ejmp.2017.01.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 01/09/2017] [Accepted: 01/18/2017] [Indexed: 11/18/2022] Open
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13
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Measurement and simulation of secondary neutrons from uniform scanning proton beams in proton radiotherapy. RADIAT MEAS 2017. [DOI: 10.1016/j.radmeas.2016.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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14
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Hoppe BS, Harris S, Rhoton-Vlasak A, Bryant C, Morris CG, Dagan R, Nichols RC, Mendenhall WM, Henderson RH, Li Z, Mendenhall NP. Sperm preservation and neutron contamination following proton therapy for prostate cancer study. Acta Oncol 2017; 56:17-20. [PMID: 27420031 DOI: 10.1080/0284186x.2016.1205219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The present study investigates the impact of scatter dose radiation to the testis on ejaculate and sperm counts from treatment of prostate cancer with passive-scatter proton therapy. MATERIAL AND METHODS From March 2010 to November 2014, 20 men with low- or intermediate-risk prostate cancer enrolled in an IRB-approved protocol and provided a semen sample prior to passive-scatter proton therapy and 6-12 months following treatment. Men were excluded if they had high-risk prostate cancer, received androgen deprivation therapy, were on alpha blockers (due to retrograde ejaculation) prior to treatment, had baseline sperm count <1 million, or were unable to produce a pre-treatment sample or could not provide a follow-up specimen. Sperm counts of 0 were considered azoospermia and <15 million/ml were classified as oligospermia. RESULTS Four patients were unable to provide a sufficient quantity of semen for analysis. Among the 16 remaining patients, only one was found to have oligospermia (7 million/ml). There was a statistically significant reduction in semen volume (median, 0.5 ml) and increase in pH (median 0.5). Although not statistically significant, there appeared to be a decline in sperm concentration (median, 16 million/ml), total sperm count (median, 98.5 million), normal morphology (median, 9%), and rapid progressive motility (median, 9.5%). DISCUSSION Men did not have azoospermia 6-12 months following passive-scatter proton therapy indicating minimal scatter radiation to the testis during treatment. Changes in semen quantity and consistency may occur due to prostate irradiation, which could impact future fertility and/or sexual activity.
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Affiliation(s)
- Bradford S. Hoppe
- The Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Stephanie Harris
- The Department of Surgery, Division of Urology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Alice Rhoton-Vlasak
- The Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Curtis Bryant
- The Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Christopher G. Morris
- The Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Roi Dagan
- The Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Romaine C. Nichols
- The Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - William M. Mendenhall
- The Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Randal H. Henderson
- The Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Zuofeng Li
- The Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Nancy P. Mendenhall
- The Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
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15
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Bonfrate A, Farah J, De Marzi L, Delacroix S, Hérault J, Sayah R, Lee C, Bolch WE, Clairand I. Influence of beam incidence and irradiation parameters on stray neutron doses to healthy organs of pediatric patients treated for an intracranial tumor with passive scattering proton therapy. Phys Med 2016; 32:590-9. [PMID: 27050170 DOI: 10.1016/j.ejmp.2016.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 02/05/2016] [Accepted: 03/14/2016] [Indexed: 11/28/2022] Open
Abstract
PURPOSE In scattering proton therapy, the beam incidence, i.e. the patient's orientation with respect to the beam axis, can significantly influence stray neutron doses although it is almost not documented in the literature. METHODS MCNPX calculations were carried out to estimate stray neutron doses to 25 healthy organs of a 10-year-old female phantom treated for an intracranial tumor. Two beam incidences were considered in this article, namely a superior (SUP) field and a right lateral (RLAT) field. For both fields, a parametric study was performed varying proton beam energy, modulation width, collimator aperture and thickness, compensator thickness and air gap size. RESULTS Using a standard beam line configuration for a craniopharyngioma treatment, neutron absorbed doses per therapeutic dose of 63μGyGy(-1) and 149μGyGy(-1) were found at the heart for the SUP and the RLAT fields, respectively. This dose discrepancy was explained by the different patient's orientations leading to changes in the distance between organs and the final collimator where external neutrons are mainly produced. Moreover, investigations on neutron spectral fluence at the heart showed that the number of neutrons was 2.5times higher for the RLAT field compared against the SUP field. Finally, the influence of some irradiation parameters on neutron doses was found to be different according to the beam incidence. CONCLUSION Beam incidence was thus found to induce large variations in stray neutron doses, proving that this parameter could be optimized to enhance the radiation protection of the patient.
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Affiliation(s)
- A Bonfrate
- IRSN - Institut de Radioprotection et de Sûreté Nucléaire, Service de Dosimétrie Externe BP17, 92262 Fontenay-aux-Roses Cedex, France.
| | - J Farah
- IRSN - Institut de Radioprotection et de Sûreté Nucléaire, Service de Dosimétrie Externe BP17, 92262 Fontenay-aux-Roses Cedex, France.
| | - L De Marzi
- Institut Curie - Centre de Protonthérapie d'Orsay (CPO) - Campus universitaire bâtiment 101, 91898 Orsay, France
| | - S Delacroix
- Institut Curie - Centre de Protonthérapie d'Orsay (CPO) - Campus universitaire bâtiment 101, 91898 Orsay, France
| | - J Hérault
- Centre Antoine Lacassagne (CAL) - Cyclotron biomédical, 227 avenue de la Lanterne, 06200 Nice, France
| | - R Sayah
- IRSN - Institut de Radioprotection et de Sûreté Nucléaire, Service de Dosimétrie Externe BP17, 92262 Fontenay-aux-Roses Cedex, France
| | - C Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institute of Health, Rockville, MD 20850, USA
| | - W E Bolch
- J Crayton Pruitt Family Departments of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA
| | - I Clairand
- IRSN - Institut de Radioprotection et de Sûreté Nucléaire, Service de Dosimétrie Externe BP17, 92262 Fontenay-aux-Roses Cedex, France
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Yonekura Y, Tsujii H, Hopewell JW, López PO, Cosset JM, Paganetti H, Montelius A, Schardt D, Jones B, Nakamura T. ICRP Publication 127: Radiological Protection in Ion Beam Radiotherapy. Ann ICRP 2014; 43:5-113. [PMID: 25915952 DOI: 10.1177/0146645314559144] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The goal of external-beam radiotherapy is to provide precise dose localisation in the treatment volume of the target with minimal damage to the surrounding normal tissue. Ion beams, such as protons and carbon ions, provide excellent dose distributions due primarily to their finite range, allowing a significant reduction of undesired exposure of normal tissue. Careful treatment planning is required for the given type and localisation of the tumour to be treated in order to maximise treatment efficiency and minimise the dose to normal tissue. Radiation exposure in out-of-field volumes arises from secondary neutrons and photons, particle fragments, and photons from activated materials. These unavoidable doses should be considered from the standpoint of radiological protection of the patient. Radiological protection of medical staff at ion beam radiotherapy facilities requires special attention. Appropriate management and control are required for the therapeutic equipment and the air in the treatment room that can be activated by the particle beam and its secondaries. Radiological protection and safety management should always conform with regulatory requirements. The current regulations for occupational exposures in photon radiotherapy are applicable to ion beam radiotherapy with protons or carbon ions. However, ion beam radiotherapy requires a more complex treatment system than conventional radiotherapy, and appropriate training of staff and suitable quality assurance programmes are recommended to avoid possible accidental exposure of patients, to minimise unnecessary doses to normal tissue, and to minimise radiation exposure of staff.
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17
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Howell RM, Burgett EA. Secondary neutron spectrum from 250-MeV passively scattered proton therapy: measurement with an extended-range Bonner sphere system. Med Phys 2014; 41:092104. [PMID: 25186404 PMCID: PMC4149696 DOI: 10.1118/1.4892929] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 07/25/2014] [Accepted: 07/28/2014] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Secondary neutrons are an unavoidable consequence of proton therapy. While the neutron dose is low compared to the primary proton dose, its presence and contribution to the patient dose is nonetheless important. The most detailed information on neutrons includes an evaluation of the neutron spectrum. However, the vast majority of the literature that has reported secondary neutron spectra in proton therapy is based on computational methods rather than measurements. This is largely due to the inherent limitations in the majority of neutron detectors, which are either not suitable for spectral measurements or have limited response at energies greater than 20 MeV. Therefore, the primary objective of the present study was to measure a secondary neutron spectrum from a proton therapy beam using a spectrometer that is sensitive to neutron energies over the entire neutron energy spectrum. METHODS The authors measured the secondary neutron spectrum from a 250-MeV passively scattered proton beam in air at a distance of 100 cm laterally from isocenter using an extended-range Bonner sphere (ERBS) measurement system. Ambient dose equivalent H*(10) was calculated using measured fluence and fluence-to-ambient dose equivalent conversion coefficients. RESULTS The neutron fluence spectrum had a high-energy direct neutron peak, an evaporation peak, a thermal peak, and an intermediate energy continuum between the thermal and evaporation peaks. The H*(10) was dominated by the neutrons in the evaporation peak because of both their high abundance and the large quality conversion coefficients in that energy interval. The H*(10) 100 cm laterally from isocenter was 1.6 mSv per proton Gy (to isocenter). Approximately 35% of the dose equivalent was from neutrons with energies ≥20 MeV. CONCLUSIONS The authors measured a neutron spectrum for external neutrons generated by a 250-MeV proton beam using an ERBS measurement system that was sensitive to neutrons over the entire energy range being measured, i.e., thermal to 250 MeV. The authors used the neutron fluence spectrum to demonstrate experimentally the contribution of neutrons with different energies to the total dose equivalent and in particular the contribution of high-energy neutrons (≥20 MeV). These are valuable reference data that can be directly compared with Monte Carlo and experimental data in the literature.
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Affiliation(s)
- Rebecca M Howell
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030
| | - E A Burgett
- Department of Nuclear Engineering, Idaho State University, Pocatello, Idaho 83201
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18
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Holtzman AL, Hoppe BS, Li Z, Su Z, Slayton WB, Ozdemir S, Joyce M, Sandler E, Mendenhall NP, Flampouri S. Advancing the Therapeutic Index in Stage III/IV Pediatric Hodgkin Lymphoma with Proton Therapy. Int J Part Ther 2014. [DOI: 10.14338/ijpt.14.00001.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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19
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Farah J, Martinetti F, Sayah R, Lacoste V, Donadille L, Trompier F, Nauraye C, Marzi LD, Vabre I, Delacroix S, Hérault J, Clairand I. Monte Carlo modeling of proton therapy installations: a global experimental method to validate secondary neutron dose calculations. Phys Med Biol 2014; 59:2747-65. [DOI: 10.1088/0031-9155/59/11/2747] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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20
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Dawidowska A, Ferszt MP, Konefał A. The determination of a dose deposited in reference medium due to (p,n) reaction occurring during proton therapy. Rep Pract Oncol Radiother 2014; 19:S3-S8. [PMID: 28443192 DOI: 10.1016/j.rpor.2014.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 11/15/2013] [Accepted: 02/27/2014] [Indexed: 10/25/2022] Open
Abstract
AIM The aim of the investigation was to determine the undesirable dose coming from neutrons produced in reactions (p,n) in irradiated tissues represented by water. BACKGROUND Production of neutrons in the system of beam collimators and in irradiated tissues is the undesirable phenomenon related to the application of protons in radiotherapy. It makes that proton beams are contaminated by neutrons and patients receive the undesirable neutron dose. MATERIALS AND METHODS The investigation was based on the Monte Carlo simulations (GEANT4 code). The calculations were performed for five energies of protons: 50 MeV, 55 MeV, 60 MeV, 65 MeV and 75 MeV. The neutron doses were calculated on the basis of the neutron fluence and neutron energy spectra derived from simulations and by means of the neutron fluence-dose conversion coefficients taken from the ICRP dosimetry protocol no. 74 for the antero-posterior irradiation geometry. RESULTS The obtained neutron doses are much less than the proton ones. They do not exceed 0.1%, 0.4%, 0.5%, 0.6% and 0.7% of the total dose at a given depth for the primary protons with energy of 50 MeV, 55 MeV, 60 MeV, 65 MeV and 70 MeV, respectively. CONCLUSIONS The neutron production takes place mainly along the central axis of the beam. The maximum neutron dose appears at about a half of the depth of the maximum proton dose (Bragg peak), i.e. in the volume of a healthy tissue. The doses of neutrons produced in the irradiated medium (water) are about two orders of magnitude less than the proton doses for the considered range of energy of protons.
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Affiliation(s)
- Anna Dawidowska
- Department of Nuclear Physics and Its Applications, Institute of Physics, University of Silesia, Katowice, Poland
| | - Monika Paluch Ferszt
- Department of Nuclear Physics and Its Applications, Institute of Physics, University of Silesia, Katowice, Poland
| | - Adam Konefał
- Department of Nuclear Physics and Its Applications, Institute of Physics, University of Silesia, Katowice, Poland
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Islam MR, Collums TL, Zheng Y, Monson J, Benton ER. Off-axis dose equivalent due to secondary neutrons from uniform scanning proton beams during proton radiotherapy. Phys Med Biol 2013; 58:8235-51. [DOI: 10.1088/0031-9155/58/22/8235] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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22
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Kim DW, Chung WK, Shin J, Lim YK, Shin D, Lee SB, Yoon M, Park SY, Shin DO, Cho JK. Secondary neutron dose measurement for proton eye treatment using an eye snout with a borated neutron absorber. Radiat Oncol 2013; 8:182. [PMID: 23866307 PMCID: PMC3723544 DOI: 10.1186/1748-717x-8-182] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 07/15/2013] [Indexed: 11/30/2022] Open
Abstract
Background We measured and assessed ways to reduce the secondary neutron dose from a system for proton eye treatment. Methods Proton beams of 60.30 MeV were delivered through an eye-treatment snout in passive scattering mode. Allyl diglycol carbonate (CR-39) etch detectors were used to measure the neutron dose in the external field at 0.00, 1.64, and 6.00 cm depths in a water phantom. Secondary neutron doses were measured and compared between those with and without a high-hydrogen–boron-containing block. In addition, the neutron energy and vertices distribution were obtained by using a Geant4 Monte Carlo simulation. Results The ratio of the maximum neutron dose equivalent to the proton absorbed dose (H(10)/D) at 2.00 cm from the beam field edge was 8.79 ± 1.28 mSv/Gy. The ratio of the neutron dose equivalent to the proton absorbed dose with and without a high hydrogen-boron containing block was 0.63 ± 0.06 to 1.15 ± 0.13 mSv/Gy at 2.00 cm from the edge of the field at depths of 0.00, 1.64, and 6.00 cm. Conclusions We found that the out-of-field secondary neutron dose in proton eye treatment with an eye snout is relatively small, and it can be further reduced by installing a borated neutron absorbing material.
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Affiliation(s)
- Dong Wook Kim
- Department of Radiation Oncology, Kyung Hee University Hospital at Gandong, Seoul, Korea
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Braunstein S, Nakamura JL. Radiotherapy-induced malignancies: review of clinical features, pathobiology, and evolving approaches for mitigating risk. Front Oncol 2013; 3:73. [PMID: 23565507 PMCID: PMC3615242 DOI: 10.3389/fonc.2013.00073] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 03/21/2013] [Indexed: 12/24/2022] Open
Abstract
One of the most significant effects of radiation therapy on normal tissues is mutagenesis, which is the basis for radiation-induced malignancies. Radiation-induced malignancies are late complications arising after radiotherapy, increasing in frequency among survivors of both pediatric and adult cancers. Genetic backgrounds harboring germline mutations in tumor suppressor genes are recognized risk factors. Some success has been found with using genome wide association studies to identify germline polymorphisms associated with susceptibility. The insights generated by genetics, epidemiology, and the development of experimental models are defining potential strategies to offer to individuals at risk for radiation-induced malignancies. Concurrent technological efforts are developing novel radiotherapy delivery to reduce irradiation of normal tissues, and thereby, to mitigate the risk of radiation-induced malignancies. The goal of this review is to discuss epidemiologic, modeling, and radiotherapy delivery data, where these lines of research intersect and their potential impact on patient care.
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Affiliation(s)
- Steve Braunstein
- Department of Radiation Oncology, University of California San FranciscoSan Francisco, CA, USA
| | - Jean L. Nakamura
- Department of Radiation Oncology, University of California San FranciscoSan Francisco, CA, USA
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24
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Kil WJ, Nichols RC, Hoppe BS, Morris CG, Marcus RB, Mendenhall W, Mendenhall NP, Li Z, Costa JA, Williams CR, Henderson RH. Hypofractionated passively scattered proton radiotherapy for low- and intermediate-risk prostate cancer is not associated with post-treatment testosterone suppression. Acta Oncol 2013; 52:492-7. [PMID: 23477360 PMCID: PMC3613975 DOI: 10.3109/0284186x.2013.767983] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background. To investigate post-treatment changes in serum testosterone in low- and intermediate-risk prostate cancer patients treated with hypofractionated passively scattered proton radiotherapy. Material and methods. Between April 2008 and October 2011, 228 patients with low- and intermediate-risk prostate cancer were enrolled into an institutional review board-approved prospective protocol. Patients received doses ranging from 70 Cobalt Gray Equivalent (CGE) to 72.5 CGE at 2.5 CGE per fraction using passively scattered protons. Three patients were excluded for receiving androgen deprivation therapy (n = 2) or testosterone supplementation (n = 1) before radiation. Of the remaining 226 patients, pretreatment serum testosterone levels were available for 217. Of these patients, post-treatment serum testosterone levels were available for 207 in the final week of treatment, 165 at the six-month follow-up, and 116 at the 12-month follow-up. The post-treatment testosterone levels were compared with the pretreatment levels using Wilcoxon's signed-rank test for matched pairs. Results. The median pretreatment serum testosterone level was 367.7 ng/dl (12.8 nmol/l). The median changes in post-treatment testosterone value were as follows: +3.0 ng/dl (+0.1 nmol/l) at treatment completion; +6.0 ng/dl (+0.2 nmol/l) at six months after treatment; and +5.0 ng/dl (0.2 nmol/l) at 12 months after treatment. None of these changes were statistically significant. Conclusion. Patients with low- and intermediate-risk prostate cancer treated with hypofractionated passively scattered proton radiotherapy do not experience testosterone suppression. Our findings are consistent with physical measurements demonstrating that proton radiotherapy is associated with less scatter radiation exposure to tissues beyond the beam paths compared with intensity-modulated photon radiotherapy.
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Affiliation(s)
- Whoon Jong Kil
- Department of Radiation Oncology, University of Florida,
Gainesville, Florida, USA
- University of Florida Proton Therapy Institute,
Jacksonville, Florida, USA
| | - Romaine C. Nichols
- Department of Radiation Oncology, University of Florida,
Gainesville, Florida, USA
- University of Florida Proton Therapy Institute,
Jacksonville, Florida, USA
| | - Bradford S. Hoppe
- Department of Radiation Oncology, University of Florida,
Gainesville, Florida, USA
- University of Florida Proton Therapy Institute,
Jacksonville, Florida, USA
| | - Christopher G. Morris
- Department of Radiation Oncology, University of Florida,
Gainesville, Florida, USA
- University of Florida Proton Therapy Institute,
Jacksonville, Florida, USA
| | - Robert B. Marcus
- Department of Radiation Oncology, University of Florida,
Gainesville, Florida, USA
- University of Florida Proton Therapy Institute,
Jacksonville, Florida, USA
| | - William Mendenhall
- Department of Radiation Oncology, University of Florida,
Gainesville, Florida, USA
- University of Florida Proton Therapy Institute,
Jacksonville, Florida, USA
| | - Nancy P. Mendenhall
- Department of Radiation Oncology, University of Florida,
Gainesville, Florida, USA
- University of Florida Proton Therapy Institute,
Jacksonville, Florida, USA
| | - Zuofeng Li
- Department of Radiation Oncology, University of Florida,
Gainesville, Florida, USA
- University of Florida Proton Therapy Institute,
Jacksonville, Florida, USA
| | - Joseph A. Costa
- Division of Urology, University of Florida Shands Hospital,
Jacksonville, Florida, USA
| | | | - Randal H. Henderson
- Department of Radiation Oncology, University of Florida,
Gainesville, Florida, USA
- University of Florida Proton Therapy Institute,
Jacksonville, Florida, USA
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Muren LP, Rossi C, Hug E, Lee A, Glimelius B. Establishing and expanding the indications for proton and particle therapy. Acta Oncol 2013; 52:459-62. [PMID: 23477358 DOI: 10.3109/0284186x.2013.770167] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ludvig P. Muren
- Department of Medical Physics, Aarhus University/Aarhus University Hospital,
Aarhus, Denmark
- Department of Physics and Technology, University of Bergen,
Bergen, Norway
| | - Carl Rossi
- Scripps Proton Radiotherapy Center,
San Diego, California, USA
| | - Eugen Hug
- Procure Proton Therapy Centers,
New York, New York, USA
| | - Andrew Lee
- Proton Therapy Center, Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center,
Houston, Texas, USA
| | - Bengt Glimelius
- Department of Radiology, Oncology and Radiation Science, Uppsala University,
Uppsala, Sweden
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Zheng Y, Liu Y, Zeidan O, Schreuder AN, Keole S. Measurements of neutron dose equivalent for a proton therapy center using uniform scanning proton beams. Med Phys 2012; 39:3484-92. [PMID: 22755728 DOI: 10.1118/1.4718685] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Neutron exposure is of concern in proton therapy, and varies with beam delivery technique, nozzle design, and treatment conditions. Uniform scanning is an emerging treatment technique in proton therapy, but neutron exposure for this technique has not been fully studied. The purpose of this study is to investigate the neutron dose equivalent per therapeutic dose, H/D, under various treatment conditions for uniform scanning beams employed at our proton therapy center. METHODS Using a wide energy neutron dose equivalent detector (SWENDI-II, ThermoScientific, MA), the authors measured H/D at 50 cm lateral to the isocenter as a function of proton range, modulation width, beam scanning area, collimated field size, and snout position. They also studied the influence of other factors on neutron dose equivalent, such as aperture material, the presence of a compensator, and measurement locations. They measured H/D for various treatment sites using patient-specific treatment parameters. Finally, they compared H/D values for various beam delivery techniques at various facilities under similar conditions. RESULTS H/D increased rapidly with proton range and modulation width, varying from about 0.2 mSv/Gy for a 5 cm range and 2 cm modulation width beam to 2.7 mSv/Gy for a 30 cm range and 30 cm modulation width beam when 18 × 18 cm(2) uniform scanning beams were used. H/D increased linearly with the beam scanning area, and decreased slowly with aperture size and snout retraction. The presence of a compensator reduced the H/D slightly compared with that without a compensator present. Aperture material and compensator material also have an influence on neutron dose equivalent, but the influence is relatively small. H/D varied from about 0.5 mSv/Gy for a brain tumor treatment to about 3.5 mSv/Gy for a pelvic case. CONCLUSIONS This study presents H/D as a function of various treatment parameters for uniform scanning proton beams. For similar treatment conditions, the H/D value per uncollimated beam size for uniform scanning beams was slightly lower than that from a passive scattering beam and higher than that from a pencil beam scanning beam, within a factor of 2. Minimizing beam scanning area could effectively reduce neutron dose equivalent for uniform scanning beams, down to the level close to pencil beam scanning.
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Affiliation(s)
- Yuanshui Zheng
- ProCure Proton Therapy Center, 5901 West Memorial Road, Oklahoma City, OK 73142, USA.
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Results of a multicentric in silico clinical trial (ROCOCO): comparing radiotherapy with photons and protons for non-small cell lung cancer. J Thorac Oncol 2012; 7:165-76. [PMID: 22071782 DOI: 10.1097/jto.0b013e31823529fc] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION This multicentric in silico trial compares photon and proton radiotherapy for non-small cell lung cancer patients. The hypothesis is that proton radiotherapy decreases the dose and the volume of irradiated normal tissues even when escalating to the maximum tolerable dose of one or more of the organs at risk (OAR). METHODS Twenty-five patients, stage IA-IIIB, were prospectively included. On 4D F18-labeled fluorodeoxyglucose-positron emission tomography-computed tomography scans, the gross tumor, clinical and planning target volumes, and OAR were delineated. Three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) photon and passive scattered conformal proton therapy (PSPT) plans were created to give 70 Gy to the tumor in 35 fractions. Dose (de-)escalation was performed by rescaling to the maximum tolerable dose. RESULTS Protons resulted in the lowest dose to the OAR, while keeping the dose to the target at 70 Gy. The integral dose (ID) was higher for 3DCRT (59%) and IMRT (43%) than for PSPT. The mean lung dose reduced from 18.9 Gy for 3DCRT and 16.4 Gy for IMRT to 13.5 Gy for PSPT. For 10 patients, escalation to 87 Gy was possible for all 3 modalities. The mean lung dose and ID were 40 and 65% higher for photons than for protons, respectively. CONCLUSIONS The treatment planning results of the Radiation Oncology Collaborative Comparison trial show a reduction of ID and the dose to the OAR when treating with protons instead of photons, even with dose escalation. This shows that PSPT is able to give a high tumor dose, while keeping the OAR dose lower than with the photon modalities.
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Proton Radiotherapy for Prostate Cancer Is Not Associated With Post-Treatment Testosterone Suppression. Int J Radiat Oncol Biol Phys 2012; 82:1222-6. [DOI: 10.1016/j.ijrobp.2010.12.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 10/20/2010] [Accepted: 12/20/2010] [Indexed: 11/16/2022]
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Craniospinal Irradiation Techniques: A Dosimetric Comparison of Proton Beams With Standard and Advanced Photon Radiotherapy. Int J Radiat Oncol Biol Phys 2011; 81:637-46. [DOI: 10.1016/j.ijrobp.2010.06.039] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 06/14/2010] [Accepted: 06/18/2010] [Indexed: 11/24/2022]
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Diffenderfer ES, Ainsley CG, Kirk ML, McDonough JE, Maughan RL. Comparison of secondary neutron dose in proton therapy resulting from the use of a tungsten alloy MLC or a brass collimator system. Med Phys 2011; 38:6248-56. [DOI: 10.1118/1.3656025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Zhang R, Pérez-Andújar A, Fontenot JD, Taddei PJ, Newhauser WD. An analytic model of neutron ambient dose equivalent and equivalent dose for proton radiotherapy. Phys Med Biol 2010; 55:6975-85. [PMID: 21076197 DOI: 10.1088/0031-9155/55/23/s01] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Stray neutrons generated in passively scattered proton therapy are of concern because they increase the risk that a patient will develop a second cancer. Several investigations characterized stray neutrons in proton therapy using experimental measurements and Monte Carlo simulations, but capabilities of analytical methods to predict neutron exposures are less well developed. The goal of this study was to develop a new analytical model to calculate neutron ambient dose equivalent in air and equivalent dose in phantom based on Monte Carlo modeling of a passively scattered proton therapy unit. The accuracy of the new analytical model is superior to a previous analytical model and comparable to the accuracy of typical Monte Carlo simulations and measurements. Predictions from the new analytical model agreed reasonably well with corresponding values predicted by a Monte Carlo code using an anthropomorphic phantom.
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Affiliation(s)
- Rui Zhang
- Graduate School of Biomedical Sciences, The University of Texas at Houston, Houston, TX 77030, USA
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Hultqvist M, Gudowska I. Secondary absorbed doses from light ion irradiation in anthropomorphic phantoms representing an adult male and a 10 year old child. Phys Med Biol 2010; 55:6633-53. [DOI: 10.1088/0031-9155/55/22/004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Brenner DJ, Elliston CD, Hall EJ, Paganetti H. Reduction of the secondary neutron dose in passively scattered proton radiotherapy, using an optimized pre-collimator/collimator. Phys Med Biol 2009; 54:6065-78. [PMID: 19779218 PMCID: PMC3688272 DOI: 10.1088/0031-9155/54/20/003] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Proton radiotherapy represents a potential major advance in cancer therapy. Most current proton beams are spread out to cover the tumor using passive scattering and collimation, resulting in an extra whole-body high-energy neutron dose, primarily from proton interactions with the final collimator. There is considerable uncertainty as to the carcinogenic potential of low doses of high-energy neutrons, and thus we investigate whether this neutron dose can be significantly reduced without major modifications to passively scattered proton beam lines. Our goal is to optimize the design features of a patient-specific collimator or pre-collimator/collimator assembly. There are a number of often contradictory design features, in terms of geometry and material, involved in an optimal design. For example, plastic or hybrid plastic/metal collimators have a number of advantages. We quantify these design issues, and investigate the practical balances that can be achieved to significantly reduce the neutron dose without major alterations to the beamline design or function. Given that the majority of proton therapy treatments, at least for the next few years, will use passive scattering techniques, reducing the associated neutron-related risks by simple modifications of the collimator assembly design is a desirable goal.
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Affiliation(s)
- David J Brenner
- Center for Radiological Research, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA.
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