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Verdera A, Torres-Sánchez P, Praena J, Porras I. Study of the out-of-field dose from an accelerator-based neutron source for boron neutron capture therapy. Appl Radiat Isot 2024; 212:111458. [PMID: 39111051 DOI: 10.1016/j.apradiso.2024.111458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 03/29/2024] [Accepted: 07/23/2024] [Indexed: 09/06/2024]
Abstract
One important issue in Boron Neutron Capture Therapy is the delivered dose to the tissues outside the tumor. An international standard for light ion beam systems sets two recommended limits for out-of-field dose based on distance from the field edge: maximum absorbed dose from all radiation types shall not exceed 0.5 % of the maximum dose at distances 15 cm to 50 cm from the field edge. At distances >50 cm from the field edge, the maximum absorbed dose shall not exceed 0.1 %. This paper is a continuation of our previous works focused on the design of an accelerator-based neutron source for BNCT. We already designed a novel Beam Shape Assembly which meets the IAEA criteria for BNCT treatments. Using this BSA, in the present work, we characterize by Monte Carlo simulations the dose outside the neutron field. The out-of-field dose has been assessed via estimates using the ambient and equivalent dose. Also the boron uptake in healthy tissues has been analyzed for the equivalent dose computation. It is concluded that our design for a future accelerator-based source for BNCT meets reasonably well the criteria defined from other forms of radiotherapy on both equivalent and effective dose outside the field.
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Affiliation(s)
- Antònia Verdera
- Department of Atomic, Molecular and Nuclear Physics, University of Granada, Granada, Spain
| | | | - Javier Praena
- Department of Atomic, Molecular and Nuclear Physics, University of Granada, Granada, Spain
| | - Ignacio Porras
- Department of Atomic, Molecular and Nuclear Physics, University of Granada, Granada, Spain
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Zhang Y, Xie J, Zhang H, Li J, Mi X, Zhou X, Ding Z. Serum exosomal miRNA promote glioma progression by targeting SOS1 via abscopal effect of radiation. Arch Biochem Biophys 2024; 761:110138. [PMID: 39303929 DOI: 10.1016/j.abb.2024.110138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 08/22/2024] [Accepted: 09/03/2024] [Indexed: 09/22/2024]
Abstract
INTRODUCTION Local exposure to ionizing radiation (IR) can induce changes in biological processes in distant tissues and organs. Exosomes are nanoscale vesicles that transport biomolecules, mediate communication between cells and tissues, and can affect the abscopal effects of radiotherapy. METHODS Mice were treated with 8.0 Gy doses of chest and abdomen IR, after which serum samples were taken 24 h after exposure. Their serum exosomes were then isolated via ultracentrifugation and the small RNA portions were extracted for sequencing and bioinformatic analysis. Exosomes were injected intravenously into the mice to assess their ability to cross the blood-brain barrier (BBB). Glioma cells and glioma stem cells (GSCs) were examined for malignant biological behaviors, stemness, and tumorigenic capacity after co-culturing with different groups of exosomes. RESULTS We found that serum exosomes crossed the BBB in mice after local IR exposure-which induced decreases in the expression of BBB tight-junction proteins and increased brain endothelial cell apoptosis. Exosomes from the exposed groups promoted malignant biological behaviors, stemness, and tumorigenic capacity in glioma cells and GSCs by upregulating the expression of SOS1. Phospho-MEK1/2 and Phospho-ERK1/2, of the MAPK signaling pathway, were found to be up-regulated in cells that were co-cultured with the exposing groups of the exosomes. Further analyses demonstrated that differentially expressed levels of miR-93-5p in mouse serum exosomes regulated the cellular expression of SOS1. CONCLUSION Following local IR exposure, serum exosomes cross the BBB to promote the progression of distant gliomas. Exosomal microRNAs play an important role in this process.
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Affiliation(s)
- Ying Zhang
- Department of Radiation Medicine, Guangdong Provincial Key Laboratory of Tropical Disease Research, NMPA Key Laboratory for Safety Evaluation of Cosmetics, School of Public Health, Southern Medical University, Guangzhou, 510515, China.
| | - Jing Xie
- Department of Radiation Medicine, Guangdong Provincial Key Laboratory of Tropical Disease Research, NMPA Key Laboratory for Safety Evaluation of Cosmetics, School of Public Health, Southern Medical University, Guangzhou, 510515, China.
| | - Huimin Zhang
- Department of Radiation Medicine, Guangdong Provincial Key Laboratory of Tropical Disease Research, NMPA Key Laboratory for Safety Evaluation of Cosmetics, School of Public Health, Southern Medical University, Guangzhou, 510515, China.
| | - Jiacheng Li
- Department of Radiation Medicine, Guangdong Provincial Key Laboratory of Tropical Disease Research, NMPA Key Laboratory for Safety Evaluation of Cosmetics, School of Public Health, Southern Medical University, Guangzhou, 510515, China.
| | - Xing Mi
- Department of Radiation Medicine, Guangdong Provincial Key Laboratory of Tropical Disease Research, NMPA Key Laboratory for Safety Evaluation of Cosmetics, School of Public Health, Southern Medical University, Guangzhou, 510515, China.
| | - Xuyi Zhou
- Department of Radiation Medicine, Guangdong Provincial Key Laboratory of Tropical Disease Research, NMPA Key Laboratory for Safety Evaluation of Cosmetics, School of Public Health, Southern Medical University, Guangzhou, 510515, China.
| | - Zhenhua Ding
- Department of Radiation Medicine, Guangdong Provincial Key Laboratory of Tropical Disease Research, NMPA Key Laboratory for Safety Evaluation of Cosmetics, School of Public Health, Southern Medical University, Guangzhou, 510515, China.
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Jiang C, Kim M, Han X, Chelius M, Hoover T, Kersun L, Reilly AF, Hubbeling H, Cummings E, Kurtz G, Hill-Kayser C, Plastaras JP, LaRiviere MJ. Outcomes of proton therapy to infradiaphragmatic sites in pediatric patients with Hodgkin lymphoma. Pediatr Blood Cancer 2024:e31290. [PMID: 39267229 DOI: 10.1002/pbc.31290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 07/24/2024] [Accepted: 08/12/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND Proton therapy (PT) has potential advantages in pediatric Hodgkin lymphoma (pHL). However, there are limited data on PT, specifically to infradiaphragmatic targets. We report on PT planning details, doses achieved to organs at risk (OARs), and clinical and toxicity outcomes for patients with pHL who received PT to infradiaphragmatic regions. METHODS This is a retrospective study including patients treated between 2011 and 2022. Demographic and clinical factors were collected, and toxicity was reported using Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Dosimetric and clinical factors associated with key outcomes were assessed via Cox regression. Photon plans were generated for all patients, and the paired t-tests or Wilcoxon signed rank sum tests were used for dosimetric comparisons. RESULTS Twenty-one patients comprising 22 PT courses were included. Median follow-up was 5.0 years, and mean age was 14.2 years. Median dose was 21 Gray equivalent (GyE) over 14 fractions. Top acute grade 1 (G1) toxicities included fatigue (59%) and anorexia (36%). Rates of acute G2 and G3+ toxicity were 18% and 0%, respectively. After PT, no local or marginal failures occurred. Five percent experienced disease progression, who were all successfully salvaged, and all patients were alive and disease-free at last follow-up. No secondary malignancies developed. Compared to photon radiotherapy, PT achieved significantly lower doses to the bowels, stomach, spleen, pancreatic tail, liver, kidneys, and pelvic bones. CONCLUSIONS PT is well-tolerated and leads to excellent oncologic and toxicity outcomes with long-term follow-up. PT confers dosimetric advantages when compared to photons.
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Affiliation(s)
- Cecilia Jiang
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michele Kim
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Xiaoyan Han
- Department of Biostatics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Monica Chelius
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Travis Hoover
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland, USA
| | - Leslie Kersun
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Anne F Reilly
- Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Harper Hubbeling
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elizabeth Cummings
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Goldie Kurtz
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christine Hill-Kayser
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John P Plastaras
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael J LaRiviere
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Benzazon N, Carré A, de Kermenguy F, Niyoteka S, Maury P, Colnot J, M'hamdi M, Aichi ME, Veres C, Allodji R, de Vathaire F, Sarrut D, Journy N, Alapetite C, Grégoire V, Deutsch E, Diallo I, Robert C. Deep-Learning for Rapid Estimation of the Out-of-Field Dose in External Beam Photon Radiation Therapy - A Proof of Concept. Int J Radiat Oncol Biol Phys 2024; 120:253-264. [PMID: 38554830 DOI: 10.1016/j.ijrobp.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 02/26/2024] [Accepted: 03/07/2024] [Indexed: 04/02/2024]
Abstract
PURPOSE The dose deposited outside of the treatment field during external photon beam radiation therapy treatment, also known as out-of-field dose, is the subject of extensive study as it may be associated with a higher risk of developing a second cancer and could have deleterious effects on the immune system that compromise the efficiency of combined radio-immunotherapy treatments. Out-of-field dose estimation tools developed today in research, including Monte Carlo simulations and analytical methods, are not suited to the requirements of clinical implementation because of their lack of versatility and their cumbersome application. We propose a proof of concept based on deep learning for out-of-field dose map estimation that addresses these limitations. METHODS AND MATERIALS For this purpose, a 3D U-Net, considering as inputs the in-field dose, as computed by the treatment planning system, and the patient's anatomy, was trained to predict out-of-field dose maps. The cohort used for learning and performance evaluation included 3151 pediatric patients from the FCCSS database, treated in 5 clinical centers, whose whole-body dose maps were previously estimated with an empirical analytical method. The test set, composed of 433 patients, was split into 5 subdata sets, each containing patients treated with devices unseen during the training phase. Root mean square deviation evaluated only on nonzero voxels located in the out-of-field areas was computed as performance metric. RESULTS Root mean square deviations of 0.28 and 0.41 cGy/Gy were obtained for the training and validation data sets, respectively. Values of 0.27, 0.26, 0.28, 0.30, and 0.45 cGy/Gy were achieved for the 6 MV linear accelerator, 16 MV linear accelerator, Alcyon cobalt irradiator, Mobiletron cobalt irradiator, and betatron device test sets, respectively. CONCLUSIONS This proof-of-concept approach using a convolutional neural network has demonstrated unprecedented generalizability for this task, although it remains limited, and brings us closer to an implementation compatible with clinical routine.
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Affiliation(s)
- Nathan Benzazon
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France.
| | - Alexandre Carré
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - François de Kermenguy
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Stéphane Niyoteka
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Pauline Maury
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Julie Colnot
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France; THERYQ, PMB-Alcen, Peynier, France
| | - Meissane M'hamdi
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Mohammed El Aichi
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Cristina Veres
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Rodrigue Allodji
- Unité Mixte de Recherche (UMR) 1018 Centre de Recherche en épidémiologie et Santé des Populations (CESP), Radiation Epidemiology Team, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France
| | - Florent de Vathaire
- Unité Mixte de Recherche (UMR) 1018 Centre de Recherche en épidémiologie et Santé des Populations (CESP), Radiation Epidemiology Team, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France
| | - David Sarrut
- Université de Lyon; CREATIS; CNRS UMR5220; Inserm U1294; INSA-Lyon; Léon Bérard cancer center, Lyon, France
| | - Neige Journy
- Unité Mixte de Recherche (UMR) 1018 Centre de Recherche en épidémiologie et Santé des Populations (CESP), Radiation Epidemiology Team, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France
| | | | - Vincent Grégoire
- Department of Radiation Oncology, centre Léon-Bérard, Lyon, France
| | - Eric Deutsch
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Ibrahima Diallo
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Charlotte Robert
- Unité Mixte de Recherche (UMR) 1030 Radiothérapie Moléculaire et Innovation Thérapeutique, ImmunoRadAI, Inserm, Université Paris-Saclay, Institut Gustave Roussy, Villejuif, France; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
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Levy BB, Biasio MJD, Toledo NA, Das S, Bartling M, Aldahari F, de Almeida JR, Weinreb I, Chan Y. Sinonasal Malignancy Following Cranial Irradiation: A Scoping Review and Case Report of Sinonasal Teratocarcinosarcoma. J Neurol Surg Rep 2024; 85:e101-e111. [PMID: 38974921 PMCID: PMC11226344 DOI: 10.1055/s-0044-1788310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/17/2024] [Indexed: 07/09/2024] Open
Abstract
Background Radiation therapy is a mainstay of treatment for brain tumors, but delayed complications include secondary malignancy which may occur months to years after treatment completion. Methods We reviewed the medical records of a 41-year-old female treated with 60 Gy of radiation for a recurrent astrocytoma, who 6 years later developed a locally advanced sinonasal teratocarcinosarcoma. We searched MEDLINE, Embase, and Web of Science to conduct a scoping review of biopsy-proven sinonasal malignancy in patients who previously received cranial irradiation for a brain tumor. Results To our knowledge, this is the first report of a patient to present with a sinonasal teratocarcinosarcoma after receiving irradiation for a brain tumor. Our scoping review of 1,907 studies produced 14 similar cases of secondary sinonasal malignancy. Median age of primary cancer diagnosis was 39.5 years old (standard deviation [SD]: 21.9), and median radiation dose was 54 Gy (SD: 20.3). Median latency time between the primary cancer and secondary sinonasal cancer was 9.5 years (SD: 5.8). Olfactory neuroblastoma was the most common sinonasal cancer ( n = 4). Fifty percent of patients died from their sinonasal cancer within 1.5 years. Conclusion Patients who receive radiation exposure to the sinonasal region for treatment of a primary brain tumor, including low doses or scatter radiation, may be at risk of a secondary sinonasal malignancy later in life. Physicians who monitor at-risk patients must be vigilant of symptoms which may suggest sinonasal malignancy, and surveillance should include radiographic review with careful monitoring for a secondary malignancy throughout the entire irradiated field.
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Affiliation(s)
- Ben B. Levy
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Nilo Alvarez Toledo
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
| | - Sunit Das
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
| | - Mandolin Bartling
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Fahad Aldahari
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - John R. de Almeida
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, University Health Network, Toronto, Ontario, Canada
| | - Ilan Weinreb
- Department of Pathology, University Health Network, Toronto, Ontario, Canada
- Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Yvonne Chan
- Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Otolaryngology–Head and Neck Surgery, St. Michael's Hospital, Unity Health, Toronto, Ontario, Canada
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Woo PYM, Lee JWY, Lam SW, Pu JKS, Chan DTM, Mak CHK, Ho JMK, Wong ST, Po YC, Lee MWY, Chan KY, Poon WS. Radiotherapy-induced glioblastoma: distinct differences in overall survival, tumor location, pMGMT methylation and primary tumor epidemiology in Hong Kong chinese patients. Br J Neurosurg 2024; 38:385-392. [PMID: 33576706 DOI: 10.1080/02688697.2021.1881445] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Radiotherapy-induced glioblastomas (RIGB) are a well-known late and rare complication of brain irradiation. Yet the clinical, radiological and molecular characteristics of these tumors are not well characterized. METHODS This was a retrospective multicentre study that analysed adult patients with newly diagnosed glioblastoma over a 10-year period. Patients with RIGB were identified according to Cahan's criteria for radiation-induced tumors. A case-control analysis was performed to compare known prognostic factors for overall survival (OS) with an independent cohort of IDH-1 wildtype de novo glioblastomas treated with standard temozolomide chemoradiotherapy. Survival analysis was performed by Cox proportional hazards regression. RESULTS A total of 590 adult patients were diagnosed with glioblastoma. 19 patients (3%) had RIGB. The mean age of patients upon diagnosis was 48 years ± 15. The mean latency duration from radiotherapy to RIGB was 14 years ± 8. The mean total dose was 58Gy ± 10. One-third of patients (37%, 7/19) had nasopharyngeal cancer and a fifth (21%, 4/19) had primary intracranial germinoma. Compared to a cohort of 146 de novo glioblastoma patients, RIGB patients had a shorter median OS of 4.8 months versus 19.2 months (p-value: <.001). Over a third of RIGBs involved the cerebellum (37%, 7/19) and was higher than the control group (4%, 6/146; p-value: <.001). A fifth of RIGBs (21%, 3/19) were pMGMT methylated which was significantly fewer than the control group (49%, 71/146; p-value: .01). For RIGB patients (32%, 6/19) treated with re-irradiation, the one-year survival rate was 67% and only 8% for those without such treatment (p-value: .007). CONCLUSION The propensity for RIGBs to develop in the cerebellum and to be pMGMT unmethylated may contribute to their poorer prognosis. When possible re-irradiation may offer a survival benefit. Nasopharyngeal cancer and germinomas accounted for the majority of original malignancies reflecting their prevalence among Southern Chinese.
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Affiliation(s)
- Peter Y M Woo
- Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, Hong Kong
| | - Jennifer W Y Lee
- Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, Hong Kong
| | - Sandy W Lam
- Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, Hong Kong
| | - Jenny K S Pu
- Division of Neurosurgery, Department of Surgery, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Danny T M Chan
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong
| | - Calvin H K Mak
- Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - Jason M K Ho
- Department of Neurosurgery, Tuen Mun Hospital, Hong Kong, Hong Kong
| | - Sui-To Wong
- Department of Neurosurgery, Tuen Mun Hospital, Hong Kong, Hong Kong
| | - Yin-Chung Po
- Department of Neurosurgery, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Michael W Y Lee
- Department of Neurosurgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong, Hong Kong
| | - Kwong-Yau Chan
- Department of Neurosurgery, Kwong Wah Hospital, Hong Kong, Hong Kong
| | - Wai-Sang Poon
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong
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Yamamori A, Murayama S, Takahashi I, Akaihata M, Kakuda Y, Sugino T, Aramaki T, Onoe T, Takahashi Y, Ishida Y. Young Adult Secondary Cancer After Proton Beam Therapy: A Case Study. Adv Radiat Oncol 2024; 9:101307. [PMID: 38260212 PMCID: PMC10801643 DOI: 10.1016/j.adro.2023.101307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/26/2023] [Indexed: 01/24/2024] Open
Affiliation(s)
- Ayako Yamamori
- Division of Pediatrics (and the AYA Generation), Shizuoka Cancer Center, Shizuoka, Japan
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Ikuko Takahashi
- Division of Pediatrics (and the AYA Generation), Shizuoka Cancer Center, Shizuoka, Japan
| | - Mitsuko Akaihata
- Division of Pediatrics (and the AYA Generation), Shizuoka Cancer Center, Shizuoka, Japan
| | | | | | - Takeshi Aramaki
- Interventional Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Yoshiyuki Takahashi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuji Ishida
- Division of Pediatrics (and the AYA Generation), Shizuoka Cancer Center, Shizuoka, Japan
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8
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Yamic F, Koca T, Tuncel N, Aksoy RA, Korcum AF. Comparison of Doses to Parotid, Temporomandibular Joint, and Pharyngeal Constrictor Muscles Using Different Techniques in Radiotherapy for Oropharyngeal Cancer. Technol Cancer Res Treat 2024; 23:15330338241260646. [PMID: 38841792 PMCID: PMC11155356 DOI: 10.1177/15330338241260646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/02/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024] Open
Abstract
OBJECTIVE The purpose of this research was to compare two treatment techniques for oropharyngeal cancers: conventional linac-based static intensity-modulated radiotherapy (sIMRT) and helical tomotherapy (HT). The study examined several parameters, including target coverage, organs at risk, integral dose, and beam on time. Additionally, the study evaluated the doses to the parotid, temporomandibular joint, and pharyngeal constrictor muscles, which are important for swallowing. METHOD The present study retrospectively analyzed the data of 13 patients with oropharyngeal cancer who underwent radiotherapy between 2019 and 2021. The treatment plans for each patient were regenerated using both sIMRT and HT treatment planning systems with the sequential boost method. The techniques were evaluated and compared based on dose-volume histogram, homogeneity index, and conformity index parameters. The target coverage and organs at risk were statistically compared for two techniques. Additionally, the doses received by the healthy tissue volume were obtained for integral dose evaluation. The beam on time for each technique was assessed. RESULTS When considering planning target volume evaluation, there was no difference in Dmeans between the two techniques and sIMRT demonstrated higher D2% values compared to the HT. The HT technique had better results for all organs at risk, such as the parotid, temporomandibular joint, and pharyngeal constrictor muscle. As for integral dose, it has been shown that the sIMRT technique provides better protection compared to HT. In addition, the beam on time was also longer with the HT technique. CONCLUSION Both techniques may provide optimal target coverage for patients with oropharyngeal cancer. HT conferred notable advantages, especially with regard to critical structures implicated in swallowing, such as the parotid, temporomandibular joint, and pharyngeal constrictor muscle, in comparison to sIMRT.
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Affiliation(s)
- Ferda Yamic
- Department of Radiation Oncology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Timur Koca
- Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Nina Tuncel
- Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Rahmi Atil Aksoy
- Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Aylin Fidan Korcum
- Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey
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Muñoz-Hernández IS, Espinoza I, López-Martínez IN, Sánchez-Nieto B. IS 2aR, a computational tool to transform voxelized reference phantoms into patient-specific whole-body virtual CTs for peripheral dose estimation. Phys Med 2023; 116:103183. [PMID: 38000102 DOI: 10.1016/j.ejmp.2023.103183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/30/2023] [Accepted: 11/19/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The risk of radiogenic cancer induction due to radiotherapy depends on the dose received by the patient's organs. Knowing the position of all organs is needed to assess this dose in a personalized way. However, radiotherapy planning computed tomography (pCT) scans contain truncated patient anatomy, limiting personalized dose evaluation. PURPOSE To develop a simple and freely available computational tool that adapts an ICRP reference computational phantom to generate a patient-specific whole-body CT for peripheral dose computations. METHODS Various bone-segmentation methods were explored onto fifteen pCTs, and the one with the highest Sørensen-Dice coefficient was implemented. The reference phantom is registered to the pCT, obtaining a registration transform matrix, which is then applied to create the whole-body virtual CT. Additional validation involved a comparison of absorbed doses to organs delineated on both the pCT and the virtual CT. RESULTS A dedicated graphical user interface was designed and implemented to house the developed functions for i) selecting a registration region on which automatic bone segmentation and rigid registration will occur, ii) displaying the results of these processes under selectable views, and iii) exporting the final patient-specific whole-body CT. This software was termed IS2aR. The tested whole-body virtual CT generated by IS2aR fulfilled our requirements. CONCLUSIONS IS2aR is a user-friendly computational software to create a personalized whole-body CT containing the original structures in the reference phantom. The personalized dose deposited in peripheral organs can be estimated further to assess second cancer induction risk in epidemiological studies.
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Affiliation(s)
| | - Ignacio Espinoza
- Institute of Physics, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Bugdadi A, Cherif MA, Loganadane G, Brugières P, Marniche A, Itti E, Belkacemi Y, Tauziède-Espariat A, Palfi S, Senova S. Epithelioid glioblastoma diagnosed 70 years after craniofacial radiotherapy. Acta Neurochir (Wien) 2023; 165:2769-2774. [PMID: 37269332 DOI: 10.1007/s00701-023-05637-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/14/2023] [Indexed: 06/05/2023]
Abstract
The authors report a rare case of most likely radiation-induced glioma (RIG) with epithelioid features and the presence of molecular features consistent with RIG. This occurred 70 years after craniofacial brachytherapy. Such a late development of radiation-induced glioblastoma (RIGBM) and the advanced age of presentation for an epithelioid glioblastoma are both unique in the literature. Despite not receiving the full course of adjuvant chemotherapy after surgery and radiotherapy, the patient displayed no signs of recurrence during a 5-year follow-up. RIGBM should be further studied to reveal potential unique clinical and molecular characteristics, as well as to better predict survival and treatment response.
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Affiliation(s)
- Abdulgadir Bugdadi
- Department of Neurosurgery, INSERM Laboratory of Translational Neuropsychiatry, IMRB, Université Paris Est Créteil, Henri-Mondor University Hospital, Assistance Publique des Hôpitaux de Paris, Creteil, France
- Department of Surgery, Faculty of Medicine, Umm Al Qura University, Makkah, Saudi Arabia
| | - Mohamed Aziz Cherif
- Department of Radiotherapy, Henri-Mondor University Hospital, Creteil, France
| | | | - Pierre Brugières
- Department of Neuroradiology, Henri-Mondor University Hospital, Creteil, France
| | - Amel Marniche
- Department of Neurosurgery, INSERM Laboratory of Translational Neuropsychiatry, IMRB, Université Paris Est Créteil, Henri-Mondor University Hospital, Assistance Publique des Hôpitaux de Paris, Creteil, France
| | - Emmanuel Itti
- Department of Nuclear Medicine, Henri-Mondor University Hospital, Creteil, France
| | - Yazid Belkacemi
- Department of Radiotherapy, Henri-Mondor University Hospital, Creteil, France
| | | | - Stephane Palfi
- Department of Neurosurgery, INSERM Laboratory of Translational Neuropsychiatry, IMRB, Université Paris Est Créteil, Henri-Mondor University Hospital, Assistance Publique des Hôpitaux de Paris, Creteil, France
| | - Suhan Senova
- Department of Neurosurgery, INSERM Laboratory of Translational Neuropsychiatry, IMRB, Université Paris Est Créteil, Henri-Mondor University Hospital, Assistance Publique des Hôpitaux de Paris, Creteil, France.
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De Saint-Hubert M, Boissonnat G, Schneider U, Bäumer C, Verbeek N, Esser J, Wulff J, Stuckmann F, Suesselbeck F, Nabha R, Dabin J, Vasi F, Radonic S, Rodriguez M, Simon AC, Journy N, Timmermann B, Thierry-Chef I, Brualla L. Complete patient exposure during paediatric brain cancer treatment for photon and proton therapy techniques including imaging procedures. Front Oncol 2023; 13:1222800. [PMID: 37795436 PMCID: PMC10546320 DOI: 10.3389/fonc.2023.1222800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/21/2023] [Indexed: 10/06/2023] Open
Abstract
Background In radiotherapy, especially when treating children, minimising exposure of healthy tissue can prevent the development of adverse outcomes, including second cancers. In this study we propose a validated Monte Carlo framework to evaluate the complete patient exposure during paediatric brain cancer treatment. Materials and methods Organ doses were calculated for treatment of a diffuse midline glioma (50.4 Gy with 1.8 Gy per fraction) on a 5-year-old anthropomorphic phantom with 3D-conformal radiotherapy, intensity modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT) and intensity modulated pencil beam scanning (PBS) proton therapy. Doses from computed tomography (CT) for planning and on-board imaging for positioning (kV-cone beam CT and X-ray imaging) accounted for the estimate of the exposure of the patient including imaging therapeutic dose. For dose calculations we used validated Monte Carlo-based tools (PRIMO, TOPAS, PENELOPE), while lifetime attributable risk (LAR) was estimated from dose-response relationships for cancer induction, proposed by Schneider et al. Results Out-of-field organ dose equivalent data of proton therapy are lower, with doses between 0.6 mSv (testes) and 120 mSv (thyroid), when compared to photon therapy revealing the highest out-of-field doses for IMRT ranging between 43 mSv (testes) and 575 mSv (thyroid). Dose delivered by CT ranged between 0.01 mSv (testes) and 72 mSv (scapula) while a single imaging positioning ranged between 2 μSv (testes) and 1.3 mSv (thyroid) for CBCT and 0.03 μSv (testes) and 48 μSv (scapula) for X-ray. Adding imaging dose from CT and daily CBCT to the therapeutic demonstrated an important contribution of imaging to the overall radiation burden in the course of treatment, which is subsequently used to predict the LAR, for selected organs. Conclusion The complete patient exposure during paediatric brain cancer treatment was estimated by combining the results from different Monte Carlo-based dosimetry tools, showing that proton therapy allows significant reduction of the out-of-field doses and secondary cancer risk in selected organs.
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Affiliation(s)
| | | | - Uwe Schneider
- Physik Institut, Universitat Zürich, Zürich, Switzerland
| | - Christian Bäumer
- West German Proton Therapy Centre Essen WPE, Essen, Germany
- West German Cancer Centre (WTZ), Essen, Germany
- Radiation Oncology and Imaging, German Cancer Consortium DKTK, Essen, Germany
- Department of Physics, TU Dortmund University, Dortmund, Germany
| | - Nico Verbeek
- West German Proton Therapy Centre Essen WPE, Essen, Germany
- West German Cancer Centre (WTZ), Essen, Germany
| | - Johannes Esser
- West German Proton Therapy Centre Essen WPE, Essen, Germany
- West German Cancer Centre (WTZ), Essen, Germany
- Faculty of Mathematics and Science Institute of Physics and Medical Physics, Heinrich-Heine University, Düsseldorf, Germany
| | - Jörg Wulff
- West German Proton Therapy Centre Essen WPE, Essen, Germany
- West German Cancer Centre (WTZ), Essen, Germany
| | - Florian Stuckmann
- West German Proton Therapy Centre Essen WPE, Essen, Germany
- West German Cancer Centre (WTZ), Essen, Germany
| | - Finja Suesselbeck
- West German Proton Therapy Centre Essen WPE, Essen, Germany
- West German Cancer Centre (WTZ), Essen, Germany
| | - Racell Nabha
- Belgian Nuclear Research Center (SCK CEN), Mol, Belgium
| | - Jérémie Dabin
- Belgian Nuclear Research Center (SCK CEN), Mol, Belgium
| | - Fabiano Vasi
- Physik Institut, Universitat Zürich, Zürich, Switzerland
| | | | - Miguel Rodriguez
- Hospital Paitilla, Panama City, Panama
- Instituto de Investigaciones Científicas y de Alta Tecnología INDICASAT-AIP, Panama City, Panama
| | | | - Neige Journy
- INSERM U1018, Paris Sud-Paris Saclay University, Villejuif, France
| | - Beate Timmermann
- West German Proton Therapy Centre Essen WPE, Essen, Germany
- West German Cancer Centre (WTZ), Essen, Germany
- Radiation Oncology and Imaging, German Cancer Consortium DKTK, Essen, Germany
- Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
- Department of Particle Therapy, University Hospital Essen, Essen, Germany
| | - Isabelle Thierry-Chef
- Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain
- University Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Lorenzo Brualla
- West German Proton Therapy Centre Essen WPE, Essen, Germany
- West German Cancer Centre (WTZ), Essen, Germany
- Radiation Oncology and Imaging, German Cancer Consortium DKTK, Essen, Germany
- Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
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Nelson BE, Adashek JJ, Lin SH, Subbiah V. The abscopal effect in patients with cancer receiving immunotherapy. MED 2023; 4:233-244. [PMID: 36893753 PMCID: PMC10116408 DOI: 10.1016/j.medj.2023.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 10/08/2022] [Accepted: 02/07/2023] [Indexed: 03/10/2023]
Abstract
Interest in the abscopal effect has been rekindled over the past decade with the advent of immunotherapy. Although purportedly elusive, this phenomenon is being increasingly reported. Venturing further using a multimodality approach with an array of systemic agents and unconventional modalities is direly needed. In this perspective, we describe the fundamentals of abscopal responses (ARs), explore combinations with systemic therapies that hold promise in eliciting ARs, and reconnoiter unconventional modalities that may induce ARs. Finally, we scrutinize prospective agents and modalities that exhibit preclinical ability to elicit ARs and discuss prognostic biomarkers, their limitations, and pathways of abscopal resistance for reproducibility.
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Affiliation(s)
- Blessie Elizabeth Nelson
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jacob J Adashek
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Vivek Subbiah
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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13
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Attalla EM, Sinousy DM, Ibrahim HF, Elmekawy AF, Elhussiny FA. The accuracy of out of field dose calculations in commercial treatment planning system using GATE/GEANT4 Monte Carlo simulation. Radiat Phys Chem Oxf Engl 1993 2023. [DOI: 10.1016/j.radphyschem.2023.110772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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14
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Grandt CL, Brackmann LK, Poplawski A, Schwarz H, Marini F, Hankeln T, Galetzka D, Zahnreich S, Mirsch J, Spix C, Blettner M, Schmidberger H, Marron M. Identification of lncRNAs involved in response to ionizing radiation in fibroblasts of long-term survivors of childhood cancer and cancer-free controls. Front Oncol 2023; 13:1158176. [PMID: 37182169 PMCID: PMC10174438 DOI: 10.3389/fonc.2023.1158176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/27/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction Long non-coding ribonucleic acids (lncRNAs) are involved in the cellular damage response following exposure to ionizing radiation as applied in radiotherapy. However, the role of lncRNAs in radiation response concerning intrinsic susceptibility to late effects of radiation exposure has not been examined in general or in long-term survivors of childhood cancer with and without potentially radiotherapy-related second primary cancers, in particular. Methods Primary skin fibroblasts (n=52 each) of long-term childhood cancer survivors with a first primary cancer only (N1), at least one second primary neoplasm (N2+), as well as tumor-free controls (N0) from the KiKme case-control study were matched by sex, age, and additionally by year of diagnosis and entity of the first primary cancer. Fibroblasts were exposed to 0.05 and 2 Gray (Gy) X-rays. Differentially expressed lncRNAs were identified with and without interaction terms for donor group and dose. Weighted co-expression networks of lncRNA and mRNA were constructed using WGCNA. Resulting gene sets (modules) were correlated to the radiation doses and analyzed for biological function. Results After irradiation with 0.05Gy, few lncRNAs were differentially expressed (N0: AC004801.4; N1: PCCA-DT, AF129075.3, LINC00691, AL158206.1; N2+: LINC02315). In reaction to 2 Gy, the number of differentially expressed lncRNAs was higher (N0: 152, N1: 169, N2+: 146). After 2 Gy, AL109976.1 and AL158206.1 were prominently upregulated in all donor groups. The co-expression analysis identified two modules containing lncRNAs that were associated with 2 Gy (module1: 102 mRNAs and 4 lncRNAs: AL158206.1, AL109976.1, AC092171.5, TYMSOS, associated with p53-mediated reaction to DNA damage; module2: 390 mRNAs, 7 lncRNAs: AC004943.2, AC012073.1, AC026401.3, AC092718.4, MIR31HG, STXBP5-AS1, TMPO-AS1, associated with cell cycle regulation). Discussion For the first time, we identified the lncRNAs AL158206.1 and AL109976.1 as involved in the radiation response in primary fibroblasts by differential expression analysis. The co-expression analysis revealed a role of these lncRNAs in the DNA damage response and cell cycle regulation post-IR. These transcripts may be targets in cancer therapy against radiosensitivity, as well as provide grounds for the identification of at-risk patients for immediate adverse reactions in healthy tissues. With this work we deliver a broad basis and new leads for the examination of lncRNAs in the radiation response.
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Affiliation(s)
- Caine Lucas Grandt
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
- Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
- *Correspondence: Caine Lucas Grandt,
| | - Lara Kim Brackmann
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Alicia Poplawski
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Heike Schwarz
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Federico Marini
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Thomas Hankeln
- Institute of Organismic and Molecular Evolution, Molecular Genetics and Genome Analysis, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Danuta Galetzka
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sebastian Zahnreich
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Johanna Mirsch
- Radiation Biology and DNA Repair, Technical University of Darmstadt, Darmstadt, Germany
| | - Claudia Spix
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Heinz Schmidberger
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Manuela Marron
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
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Figuracion KCF, Halasz LM, Lam NY, Goldberg M, Stuckey J, Failor RA, Knowles LM, Artherholt S, Chou B, Francis CE, Knight K, Kaur M, Sadak T, McGranahan T. Surveillance of long-term complications after treatment of adult brain tumor survivors-review and evidence-based recommendations. Neurooncol Pract 2022; 9:475-486. [PMID: 36388419 PMCID: PMC9665061 DOI: 10.1093/nop/npac053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2024] Open
Abstract
As a result of treatment and diagnosis, adults with primary or metastatic brain tumors experience comorbidities that impacts their health and well-being. The Children's Oncology Group has guideline recommendations for childhood survivors of brain tumors; however, guidelines for monitoring long-term sequela among adult brain tumor survivors are lacking. The purpose of this review is to present the screening recommendations for the long-term complications after brain tumor treatment from a multidisciplinary panel of healthcare professionals. Chronic complications identified include cognitive dysfunction, vasculopathy, endocrinopathy, ophthalmic, ototoxicity, physical disability, sleep disturbance, mood disorder, unemployment, financial toxicity, and secondary malignancy. We invited specialists across disciplines to perform a literature search and provide expert recommendations for surveillance for long-term complications for adult brain tumor survivors. The Brain Tumor Center Survivorship Committee recommends routine screening using laboratory testing, subjective assessment of symptoms, and objective evaluations to appropriately monitor the complications of brain tumor treatments. Effective monitoring and treatment should involve collaboration with primary care providers and may require referral to other specialties and support services to provide patient-centered care during neuro-oncology survivorship. Further research is necessary to document the incidence and prevalence of medical complications as well as evaluate the efficacy of screening and neuro-oncology survivorship programs.
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Affiliation(s)
- Karl Cristie F Figuracion
- ITHS TL1 Training Program University of Washington School of Nursing, Seattle, Washington 98105, USA
- Alvord Brain Tumor Center, Department of Radiation Oncology, University of Washington, Seattle, Washington 98105, USA
| | - Lia M Halasz
- Department of Radiation Oncology, School of Medicine, University of Washington, Seattle, Washington 98105, USA
| | - Ny-Ying Lam
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington 98105, USA
| | - Myron Goldberg
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington 98105, USA
| | - Joe Stuckey
- Department of Rehabilitation Medicine, School of Medicine, 98105 University of Washington, Seattle, Washington 98105, USA
| | - Richard A Failor
- Department of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, Washington, 98105, USA
| | - Lindsey M Knowles
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington 98105, USA
| | - Samantha Artherholt
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington 98105, USA
| | - Brian Chou
- Department of Ophthalmology, School of Medicine, University of Washington, Seattle, Washington 98105, USA
| | - Courtney E Francis
- Department of Ophthalmology, School of Medicine, University of Washington, Seattle, Washington 98105, USA
| | - Kristin Knight
- Oregon Health and Science University, Portland, Oregon 97239, USA
| | - Maninder Kaur
- Loma Linda University Health, Loma Linda, California, USA
| | - Tatiana Sadak
- Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington 98105, USA
| | - Tresa McGranahan
- Department of Neurology, School of Medicine, University of Washington, Seattle, Washington 98105, USA
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Pazzaglia S, Eidemüller M, Lumniczky K, Mancuso M, Ramadan R, Stolarczyk L, Moertl S. Out-of-field effects: lessons learned from partial body exposure. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2022; 61:485-504. [PMID: 36001144 PMCID: PMC9722818 DOI: 10.1007/s00411-022-00988-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/03/2022] [Indexed: 05/27/2023]
Abstract
Partial body exposure and inhomogeneous dose delivery are features of the majority of medical and occupational exposure situations. However, mounting evidence indicates that the effects of partial body exposure are not limited to the irradiated area but also have systemic effects that are propagated outside the irradiated field. It was the aim of the "Partial body exposure" session within the MELODI workshop 2020 to discuss recent developments and insights into this field by covering clinical, epidemiological, dosimetric as well as mechanistic aspects. Especially the impact of out-of-field effects on dysfunctions of immune cells, cardiovascular diseases and effects on the brain were debated. The presentations at the workshop acknowledged the relevance of out-of-field effects as components of the cellular and organismal radiation response. Furthermore, their importance for the understanding of radiation-induced pathologies, for the discovery of early disease biomarkers and for the identification of high-risk organs after inhomogeneous exposure was emphasized. With the rapid advancement of clinical treatment modalities, including new dose rates and distributions a better understanding of individual health risk is urgently needed. To achieve this, a deeper mechanistic understanding of out-of-field effects in close connection to improved modelling was suggested as priorities for future research. This will support the amelioration of risk models and the personalization of risk assessments for cancer and non-cancer effects after partial body irradiation.
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Affiliation(s)
- S. Pazzaglia
- Laboratory of Biomedical Technologies, ENEA CR-Casaccia, Via Anguillarese 301, 00123 Rome, Italy
| | - M. Eidemüller
- Institute of Radiation Medicine, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - K. Lumniczky
- Department of Radiobiology and Radiohygiene, Unit of Radiation Medicine, National Public Health Centre, Albert Florian u. 2-6, 1097 Budapest, Hungary
| | - M. Mancuso
- Laboratory of Biomedical Technologies, ENEA CR-Casaccia, Via Anguillarese 301, 00123 Rome, Italy
| | - R. Ramadan
- Radiobiology Unit, Belgian Nuclear Research Centre (SCK CEN), Mol, Belgium
| | - L. Stolarczyk
- Danish Centre for Particle Therapy, Palle Juul-Jensens Boulevard 25, 8200 Aarhus N, Denmark
| | - S. Moertl
- Federal Office for Radiation Protection, Ingolstädter Landstr. 1, 85764 Oberschleißheim, Germany
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Kollitz E, Roew M, Han H, Pinto M, Kamp F, Kim CH, Schwarz M, Belka C, Newhauser W, Parodi K, Dedes G. Applications of a patient-specific whole-body CT-mesh hybrid computational phantom in second cancer risk prediction. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac8851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/09/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Objective. CT-mesh hybrid phantoms (or ‘hybrid(s)’) made from integrated patient CT data and mesh-type reference computational phantoms (MRCPs) can be beneficial for patient-specific whole-body dose evaluation, but this benefit has yet to be evaluated for second cancer risk prediction. The purpose of this study is to compare the hybrid’s ability to predict risk throughout the body with a patient-scaled MRCP against ground truth whole-body CTs (WBCTs). Approach. Head and neck active scanning proton treatment plans were created for and simulated on seven hybrids and the corresponding scaled MRCPs and WBCTs. Equivalent dose throughout the body was calculated and input into five second cancer risk models for both excess absolute and excess relative risk (EAR and ERR). The hybrid phantom was evaluated by comparing equivalent dose and risk predictions against the WBCT. Main results. The hybrid most frequently provides whole-body second cancer risk predictions which are closer to the ground truth when compared to a scaled MRCP alone. The performance of the hybrid relative to the scaled MRCP was consistent across ERR, EAR, and all risk models. For all in-field organs, where the hybrid shares the WBCT anatomy, the hybrid was better than or equal to the scaled MRCP for both equivalent dose and risk prediction. For out-of-field organs across all patients, the hybrid’s equivalent dose prediction was superior than the scaled MRCP in 48% of all comparisons, equivalent for 34%, and inferior for 18%. For risk assessment in the same organs, the hybrid’s prediction was superior than the scaled MRCP in 51.8% of all comparisons, equivalent in 28.6%, and inferior in 19.6%. Significance. Whole-body risk predictions from the CT-mesh hybrid have shown to be more accurate than those from a reference phantom alone. These hybrids could aid in risk-optimized treatment planning and individual risk assessment to minimize second cancer incidence.
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Grandt CL, Brackmann LK, Poplawski A, Schwarz H, Hummel-Bartenschlager W, Hankeln T, Kraemer C, Marini F, Zahnreich S, Schmitt I, Drees P, Mirsch J, Grabow D, Schmidberger H, Binder H, Hess M, Galetzka D, Marron M. Radiation-response in primary fibroblasts of long-term survivors of childhood cancer with and without second primary neoplasms: the KiKme study. Mol Med 2022; 28:105. [PMID: 36068491 PMCID: PMC9450413 DOI: 10.1186/s10020-022-00520-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 07/28/2022] [Indexed: 02/07/2023] Open
Abstract
Background The etiology and most risk factors for a sporadic first primary neoplasm in childhood or subsequent second primary neoplasms are still unknown. One established causal factor for therapy-associated second primary neoplasms is the exposure to ionizing radiation during radiation therapy as a mainstay of cancer treatment. Second primary neoplasms occur in 8% of all cancer survivors within 30 years after the first diagnosis in Germany, but the underlying factors for intrinsic susceptibilities have not yet been clarified. Thus, the purpose of this nested case–control study was the investigation and comparison of gene expression and affected pathways in primary fibroblasts of childhood cancer survivors with a first primary neoplasm only or with at least one subsequent second primary neoplasm, and controls without neoplasms after exposure to a low and a high dose of ionizing radiation. Methods Primary fibroblasts were obtained from skin biopsies from 52 adult donors with a first primary neoplasm in childhood (N1), 52 with at least one additional primary neoplasm (N2+), as well as 52 without cancer (N0) from the KiKme study. Cultured fibroblasts were exposed to a high [2 Gray (Gy)] and a low dose (0.05 Gy) of X-rays. Messenger ribonucleic acid was extracted 4 h after exposure and Illumina-sequenced. Differentially expressed genes (DEGs) were computed using limma for R, selected at a false discovery rate level of 0.05, and further analyzed for pathway enrichment (right-tailed Fisher’s Exact Test) and (in-) activation (z ≥|2|) using Ingenuity Pathway Analysis. Results After 0.05 Gy, least DEGs were found in N0 (n = 236), compared to N1 (n = 653) and N2+ (n = 694). The top DEGs with regard to the adjusted p-value were upregulated in fibroblasts across all donor groups (SESN1, MDM2, CDKN1A, TIGAR, BTG2, BLOC1S2, PPM1D, PHLDB3, FBXO22, AEN, TRIAP1, and POLH). Here, we observed activation of p53 Signaling in N0 and to a lesser extent in N1, but not in N2+. Only in N0, DNA (excision-) repair (involved genes: CDKN1A, PPM1D, and DDB2) was predicted to be a downstream function, while molecular networks in N2+ were associated with cancer, as well as injury and abnormalities (among others, downregulation of MSH6, CCNE2, and CHUK). After 2 Gy, the number of DEGs was similar in fibroblasts of all donor groups and genes with the highest absolute log2 fold-change were upregulated throughout (CDKN1A, TIGAR, HSPA4L, MDM2, BLOC1SD2, PPM1D, SESN1, BTG2, FBXO22, PCNA, and TRIAP1). Here, the p53 Signaling-Pathway was activated in fibroblasts of all donor groups. The Mitotic Roles of Polo Like Kinase-Pathway was inactivated in N1 and N2+. Molecular Mechanisms of Cancer were affected in fibroblasts of all donor groups. P53 was predicted to be an upstream regulator in fibroblasts of all donor groups and E2F1 in N1 and N2+. Results of the downstream analysis were senescence in N0 and N2+, transformation of cells in N0, and no significant effects in N1. Seven genes were differentially expressed in reaction to 2 Gy dependent on the donor group (LINC00601, COBLL1, SESN2, BIN3, TNFRSF10A, EEF1AKNMT, and BTG2). Conclusion Our results show dose-dependent differences in the radiation response between N1/N2+ and N0. While mechanisms against genotoxic stress were activated to the same extent after a high dose in all groups, the radiation response was impaired after a low dose in N1/N2+, suggesting an increased risk for adverse effects including carcinogenesis, particularly in N2+. Supplementary Information The online version contains supplementary material available at 10.1186/s10020-022-00520-6.
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Affiliation(s)
- Caine Lucas Grandt
- Leibniz Institute for Prevention Research and Epidemiology, BIPS, Achterstraße 30, 28359, Bremen, Germany.,Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Lara Kim Brackmann
- Leibniz Institute for Prevention Research and Epidemiology, BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Alicia Poplawski
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Heike Schwarz
- Leibniz Institute for Prevention Research and Epidemiology, BIPS, Achterstraße 30, 28359, Bremen, Germany
| | | | - Thomas Hankeln
- Institute of Organismic and Molecular Evolution, Molecular Genetics and Genome Analysis, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Christiane Kraemer
- Institute of Organismic and Molecular Evolution, Molecular Genetics and Genome Analysis, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Federico Marini
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sebastian Zahnreich
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Iris Schmitt
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Johanna Mirsch
- Radiation Biology and DNA Repair, Technical University of Darmstadt, Darmstadt, Germany
| | - Desiree Grabow
- Division of Childhood Cancer Epidemiology, German Childhood Cancer Registry, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Heinz Schmidberger
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Harald Binder
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Moritz Hess
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Danuta Galetzka
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Manuela Marron
- Leibniz Institute for Prevention Research and Epidemiology, BIPS, Achterstraße 30, 28359, Bremen, Germany.
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19
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Upadhyay R, Yadav D, Venkatesulu BP, Singh R, Baliga S, Raval RR, Lazow MA, Salloum R, Fouladi M, Mardis ER, Zaorsky NG, Trifiletti DM, Paulino AC, Palmer JD. Risk of secondary malignant neoplasms in children following proton therapy vs. photon therapy for primary CNS tumors: A systematic review and meta-analysis. Front Oncol 2022; 12:893855. [PMID: 36033525 PMCID: PMC9413159 DOI: 10.3389/fonc.2022.893855] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/21/2022] [Indexed: 11/20/2022] Open
Abstract
Background Central nervous system tumors are now the most common primary neoplasms seen in children, and radiation therapy is a key component in management. Secondary malignant neoplasms (SMNs) are rare, but dreaded complications. Proton beam therapy (PBT) can potentially minimize the risk of SMNs compared to conventional photon radiation therapy (RT), and multiple recent studies with mature data have reported the risk of SMNs after PBT. We performed this systematic review and meta-analysis to characterize and compare the incidence of SMNs after proton and photon-based radiation for pediatric CNS tumors. Methods A systematic search of literature on electronic (PubMed, Cochrane Central, and Embase) databases was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. We included studies reporting the incidence and nature of SMNs in pediatric patients with primary CNS tumors. The crude incidence of SMNs and all secondary neoplasms were separately extracted, and the random-effects model was used for pooled analysis and subgroup comparison was performed between studies using photons vs. protons. Results Twenty-four studies were included for analysis. A total of 418 SMNs were seen in 38,163 patients. The most common SMN were gliomas (40.6%) followed by meningiomas (38.7%), sarcomas (4.8%), and thyroid cancers (4.2%). The median follow-up was 8.8 years [3.3–23.2].The median latency to SMN for photons and protons were 11.9 years [5-23] and 5.9 years [5-6.7], respectively. The pooled incidence of SMNs was 1.8% (95% CI: 1.1%–2.6%, I2 = 94%) with photons and 1.5% (95% CI: 0%–4.5%, I2 = 81%) with protons. The pooled incidence of all SNs was not different [photons: 3.6% (95% CI: 2.5%–4.8%, I2 = 96%) vs. protons: 1.5% (95% CI: 0–4.5%, I2 = 80%); p = 0.21]. Conclusion We observed similar rates of SMN with PBT at 1.5% compared to 1.8% with photon-based RT for pediatric CNS tumors. We observed a shorter latency to SMN with PBT compared to RT. With increasing use of pencil beam scanning PBT and VMAT, further studies are warranted to evaluate the risk of secondary cancers in patients treated with these newer modalities.
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Affiliation(s)
- Rituraj Upadhyay
- Department of Radiation Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, OH, United States
| | - Divya Yadav
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | | | - Raj Singh
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, United States
| | - Sujith Baliga
- Department of Radiation Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, OH, United States
| | - Raju R. Raval
- Department of Radiation Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, OH, United States
| | - Margot A. Lazow
- Department of Radiation Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, OH, United States
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, United States
| | - Ralph Salloum
- Department of Radiation Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, OH, United States
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, United States
| | - Maryam Fouladi
- Department of Radiation Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, OH, United States
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, United States
| | - Elaine R. Mardis
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, United States
| | - Nicholas G. Zaorsky
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve School of Medicine, Cleveland, OH, United States
| | | | - Arnold C. Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Joshua D. Palmer
- Department of Radiation Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, OH, United States
- *Correspondence: Joshua D. Palmer,
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20
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Wilson LJ, Bryce-Atkinson A, Green A, Li Y, Merchant TE, van Herk M, Vasquez Osorio E, Faught AM, Aznar MC. Image-based data mining applies to data collected from children. Phys Med 2022; 99:31-43. [PMID: 35609381 PMCID: PMC9197776 DOI: 10.1016/j.ejmp.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/14/2022] [Accepted: 05/07/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Image-based data mining (IBDM) is a novel voxel-based method for analyzing radiation dose responses that has been successfully applied in adult data. Because anatomic variability and side effects of interest differ for children compared to adults, we investigated the feasibility of IBDM for pediatric analyses. METHODS We tested IBDM with CT images and dose distributions collected from 167 children (aged 10 months to 20 years) who received proton radiotherapy for primary brain tumors. We used data from four reference patients to assess IBDM sensitivity to reference selection. We quantified spatial-normalization accuracy via contour distances and deviations of the centers-of-mass of brain substructures. We performed dose comparisons with simplified and modified clinical dose distributions with a simulated effect, assessing their accuracy via sensitivity, positive predictive value (PPV) and Dice similarity coefficient (DSC). RESULTS Spatial normalizations and dose comparisons were insensitive to reference selection. Normalization discrepancies were small (average contour distance < 2.5 mm, average center-of-mass deviation < 6 mm). Dose comparisons identified differences (p < 0.01) in 81% of simplified and all modified clinical dose distributions. The DSCs for simplified doses were high (peak frequency magnitudes of 0.9-1.0). However, the PPVs and DSCs were low (maximum 0.3 and 0.4, respectively) in the modified clinical tests. CONCLUSIONS IBDM is feasible for childhood late-effects research. Our findings may inform cohort selection in future studies of pediatric radiotherapy dose responses and facilitate treatment planning to reduce treatment-related toxicities and improve quality of life among childhood cancer survivors.
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Affiliation(s)
- Lydia J Wilson
- St. Jude Children's Research Hospital, Department of Radiation Oncology, Memphis, TN, USA.
| | - Abigail Bryce-Atkinson
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Andrew Green
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Yimei Li
- St. Jude Children's Research Hospital, Department of Biostatistics, Memphis, TN, USA
| | - Thomas E Merchant
- St. Jude Children's Research Hospital, Department of Radiation Oncology, Memphis, TN, USA
| | - Marcel van Herk
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Eliana Vasquez Osorio
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Austin M Faught
- St. Jude Children's Research Hospital, Department of Radiation Oncology, Memphis, TN, USA
| | - Marianne C Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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21
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Validation and comparison of radiograph-based organ dose reconstruction approaches for Wilms’ tumor radiation treatment plans. Adv Radiat Oncol 2022; 7:101015. [PMID: 36060631 PMCID: PMC9429523 DOI: 10.1016/j.adro.2022.101015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 06/22/2022] [Indexed: 11/22/2022] Open
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22
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Shrestha S, Newhauser WD, Donahue WP, Pérez-Andújar A. Stray neutron radiation exposures from proton therapy: physics-based analytical models of neutron spectral fluence, kerma and absorbed dose. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac7377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/25/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Objective. Patients who receive proton beam therapy are exposed to unwanted stray neutrons. Stray radiations increase the risk of late effects in normal tissues, such as second cancers and cataracts, and may cause implanted devices such as pacemakers to malfunction. Compared to therapeutic beams, little attention has been paid to modeling stray neutron exposures. In the past decade, substantial progress was made to develop semiempirical models of stray neutron dose equivalent, but models to routinely calculate neutron absorbed dose and kerma are still lacking. The objective of this work was to develop a new physics based analytical model to calculate neutron spectral fluence, kerma, and absorbed dose in a water phantom. Approach. We developed the model using dosimetric data from Monte Carlo simulations and neutron kerma coefficients from the literature. The model explicitly considers the production, divergence, scattering, and attenuation of neutrons. Neutron production was modeled for 120–250 MeV proton beams impinging on a variety of materials. Fluence, kerma and dose calculations were performed in a 30 × 180 × 44 cm3 phantom at points up to 43 cm in depth and 80 cm laterally. Main Results. Predictions of the analytical model agreed reasonably with corresponding values from Monte Carlo simulations, with a mean difference in average energy deposited of 20%, average kerma coefficient of 21%, and absorbed dose to water of 49%. Significance. The analytical model is simple to implement and use, requires less configuration data that previously reported models, and is computationally fast. This model appears potentially suitable for integration in treatment planning system, which would enable risk calculations in prospective and retrospective cases, providing a powerful tool for epidemiological studies and clinical trials.
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23
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Hufnagl A, Johansson G, Siegbahn A, Durante M, Friedrich T, Scholz M. Modeling secondary cancer risk ratios for proton versus carbon ion beam therapy: A comparative study based on the local effect model. Med Phys 2022; 49:5589-5603. [PMID: 35717591 DOI: 10.1002/mp.15805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/18/2022] [Accepted: 05/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ion beam therapy allows for substantial sparing of normal tissues. Besides deterministic normal-tissue complications, stochastic long-term effects like secondary cancer (SC) induction are of importance when comparing different treatment modalities. PURPOSE To develop a modeling approach for comparison of SC risk in proton and carbon ion therapy. METHODS AND MATERIALS The local effect model (LEM) is used to predict the relative biological effectiveness (RBE) of SC induction after particle therapy. A key feature of the new approach is the double use of the LEM, reflecting the competition between the two processes of mutation induction (leading to cancer development) and cell inactivation (leading to suppression of cancer development). Based on previous investigations, treatment plans were in this work analyzed for an idealized geometry in order to assess the underlying systematic dependencies of cancer induction. In a further step, relative SC risks were predicted for proton and carbon ion treatment plans prepared for 10 prostate cancer patients. RESULTS We investigated the impact of factors such as treatment plan geometry, fractionation scheme, and tissue radiosensitivity to photon irradiation on the ion beam SC risk. Our model studies do not result in a clear preference for either protons or carbon ions, but rather indicate a complex interplay of different aspects. Reduced lateral scattering leads to a lower SC risk for carbon ions compared to protons at the lateral field margins in the entrance channel, while an increased risk was found closely behind the tumor due to projectile fragmentation. The fractionation scheme had little impact on the expected risk ratio. With respect to sensitivity parameters, those characterizing RBE for cell killing of potentially cancerous cells as well as of the primary tumor had the most significant impact. The observed general systematic dependencies are in agreement with results from previous model studies. The prostate patient study reveals reduced SC risks predictions for skin and bones for carbon ions as compared to protons, but higher mean risks for bladder and rectum. CONCLUSION The methods established in this work provide a basis for further investigating treatment optimizing strategies for ion beam therapy with regard to SC risk comparisons.
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Affiliation(s)
- Antonia Hufnagl
- GSI Helmholtz Centre for Heavy Ion Research, Department of Biophysics, Darmstadt, Germany
| | | | - Albert Siegbahn
- Department of Oncology, Södersjukhuset, Stockholm, Sweden.,Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Marco Durante
- GSI Helmholtz Centre for Heavy Ion Research, Department of Biophysics, Darmstadt, Germany.,Technical University Darmstadt, Institute for Condensed Matter Physics
| | - Thomas Friedrich
- GSI Helmholtz Centre for Heavy Ion Research, Department of Biophysics, Darmstadt, Germany
| | - Michael Scholz
- GSI Helmholtz Centre for Heavy Ion Research, Department of Biophysics, Darmstadt, Germany
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24
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Wakeford R, Hauptmann M. The risk of cancer following high, and very high, doses of ionising radiation. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:020518. [PMID: 35671754 DOI: 10.1088/1361-6498/ac767b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
It is established that moderate-to-high doses of ionising radiation increase the risk of subsequent cancer in the exposed individual, but the question arises as to the risk of cancer from higher doses, such as those delivered during radiotherapy, accidents, or deliberate acts of malice. In general, the cumulative dose received during a course of radiation treatment is sufficiently high that it would kill a person if delivered as a single dose to the whole body, but therapeutic doses are carefully fractionated and high/very high doses are generally limited to a small tissue volume under controlled conditions. The very high cumulative doses delivered as fractions during radiation treatment are designed to inactivate diseased cells, but inevitably some healthy cells will also receive high/very high doses. How the doses (ranging from <1 Gy to tens of Gy) received by healthy tissues during radiotherapy affect the risk of second primary cancer is an increasingly important issue to address as more cancer patients survive the disease. Studies show that, except for a turndown for thyroid cancer, a linear dose-response for second primary solid cancers seems to exist over a cumulative gamma radiation dose range of tens of gray, but with a gradient of excess relative risk per Gy that varies with the type of second cancer, and which is notably shallower than that found in the Japanese atomic bomb survivors receiving a single moderate-to-high acute dose. The risk of second primary cancer consequent to high/very high doses of radiation is likely to be due to repopulation of heavily irradiated tissues by surviving stem cells, some of which will have been malignantly transformed by radiation exposure, although the exact mechanism is not known, and various models have been proposed. It is important to understand the mechanisms that lead to the raised risk of second primary cancers consequent to the receipt of high/very high doses, in particular so that the risks associated with novel radiation treatment regimens-for example, intensity modulated radiotherapy and volumetric modulated arc therapy that deliver high doses to the target volume while exposing relatively large volumes of healthy tissue to low/moderate doses, and treatments using protons or heavy ions rather than photons-may be properly assessed.
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Affiliation(s)
- Richard Wakeford
- Centre for Occupational and Environmental Health, The University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School, Fehrbelliner Strasse 38, 16816 Neuruppin, Germany
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25
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Tringale KR, Casey DL, Niyazov G, Lavery JA, Moskowitz C, Friedman DN, Wolden SL. Second cancer risk in childhood cancer survivors treated with intensity-modulated radiation therapy: An updated analysis of more than 10 years of follow-up. Pediatr Blood Cancer 2022; 69:e29600. [PMID: 35234340 PMCID: PMC9476885 DOI: 10.1002/pbc.29600] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/24/2022] [Accepted: 01/29/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND It is unclear how intensity-modulated radiation therapy (IMRT) impacts long-term risk of second malignant neoplasms (SMNs) in childhood cancer patients. PROCEDURE Patients aged ≤21 years treated with IMRT between 1998 and 2009 and who survived ≥5 years after IMRT were included. SMN site in relation to isodose level (IDL) of IMRT was evaluated. Standardized incidence ratios (SIR) and excess absolute risks (EAR) were calculated. Cumulative incidences were estimated with death as a competing risk. RESULTS Three-hundred twenty-five patients were included with median follow-up of 11.2 years from IMRT (interquartile range: 9.4-14.0) among patients alive at the end of follow-up. Two hundred (62%) patients had ≥10 years of follow-up and 284 (87%) patients were alive at the time of analysis. Fifteen patients developed SMNs (11 solid, four hematologic). Median time from IMRT to solid SMN was 11.0 years (range: 6.8-19.2) with 10- and 15-year cumulative incidences 1.8% (95% CI: 0.7-3.9) and 3.5% (95% CI: 1.4-7.5), respectively; SIR was 13.7 (95% CI: 6.9-24.6) and EAR was 2.8 per 1000 person-years (95% CI: 1.0-4.6). Eight solid SMNs developed within the IMRT field (100% IDL [n = 5], 80% IDL [n = 1], 50% IDL [n = 1], 40% IDL [n = 1]), one within the 70%-80% IDL of a conventional field, one was out-of-field, and one could not be determined. CONCLUSIONS With median follow-up of >10 years, many solid SMNs after IMRT in childhood cancer survivors develop in the high-dose region. These data serve as a foundation for comparison with other modalities of radiation treatment (e.g., proton therapy).
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Affiliation(s)
| | - Dana L. Casey
- Department of Radiation Oncology, University of North Carolina
| | - Gregory Niyazov
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center
| | - Jessica A. Lavery
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center
| | - Chaya Moskowitz
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center
| | | | - Suzanne L. Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center
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26
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Tzanis E, Mazonakis M, Damilakis J. A software tool for organ-specific second cancer risk assessment from exposure to therapeutic doses. Rep Pract Oncol Radiother 2022; 27:170-175. [PMID: 35402031 PMCID: PMC8989449 DOI: 10.5603/rpor.a2022.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/16/2022] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was the development of a software tool (SCRcalc) for the automatic estimation of the patient- and organ-specific cancer risk due to radiotherapy. SCRcalc was developed using the Python 3.8.7 programming language. It incorporates equations and parameters of mechanistic models for the calculation of the organ equivalent dose (OED), the excess absolute risk (EA R) and the lifetime attributable risk (LA R) of carcinogenesis for various organs due to radiotherapy. Data from differential dose-volume histograms, as defined by a treatment planning system, could be automatically inserted into the program. Eighteen different cancer risk estimates for various organs were performed of patients subjected to radiation therapy with conventional and modulated techniques. These software estimates were compared with manual calculations. SCRcalc was developed as a standalone executable program without any dependencies. It enables direct estimations of the OED and LAR for various organs at risk. An important aspect of the software is that it does not require pre-processing of the DVH data. No differences were found between the SCRcalc results and those derived from manual calculations. The newly developed software offers the possibility to medical physicists and radiation oncologists to directly estimate the probability of radiotherapy-induced secondary malignancies for various organs at risk.
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Affiliation(s)
- Eleftherios Tzanis
- Department of Medical Physics, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Michael Mazonakis
- Department of Medical Physics, Medical School, University of Crete, Heraklion, Crete, Greece
| | - John Damilakis
- Department of Medical Physics, Medical School, University of Crete, Heraklion, Crete, Greece
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27
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Goy E, Tomezak M, Facchin C, Martin N, Bouchaert E, Benoit J, de Schutter C, Nassour J, Saas L, Drullion C, Brodin PM, Vandeputte A, Molendi-Coste O, Pineau L, Goormachtigh G, Pluquet O, Pourtier A, Cleri F, Lartigau E, Penel N, Abbadie C. The out-of-field dose in radiation therapy induces delayed tumorigenesis by senescence evasion. eLife 2022; 11:67190. [PMID: 35302491 PMCID: PMC8933005 DOI: 10.7554/elife.67190] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
A rare but severe complication of curative-intent radiation therapy is the induction of second primary cancers. These cancers preferentially develop not inside the planning target volume (PTV) but around, over several centimeters, after a latency period of 1–40 years. We show here that normal human or mouse dermal fibroblasts submitted to the out-of-field dose scattering at the margin of a PTV receiving a mimicked patient’s treatment do not die but enter in a long-lived senescent state resulting from the accumulation of unrepaired DNA single-strand breaks, in the almost absence of double-strand breaks. Importantly, a few of these senescent cells systematically and spontaneously escape from the cell cycle arrest after a while to generate daughter cells harboring mutations and invasive capacities. These findings highlight single-strand break-induced senescence as the mechanism of second primary cancer initiation, with clinically relevant spatiotemporal specificities. Senescence being pharmacologically targetable, they open the avenue for second primary cancer prevention.
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Affiliation(s)
- Erwan Goy
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000 Lille, France
| | - Maxime Tomezak
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000 Lille, France.,Univ. Lille, CNRS, UMR8520, Institut d'Electronique, Microélectronique et Nanotechnologie, F-59652 Villeneuve d'Ascq, France
| | - Caterina Facchin
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000 Lille, France
| | - Nathalie Martin
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000 Lille, France
| | - Emmanuel Bouchaert
- Oncovet Clinical Research, Plateforme PRECI, F-59120 Loos, France.,Oncovet, Plateforme PRECI, F-59650 Villeneuve d'Ascq, France
| | - Jerome Benoit
- Oncovet Clinical Research, Plateforme PRECI, F-59120 Loos, France.,Oncovet, Plateforme PRECI, F-59650 Villeneuve d'Ascq, France
| | - Clementine de Schutter
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000 Lille, France
| | - Joe Nassour
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000 Lille, France
| | - Laure Saas
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000 Lille, France
| | - Claire Drullion
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000 Lille, France
| | - Priscille M Brodin
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - CIIL - Centre d'Infection et d'Immunité de Lille, F-59000 Lille, France
| | - Alexandre Vandeputte
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - CIIL - Centre d'Infection et d'Immunité de Lille, F-59000 Lille, France
| | - Olivier Molendi-Coste
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011 - EGID, F-59000 Lille, France
| | - Laurent Pineau
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011 - EGID, F-59000 Lille, France
| | - Gautier Goormachtigh
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000 Lille, France
| | - Olivier Pluquet
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000 Lille, France
| | - Albin Pourtier
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000 Lille, France
| | - Fabrizio Cleri
- Univ. Lille, CNRS, UMR8520, Institut d'Electronique, Microélectronique et Nanotechnologie, F-59652 Villeneuve d'Ascq, France
| | - Eric Lartigau
- Lille University, Medical School and Centre Oscar Lambret, Lille, France
| | - Nicolas Penel
- Lille University, Medical School and Centre Oscar Lambret, Lille, France
| | - Corinne Abbadie
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UMR9020-U1277 - CANTHER - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000 Lille, France
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Zolcsak Z, Loap P, Fourquet A, Kirova Y. Long-term follow-up results of intensity-modulated radiotherapy with helicoïdal tomotherapy for non-metastatic breast cancers: Single centre experience. Cancer Radiother 2022; 26:654-662. [DOI: 10.1016/j.canrad.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/18/2021] [Accepted: 12/10/2021] [Indexed: 01/19/2023]
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Tillery H, Moore M, Gallagher KJ, Taddei PJ, Leuro E, Argento DC, Moffitt GB, Kranz M, Carey M, Heymsfield S, Newhauser WD. Personalized 3D-printed anthropomorphic whole-body phantom irradiated by protons, photons, and neutrons. Biomed Phys Eng Express 2022; 8. [PMID: 35045408 DOI: 10.1088/2057-1976/ac4d04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/19/2022] [Indexed: 11/12/2022]
Abstract
The objective of this study was to confirm the feasibility of three-dimensionally-printed (3D-printed), personalized whole-body anthropomorphic phantoms for radiation dose measurements in a variety of charged and uncharged particle radiation fields. We 3D-printed a personalized whole-body phantom of an adult female with a height of 154.8 cm, mass of 90.7 kg, and body mass index of 37.8 kg/m2. The phantom comprised of a hollow plastic shell filled with water and included a watertight access conduit for positioning dosimeters. It is compatible with a wide variety of radiation dosimeters, including ionization chambers that are suitable for uncharged and charged particles. Its mass was 6.8 kg empty and 98 kg when filled with water. Watertightness and mechanical robustness were confirmed after multiple experiments and transportations between institutions. The phantom was irradiated to the cranium with therapeutic beams of 170-MeV protons, 6-MV photons, and fast neutrons. Radiation absorbed dose was measured from the cranium to the pelvis along the longitudinal central axis of the phantom. The dose measurements were made using established dosimetry protocols and well-characterized instruments. For the therapeutic environments considered in this study, stray radiation from intracranial treatment beams was the lowest for proton therapy, intermediate for photon therapy, and highest for neutron therapy. An illustrative example set of measurements at the location of the thyroid for a square field of 5.3 cm per side resulted in 0.09, 0.59, and 1.93 cGy/Gy from proton, photon, and neutron beams, respectively. In this study, we found that 3D-printed personalized phantoms are feasible, inherently reproducible, and well-suited for therapeutic radiation measurements. The measurement methodologies we developed enabled the direct comparison of radiation exposures from neutron, proton, and photon beam irradiations.
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Affiliation(s)
- Hunter Tillery
- Radiation Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, KPV4, Portland, Oregon, 97239-3098, UNITED STATES
| | - Meagan Moore
- Louisiana State University, 439-B Nicholson Hall, Tower Dr., Baton Rouge, Louisiana, 70803-4001, UNITED STATES
| | - Kyle Joseph Gallagher
- Radiation Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Road, KPV4, Portland, Oregon, 97239-3098, UNITED STATES
| | - Phillip J Taddei
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, Minnesota, 55905, UNITED STATES
| | - Eric Leuro
- Seattle Cancer Care Alliance, 1570 N 115th St, Seattle, Washington, 98133, UNITED STATES
| | - David C Argento
- Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, Washington, 98195, UNITED STATES
| | - Gregory B Moffitt
- Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, Washington, 98195, UNITED STATES
| | - Marissa Kranz
- University of Washington School of Medicine, 1959 NE Pacific St, Seattle, Washington, 98195, UNITED STATES
| | - Margaret Carey
- Louisiana State University, 439-B Nicholson Hall, Tower Dr., Baton Rouge, Louisiana, 70803-4001, UNITED STATES
| | - Steven Heymsfield
- Louisiana State University, 439-B Nicholson Hall, Tower Dr., Baton Rouge, Louisiana, 70803-4001, UNITED STATES
| | - Wayne David Newhauser
- Louisiana State University, 439-B Nicholson Hall, Tower Dr., Baton Rouge, Louisiana, 70803-4001, UNITED STATES
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30
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Kollitz E, Han H, Kim CH, Pinto M, Schwarz M, Riboldi M, Kamp F, Belka C, Newhauser WD, Dedes G, Parodi K. A patient-specific hybrid phantom for calculating radiation dose and equivalent dose to the whole body. Phys Med Biol 2021; 67. [PMID: 34969024 DOI: 10.1088/1361-6560/ac4738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/30/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE As cancer survivorship increases, there is growing interest in minimizing the late effects of radiation therapy such as radiogenic second cancer, which may occur anywhere in the body. Assessing the risk of late effects requires knowledge of the dose distribution throughout the whole body, including regions far from the treatment field, beyond the typical anatomical extent of clinical CT scans. APPROACH A hybrid phantom was developed which consists of in-field patient CT images extracted from ground truth whole-body CT (WBCT) scans, out-of-field mesh phantoms scaled to basic patient measurements, and a blended transition region. Four of these hybrid phantoms were created, representing male and female patients receiving proton therapy treatment in pelvic and cranial sites. To assess the performance of the hybrid approach, we simulated treatments using the hybrid phantoms, the scaled and unscaled mesh phantoms, and the ground truth whole-body CTs. We calculated absorbed dose and equivalent dose in and outside of the treatment field, with a focus on neutrons induced in the patient by proton therapy. Proton and neutron dose was calculated using a general purpose Monte Carlo code. MAIN RESULTS The hybrid phantom provided equal or superior accuracy in calculated organ dose and equivalent dose values relative to those obtained using the mesh phantoms in 78% in all selected organs and calculated dose quantities. Comparatively the default mesh and scaled mesh were equal or superior to the other phantoms in 21% and 28% of cases respectively. SIGNIFICANCE The proposed methodology for hybrid synthesis provides a tool for whole-body organ dose estimation for individual patients without requiring CT scans of their entire body. Such a capability would be useful for personalized assessment of late effects and risk-optimization of treatment plans.
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Affiliation(s)
- Erika Kollitz
- Department of Medical Physics, Ludwig-Maximilians-Universitat Munchen, Ludwig-Maximilians-Universität München, Department for Medical Physics (LS Parodi), Am Coulombwall 1, Garching, Bayern, 85748, GERMANY
| | - Haegin Han
- Department of Nuclear Engineering, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seongdong-gu, Seoul, 04763, Korea (the Republic of)
| | - Chan Hyeong Kim
- Department of Nuclear Engineering, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seongdong-gu, Seoul, 04763, Korea (the Republic of)
| | - Marco Pinto
- Ludwig-Maximilians-Universitat Munchen, Ludwig-Maximilians-Universität München, Department for Medical Physics (LS Parodi), Am Coulombwall 1, Garching, Bayern, 85748, GERMANY
| | - Marco Schwarz
- Provincia autonoma di Trento Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, Trento, Trentino-Alto Adige, 38123, ITALY
| | - Marco Riboldi
- Department of Medical Physics, Ludwig-Maximilians-Universitat Munchen, Ludwig-Maximilians-Universität München, Department for Medical Physics (LS Parodi), Am Coulombwall 1, Munchen, Bayern, 85748, GERMANY
| | - Florian Kamp
- Radiotherapy, Klinikum der Universitat Munchen, Marchioninistraße 15, Munich, 81377, GERMANY
| | - Claus Belka
- Department of Radiation Oncology, Klinikum der Universitat Munchen, Marchioninistraße 15, Munchen, Bayern, 81377, GERMANY
| | - Wayne David Newhauser
- Department of Physics & Astronomy, Louisiana State University, 202 Nicholson Hall, Baton Rouge, Louisiana, 70803, UNITED STATES
| | - Georgios Dedes
- Department of Medical Physics, Ludwig-Maximilians-Universitat Munchen, Ludwig-Maximilians-Universität München, Department for Medical Physics (LS Parodi), Am Coulombwall 1, Munchen, Bayern, 85748, GERMANY
| | - Katia Parodi
- Experimental Physics Medical Physics, Ludwig-Maximilians-Universitat Munchen, Ludwig-Maximilians-Universität München, Department for Medical Physics (LS Parodi), Am Coulombwall 1, Munchen, Bayern, 85748, GERMANY
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31
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Avoidance or adaptation of radiotherapy in patients with cancer with Li-Fraumeni and heritable TP53-related cancer syndromes. Lancet Oncol 2021; 22:e562-e574. [PMID: 34856153 DOI: 10.1016/s1470-2045(21)00425-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 12/18/2022]
Abstract
The management of patients with cancer and Li-Fraumeni or heritable TP53-related cancer syndromes is complex because of their increased risk of developing second malignant neoplasms after genotoxic stresses such as systemic treatments or radiotherapy (radiosusceptibility). Clinical decision making also integrates the risks of normal tissue toxicity and sequelae (radiosensitivity) and tumour response to radiotherapy (radioresistance and radiocurability). Radiotherapy should be avoided in patients with cancer and Li-Fraumeni or heritable TP53 cancer-related syndromes, but overall prognosis might be poor without radiotherapy: radioresistance in these patients seems similar to or worse than that of the general population. Radiosensitivity in germline TP53 variant carriers seems similar to that in the general population. The risk of second malignant neoplasms according to germline TP53 variant and the patient's overall oncological prognosis should be assessed during specialised multidisciplinary staff meetings. Radiotherapy should be avoided whenever other similarly curative treatment options are available. In other cases, it should be adapted to minimise the risk of second malignant neoplasms in patients who still require radiotherapy despite its genotoxicity, in view of its potential benefit. Adaptations might be achieved through the reduction of irradiated volumes using proton therapy, non-ionising diagnostic procedures, image guidance, and minimal stray radiation. Non-ionising imaging should become more systematic. Radiotherapy approaches that might result in a lower probability of misrepaired DNA damage (eg, particle therapy biology and tumour targeting) are an area of investigation.
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Marron M, Brackmann LK, Schwarz H, Hummel-Bartenschlager W, Zahnreich S, Galetzka D, Schmitt I, Grad C, Drees P, Hopf J, Mirsch J, Scholz-Kreisel P, Kaatsch P, Poplawski A, Hess M, Binder H, Hankeln T, Blettner M, Schmidberger H. Identification of Genetic Predispositions Related to Ionizing Radiation in Primary Human Skin Fibroblasts From Survivors of Childhood and Second Primary Cancer as Well as Cancer-Free Controls: Protocol for the Nested Case-Control Study KiKme. JMIR Res Protoc 2021; 10:e32395. [PMID: 34762066 PMCID: PMC8663494 DOI: 10.2196/32395] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Therapy for a first primary neoplasm (FPN) in childhood with high doses of ionizing radiation is an established risk factor for second primary neoplasms (SPN). An association between exposure to low doses and childhood cancer is also suggested; however, results are inconsistent. As only subgroups of children with FPNs develop SPNs, an interaction between radiation, genetic, and other risk factors is presumed to influence cancer development. OBJECTIVE Therefore, the population-based, nested case-control study KiKme aims to identify differences in genetic predisposition and radiation response between childhood cancer survivors with and without SPNs as well as cancer-free controls. METHODS We conducted a population-based, nested case-control study KiKme. Besides questionnaire information, skin biopsies and saliva samples are available. By measuring individual reactions to different exposures to radiation (eg, 0.05 and 2 Gray) in normal somatic cells of the same person, our design enables us to create several exposure scenarios for the same person simultaneously and measure several different molecular markers (eg, DNA, messenger RNA, long noncoding RNA, copy number variation). RESULTS Since 2013, 101 of 247 invited SPN patients, 340 of 1729 invited FPN patients, and 150 of 246 invited cancer-free controls were recruited and matched by age and sex. Childhood cancer patients were additionally matched by tumor morphology, year of diagnosis, and age at diagnosis. Participants reported on lifestyle, socioeconomical, and anthropometric factors, as well as on medical radiation history, health, and family history of diseases (n=556). Primary human fibroblasts from skin biopsies of the participants were cultivated (n=499) and cryopreserved (n=3886). DNA was extracted from fibroblasts (n=488) and saliva (n=510). CONCLUSIONS This molecular-epidemiological study is the first to combine observational epidemiological research with standardized experimental components in primary human skin fibroblasts to identify genetic predispositions related to ionizing radiation in childhood and SPNs. In the future, fibroblasts of the participants will be used for standardized irradiation experiments, which will inform analysis of the case-control study and vice versa. Differences between participants will be identified using several molecular markers. With its innovative combination of experimental and observational components, this new study will provide valuable data to forward research on radiation-related risk factors in childhood cancer and SPNs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/32395.
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Affiliation(s)
- Manuela Marron
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Lara Kim Brackmann
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Heike Schwarz
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | - Sebastian Zahnreich
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Danuta Galetzka
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Iris Schmitt
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Christian Grad
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Philipp Drees
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Johannes Hopf
- Department of Orthopedics and Traumatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Johanna Mirsch
- Radiation Biology and DNA Repair, Technical University of Darmstadt, Darmstadt, Germany
| | - Peter Scholz-Kreisel
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Peter Kaatsch
- German Childhood Cancer Registry, Institute for Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Alicia Poplawski
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Moritz Hess
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Harald Binder
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Thomas Hankeln
- Institute of Organismic and Molecular Evolution, Molecular Genetics and Genome Analysis, Johannes Gutenberg University, Mainz, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Heinz Schmidberger
- Department of Radiation Oncology and Radiation Therapy, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Węgierek-Ciuk A, Lankoff A, Lisowska H, Kędzierawski P, Akuwudike P, Lundholm L, Wojcik A. Cisplatin Reduces the Frequencies of Radiotherapy-Induced Micronuclei in Peripheral Blood Lymphocytes of Patients with Gynaecological Cancer: Possible Implications for the Risk of Second Malignant Neoplasms. Cells 2021; 10:2709. [PMID: 34685687 PMCID: PMC8534481 DOI: 10.3390/cells10102709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 01/22/2023] Open
Abstract
Gynaecologic cancers are common among women and treatment includes surgery, radiotherapy or chemotherapy, where the last two methods induce DNA damage in non-targeted cells like peripheral blood lymphocytes (PBL). Damaged normal cells can transform leading to second malignant neoplasms (SMN) but the level of risk and impact of risk modifiers is not well defined. We investigated how radiotherapy alone or in combination with chemotherapy induce DNA damage in PBL of cervix and endometrial cancer patients during therapy. Blood samples were collected from nine endometrial cancer patients (treatment with radiotherapy + chemotherapy-RC) and nine cervical cancer patients (treatment with radiotherapy alone-R) before radiotherapy, 3 weeks after onset of radiotherapy and at the end of radiotherapy. Half of each blood sample was irradiated ex vivo with 2 Gy of gamma radiation in order to check how therapy influenced the sensitivity of PBL to radiation. Analysed endpoints were micronucleus (MN) frequencies, apoptosis frequencies and cell proliferation index. The results were characterised by strong individual variation, especially the MN frequencies and proliferation index. On average, despite higher total dose and larger fields, therapy alone induced the same level of MN in PBL of RC patients as compared to R. This result was accompanied by a higher level of apoptosis and stronger inhibition of cell proliferation in RC patients. The ex vivo dose induced fewer MN, more apoptosis and more strongly inhibited proliferation of PBL of RC as compared to R patients. These results are interpreted as evidence for a sensitizing effect of chemotherapy on radiation cytotoxicity. The possible implications for the risk of second malignant neoplasms are discussed.
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Affiliation(s)
- Aneta Węgierek-Ciuk
- Department of Medical Biology, Institute of Biology, Jan Kochanowski University, Uniwersytecka 7, 25-406 Kielce, Poland; (A.L.); (H.L.); (A.W.)
| | - Anna Lankoff
- Department of Medical Biology, Institute of Biology, Jan Kochanowski University, Uniwersytecka 7, 25-406 Kielce, Poland; (A.L.); (H.L.); (A.W.)
- Centre for Radiobiology and Biological Dosimetry, Institute of Nuclear Chemistry and Technology, Dorodna 16, 03-195 Warsaw, Poland
| | - Halina Lisowska
- Department of Medical Biology, Institute of Biology, Jan Kochanowski University, Uniwersytecka 7, 25-406 Kielce, Poland; (A.L.); (H.L.); (A.W.)
| | - Piotr Kędzierawski
- Department of Radiotherapy, Holy Cross Cancer Center, Artwinskiego 3, 25-734 Kielce, Poland;
| | - Pamela Akuwudike
- Centre for Radiation Protection Research, Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, 10691 Stockholm, Sweden; (P.A.); (L.L.)
| | - Lovisa Lundholm
- Centre for Radiation Protection Research, Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, 10691 Stockholm, Sweden; (P.A.); (L.L.)
| | - Andrzej Wojcik
- Department of Medical Biology, Institute of Biology, Jan Kochanowski University, Uniwersytecka 7, 25-406 Kielce, Poland; (A.L.); (H.L.); (A.W.)
- Centre for Radiation Protection Research, Department of Molecular Biosciences, The Wenner-Gren Institute, Stockholm University, 10691 Stockholm, Sweden; (P.A.); (L.L.)
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34
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Out-of-field organ doses and associated risk of cancer development following radiation therapy with photons. Phys Med 2021; 90:73-82. [PMID: 34563834 DOI: 10.1016/j.ejmp.2021.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 11/21/2022] Open
Abstract
Innovations in cancer treatment have contributed to the improved survival rate of these patients. Radiotherapy is one of the main options for cancer management nowadays. High doses of ionizing radiation are usually delivered to the tumor site with high energy photon beams. However, the therapeutic radiation exposure may lead to second cancer induction. Moreover, the introduction of intensity-modulated radiation therapy over the last decades has increased the radiation dose to out-of-field organs compared to that from conventional irradiation. The increased organ doses might result in elevated probabilities for developing secondary malignancies to critical organs outside the treatment volume. The organ-specific dosimetry is considered necessary for the theoretical second cancer risk assessment and the proper analysis of data derived from epidemiological reports. This study reviews the methods employed for the measurement and calculation of out-of-field organ doses from exposure to photons and/or neutrons. The strengths and weaknesses of these dosimetric approaches are described in detail. This is followed by a review of the epidemiological data associated with out-of-field cancer risks. Previously published theoretical cancer risk estimates for adult and pediatric patients undergoing radiotherapy with conventional and advanced techniques are presented. The methodology for the theoretical prediction of the probability of carcinogenesis to out-of-field sites and the limitations of this approach are discussed. The article also focuses on the factors affecting the magnitude of the probability for developing radiotherapy-induced malignancies. The restriction of out-of-field doses and risks through the use of different types of shielding equipment is presented.
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Chang W, Koba Y, Furuta T, Yonai S, Hashimoto S, Matsumoto S, Sato T. Technical Note: validation of a material assignment method for a retrospective study of carbon-ion radiotherapy using Monte Carlo simulation. JOURNAL OF RADIATION RESEARCH 2021; 62:846-855. [PMID: 33998654 PMCID: PMC8438268 DOI: 10.1093/jrr/rrab028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/08/2021] [Indexed: 06/12/2023]
Abstract
We propose a two-step method to converse human tissue materials from patient computed tomography (CT) images, which is required in dose reconstructions for a retrospective study of carbon-ion radiotherapy (CIRT) using Monte Carlo (MC) simulation. The first step was to assign the standard tissues of the International Commission on Radiological Protection reference phantoms according to the CT-number. The second step was to determine the mass density of each material based on the relationship between CT-number and stopping power ratio (Hounsfield unit [HU]-SPR) registered in treatment planning system (TPS). Direct implementation of the well-calibrated HU-SPR curve allows the reproduction of previous clinical treatments recorded in TPS without uncertainty due to a mismatch of the CT scanner or scanning conditions, whereas MC simulation with realistic human tissue materials can fulfill the out-of-field dose, which was missing in the record. To validate our proposed method, depth-dose distributions in the homogenous and heterogeneous phantoms irradiated by a 400 MeV/u carbon beam with an 8 cm spread-out Bragg peak (SOBP) were computed by the MC simulation in combination with the proposed methods and compared with those of TPS. Good agreement of the depth-dose distributions between the TPS and MC simulation (within a 1% discrepancy in range) was obtained for different materials. In contrast, fluence distributions of secondary particles revealed the necessity of MC simulation using realistic human tissue. The proposed material assignment method will be used for a retrospective study using previous clinical data of CIRT at the National Institute of Radiological Sciences (NIRS).
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Affiliation(s)
- Weishan Chang
- Center for Radiation Protection Knowledge, National Institute of Radiological Sciences, QST, 4-9-1, Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Yusuke Koba
- Center for Radiation Protection Knowledge, National Institute of Radiological Sciences, QST, 4-9-1, Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Takuya Furuta
- Nuclear Science and Engineering Center, Japan Atomic Energy Agency, 2-4 Shirakata, Tokai-mura, Ibaraki 319-1195, Japan
| | - Shunsuke Yonai
- Department of Accelerator and Medical Physics, National Institute of Radiological Sciences, QST, 4-9-1, Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Shintaro Hashimoto
- Nuclear Science and Engineering Center, Japan Atomic Energy Agency, 2-4 Shirakata, Tokai-mura, Ibaraki 319-1195, Japan
| | - Shinnosuke Matsumoto
- Department of Accelerator and Medical Physics, National Institute of Radiological Sciences, QST, 4-9-1, Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Tatsuhiko Sato
- Department of Accelerator and Medical Physics, National Institute of Radiological Sciences, QST, 4-9-1, Anagawa, Inage-ku, Chiba 263-8555, Japan
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Hauri P, Radonic S, Vasi F, Ernst M, Sumila M, Mille MM, Lee C, Hartmann M, Schneider U. Development of whole-body representation and dose calculation in a commercial treatment planning system. Z Med Phys 2021; 32:159-172. [PMID: 34301443 PMCID: PMC9948842 DOI: 10.1016/j.zemedi.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 05/03/2021] [Accepted: 05/10/2021] [Indexed: 10/20/2022]
Abstract
For the epidemiological evaluation of long-term side effects of radiotherapy patients, it is important to know the doses to organs and tissues everywhere in the patient. Computed tomography (CT) images of the patients which contain the anatomical information are sometimes available for each treated patient. However, the available CT scans usually cover only the treated volume of the patient including the target and surrounding anatomy. To overcome this limitation, in this work we describe the development of a software tool using the Varian Eclipse Scripting API for extending a partial-body CT to a whole-body representation in the treatment planning system for dose calculation. The whole-body representation is created by fusing the partial-body CT with a similarly sized whole-body computational phantom selected from a library containing 64 phantoms of different heights, weights, and genders. The out-of-field dose is calculated with analytical models from the literature and merged with the treatment planning system-calculated dose. To test the method, the out-of-field dose distributions on the computational phantoms were compared to dose calculations on whole-body patient CTs. The mean doses, D2% and D98% were compared in 26 organs and tissues for 14 different treatment plans in 5 patients using 3D-CRT, IMRT, VMAT, coplanar and non-coplanar techniques. From these comparisons we found that mean relative differences between organ doses ranged from -10% and +20% with standard deviations of up to 40%. The developed method will help epidemiologists and researchers estimate organ doses outside the treated volume when only limited treatment planning CT information is available.
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Affiliation(s)
- Pascal Hauri
- Department of Physics, University of Zurich, Zurich, Switzerland,Radiotherapy Hirslanden, Hirslanden Medical Center, Aarau, Switzerland
| | - Stephan Radonic
- Department of Physics, University of Zurich, Zurich, Switzerland,Radiotherapy Hirslanden, Hirslanden Medical Center, Aarau, Switzerland,Corresponding author: Stephan Radonic, Department of Physics, University of Zurich, Zurich, Switzerland
| | - Fabiano Vasi
- Department of Physics, University of Zurich, Zurich, Switzerland,Radiotherapy Hirslanden, Hirslanden Medical Center, Aarau, Switzerland
| | - Marina Ernst
- Department of Physics, University of Zurich, Zurich, Switzerland
| | - Marcin Sumila
- Department of Physics, University of Zurich, Zurich, Switzerland,Radiotherapy Hirslanden, Hirslanden Medical Center, Aarau, Switzerland
| | - Matthew M. Mille
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA
| | - Choonsik Lee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD 20850, USA
| | - Matthias Hartmann
- Department of Physics, University of Zurich, Zurich, Switzerland,Radiotherapy Hirslanden, Hirslanden Medical Center, Aarau, Switzerland
| | - Uwe Schneider
- Department of Physics, University of Zurich, Zurich, Switzerland,Radiotherapy Hirslanden, Hirslanden Medical Center, Aarau, Switzerland
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Indelicato DJ, Bates JE, Mailhot Vega RB, Rotondo RL, Hoppe BS, Morris CG, Looi WS, Sandler ES, Aldana PR, Bradley JA. Second tumor risk in children treated with proton therapy. Pediatr Blood Cancer 2021; 68:e28941. [PMID: 33565257 DOI: 10.1002/pbc.28941] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Out-of-field neutron dissemination during double-scattered proton therapy has raised concerns of increased second malignancies, disproportionally affecting pediatric patients due to the proportion of body exposed to scatter dose and inherent radiosensitivity of developing tissue. We sought to provide empiric data on the incidence of early second tumors. METHODS Between 2006 and 2019, 1713 consecutive children underwent double-scattered proton therapy. Median age at treatment was 9.1 years; 371 were ≤3 years old. Thirty-seven patients (2.2%) had tumor predisposition syndromes. Median prescription dose was 54 Gy (range 15-75.6). Median follow-up was 3.3 years (range 0.1-12.8), including 6587 total person-years. Five hundred forty-nine patients had ≥5 years of follow-up. A second tumor was defined as any solid neoplasm throughout the body. RESULTS Eleven patients developed second tumors; the 5- and 10-year cumulative incidences were 0.8% (95% CI, 0.4-1.9%) and 3.1% (95% CI, 1.5-6.2%), respectively. Using age- and gender-specific data from the Surveillance, Epidemiology, and End Results (SEER) program, the standardized incidence ratio was 13.5; the absolute excess risk was 1.5/1000 person-years. All but one patient who developed second tumors were irradiated at ≤5 years old (p < .0005). There was also a statistically significant correlation between patients with tumor predisposition syndromes and second tumors (p < .0001). Excluding patients with tumor predisposition syndromes, 5- and 10-year rates were 0.6% (95% CI, 0.2-1.7%) and 1.7% (95% CI, 0.7-4.0%), respectively, with all five malignant second tumors occurring in the high-dose region. CONCLUSION Second tumors are rare within the decade following double-scattered proton therapy, particularly among children irradiated at >5 years old and those without tumor predisposition syndrome.
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Affiliation(s)
- Daniel J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - James E Bates
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Raymond B Mailhot Vega
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Ronny L Rotondo
- Department of Radiation Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Bradford S Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | - Christopher G Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Wen S Looi
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Eric S Sandler
- Department of Pediatrics, Nemours Children's Specialty Clinic, Jacksonville, Florida, USA
| | - Philipp R Aldana
- Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Julie A Bradley
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida, USA
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Kang DJ, Shin YJ, Jeong S, Jung JY, Lee H, Lee B. Development of clinical application program for radiotherapy induced cancer risk calculation using Monte Carlo engine in volumetric-modulated arc therapy. Radiat Oncol 2021; 16:108. [PMID: 34118968 PMCID: PMC8199704 DOI: 10.1186/s13014-020-01722-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 12/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study is to develop a clinical application program that automatically calculates the effect for secondary cancer risk (SCR) of individual patient. The program was designed based on accurate dose calculations using patient computed tomography (CT) data and Monte Carlo engine. Automated patient-specific evaluation program was configured to calculate SCR. Methods The application program is designed to re-calculate the beam sequence of treatment plan using the Monte Carlo engine and patient CT data, so it is possible to accurately calculate and evaluate scatter and leakage radiation, difficult to calculate in TPS. The Monte Carlo dose calculation system was performed through stoichiometric calibration using patient CT data. The automatic SCR evaluation program in application program created with a MATLAB was set to analyze the results to calculate SCR. The SCR for organ of patient was calculated based on Biological Effects of Ionizing Radiation (BEIR) VII models. The program is designed to sequentially calculate organ equivalent dose (OED), excess absolute risk (EAR), excess relative risk (ERR), and the lifetime attributable risk (LAR) in consideration of 3D dose distribution analysis. In order to confirm the usefulness of the developed clinical application program, the result values from clinical application program were compared with the manual calculation method used in the previous study. Results The OED values calculated in program were calculated to be at most approximately 13.3% higher than results in TPS. The SCR result calculated by the developed clinical application program showed a maximum difference of 1.24% compared to the result of the conventional manual calculation method. And it was confirmed that EAR, ERR and LAR values can be easily calculated by changing the biological parameters. Conclusions We have developed a patient-specific SCR evaluation program that can be used conveniently in the clinic. The program consists of a Monte Carlo dose calculation system for accurate calculation of scatter and leakage radiation and a patient-specific automatic SCR evaluation program using 3D dose distribution. The clinical application program that improved the disadvantages of the existing process can be used as an index for evaluating a patient treatment plan.
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Affiliation(s)
- Dong-Jin Kang
- Department of Radiation Oncology, Inje University Sanggye Paik Hospital, 1342, Dongil-ro, Nowon-gu, Seoul, Korea
| | - Young-Joo Shin
- Department of Radiation Oncology, Inje University Sanggye Paik Hospital, 1342, Dongil-ro, Nowon-gu, Seoul, Korea.
| | - Seonghoon Jeong
- Proton Therapy Center, National Cancer Center, Goyang, Korea
| | - Jae-Yong Jung
- Department of Radiation Oncology, Inje University Sanggye Paik Hospital, 1342, Dongil-ro, Nowon-gu, Seoul, Korea
| | | | - Boram Lee
- Department of Radiation Oncology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81, Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea.
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Zhang Y, Yan S, Cui Z, Wang Y, Li Z, Yin Y, Li B, Quan H, Zhu J. Out-of-field dose assessment for a 1.5 T MR-Linac with optically stimulated luminescence dosimeters. Med Phys 2021; 48:4027-4037. [PMID: 33714229 PMCID: PMC8360091 DOI: 10.1002/mp.14839] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/04/2021] [Accepted: 03/04/2021] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To assess the out-of-field surface and internal dose of the 1.5 T MR-Linac compared to the conventional external beam linac using optically stimulated luminescence dosimeters (OSLDs), and evaluate the out-of-field dose calculation accuracy of the Monaco treatment planning system (TPS) of the 1.5T MR-Linac. METHODS A cubic solid water phantom, with OSLDs on the surface, was vertically irradiated by MR-Linac square fields with different sizes. In addition, OSLDs were arranged out of the beam edges in four directions. An anthropomorphic adult phantom, with 125 cm3 simulated volume, was irradiated in four orthogonal directions by both MR-Linac and conventional linac at the head, thoracic, and pelvic sites. Out-of-field doses were measured by OSLDs on both the surface and internal emulational organs at risk (OARs). The results were compared to the simulated dose from Monaco TPS. RESULTS At different field sizes (5 × 5 to 20 × 20 cm2 ) and distances (1 to 10 cm) to beam edge, the out-of-field surface dose measured on MR-Linac varied from 0.16 % (10 cm to 5 × 5 cm2 edge) to 7.02 % (1 cm to 20 × 20 cm2 edge) of the maximum dose laterally and from 0.14 % (10 cm to 5 × 5 cm2 edge) to 8.56 % (1 cm to 20 × 20 cm2 edge) of the maximum dose longitudinally. Compared to the OSLDs measured data, the Monaco TPS presented an overestimate of the out-of-field dose of OARs at 0-2 % isodose area on both surface and internal check points, and the overestimation gets greater as the distance increases. The underestimation was found to be 0-35% at 2-5% isodose area on both surface and internal check points. Compared to the conventional linac, MR-Linac delivered higher average values of out-of-field dose on surface check points (20%, 19%, 21%) and internal simulated OARs (42%, 37%, 9%) of the anthropomorphic phantom at head, thoracic, and pelvic irradiations, respectively. CONCLUSIONS Compared to the conventional linac, MR-Linac has the same out-of-field dose distribution. However, considering the absolute dose values, MR-Linac delivered relatively higher out-of-field doses on both surface and internal OARs. Additional radiation shielding to patients undergoing MR-Linac may provide protection from out-of-field exposure.
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Affiliation(s)
- Yan Zhang
- School of Physics and Technology, Wuhan University, Wuhan, P.R. China.,Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, P.R. China
| | - Shaojie Yan
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, P.R. China.,School of Nuclear Science and Technology, University of South China, Hengyang, P.R. China
| | - Zhen Cui
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, P.R. China
| | - Yungang Wang
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, P.R. China
| | - Zhenjiang Li
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, P.R. China
| | - Yong Yin
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, P.R. China
| | - Baosheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, P.R. China
| | - Hong Quan
- School of Physics and Technology, Wuhan University, Wuhan, P.R. China
| | - Jian Zhu
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, P.R. China.,Shandong Medical Imaging and Radiotherapy Engineering Center, Jinan, P.R. China.,Shandong Key Laboratory of Digital Medicine and Computer Assisted Surgery, The Affiliated Hospital of Qingdao University, Qingdao, P.R. China
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Tiong YS, Hao ETY, Lee CC, Parameswaran R, Cheo T, Ho WLC, Yang SP. Prevalence of thyroid malignancy and hormonal dysfunction following radiation exposure in childhood. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:402-410. [PMID: 34100517 DOI: 10.47102/annals-acadmedsg.2020378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Childhood radiation exposure is a known risk factor for thyroid malignancy and dysfunction. However, local data are limited and there is no consensus on the modality and frequency of screening in this high-risk group. METHODS Retrospective analysis study evaluating patients with childhood radiation exposure in 2006-2016 and minimum of 1-year follow-up. RESULTS Of the 132 childhood cancer survivors in the study, thyroid malignancy was detected in 2 cases (1.5%) and thyroid nodules in 13 (9.8%). The earliest thyroid malignancy was detected 5 years post-radiotherapy via ultrasound. Of the 84 patients who had screening thyroid function test, 26 (31.0%) were detected with abnormal test results post-radiation, majority being subclinical hypothyroidism. CONCLUSION Regular screening via clinical examination for thyroid nodules should be performed at least annually. Where feasible and if resources permit, consideration should be given to using ultrasound for thyroid nodule(s) and malignancy screening at 5 years post-radiation therapy. Screening for thyroid dysfunction can be considered from 6-12 months post-radiotherapy.
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Affiliation(s)
- Yee Sian Tiong
- Department of Endocrinology, National University Health System, Singapore
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Paddick I, Cameron A, Dimitriadis A. Extracranial dose and the risk of radiation-induced malignancy after intracranial stereotactic radiosurgery: is it time to establish a therapeutic reference level? Acta Neurochir (Wien) 2021; 163:971-979. [PMID: 33325003 PMCID: PMC7966618 DOI: 10.1007/s00701-020-04664-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND To measure extracranial doses from Gamma Knife Perfexion (GKP) intracranial stereotactic radiosurgery (SRS) and model the risk of malignancy after SRS for different treatment platforms. METHODS Doses were measured for 20 patients undergoing SRS on a GKP at distances of 18, 43 and 75 cm from the target, corresponding to the approximate positions of the thyroid, breast and gonads respectively. A literature review was conducted to collect comparative data from other radiosurgery platforms. All data was used to calculate the dose to body organs. The National Cancer Institute (NCI) RadRAT calculator was used to estimate excess lifetime cancer risk from this exposure. Five different age groups covering childhood and younger adults were modelled for both sexes. RESULTS Extracranial doses delivered during SRS with the GKP were a median 0.04%, 0.008% and 0.002% of prescription dose at 18 cm, 43 cm and 70 cm from the isocentre respectively. Comparison with the literature revealed that the extracranial dose was lowest from GKP, then linacs equipped with micro-multileaf collimators (mMLC), then linacs equipped with circular collimators (cones), and highest from Cyberknife (CK). Estimated lifetime risks of radiation-induced malignancy in the body for patients treated with SRS aged 5-45 years were 0.03-0.88%, 0.36-11%, 0.61-18% and 2.2-39% for GKP, mMLC, cones and CK respectively. CONCLUSIONS We have compared typical extracranial doses from different platforms and quantified the lifetime risk of radiation-induced malignancy. The risk varies with platform. This should be taken into account when treating children and young adults with SRS. The concept of a therapeutic reference level (TRL), similar to the diagnostic reference level (DRL) established in radiology, is proposed.
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Affiliation(s)
- Ian Paddick
- Queen Square Radiosurgery Centre, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK.
| | - A Cameron
- Bristol Haematology and Oncology Centre, Bristol, BS2 8ED, UK
| | - A Dimitriadis
- Queen Square Radiosurgery Centre, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
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Tremi I, Nowsheen S, Aziz K, Siva S, Ventura J, Hatzi VI, Martin OA, Georgakilas AG. Inflammation and oxidatively induced DNA damage: A synergy leading to cancer development. Cancer 2021. [DOI: 10.1016/b978-0-12-819547-5.00013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Paganetti H. “Cancer risk after breast proton therapy considering physiological and radiobiological uncertainties” by Raptis et al. (Physica Medica 76 (2020) 1–6). Phys Med 2020; 80:274-276. [DOI: 10.1016/j.ejmp.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/02/2020] [Accepted: 11/07/2020] [Indexed: 11/16/2022] Open
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Harbron RW, Pasqual E. Ionising radiation as a risk factor for lymphoma: a review. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2020; 40:R151-R185. [PMID: 33017815 DOI: 10.1088/1361-6498/abbe37] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
The ability of ionising radiation to induce lymphoma is unclear. Here, we present a narrative review of epidemiological evidence of the risk of lymphoma, including chronic lymphocytic leukaemia (CLL) and multiple myeloma (MM), among various exposed populations including atomic bombing survivors, industrial and medical radiation workers, and individuals exposed for medical purposes. Overall, there is a suggestion of a positive dose-dependent association between radiation exposure and lymphoma. The magnitude of this association is highly imprecise, however, with wide confidence intervals frequently including zero risk. External comparisons tend to show similar incidence and mortality rates to the general population. Currently, there is insufficient information on the impact of age at exposure, high versus low linear energy transfer radiation, external versus internal or acute versus chronic exposures. Associations are stronger for males than females, and stronger for non-Hodgkin lymphoma and MM than for Hodgkin lymphoma, while the risk of radiation-induced CLL may be non-existent. This broad grouping of diverse diseases could potentially obscure stronger associations for certain subtypes, each with a different cell of origin. Additionally, the classification of malignancies as leukaemia or lymphoma may result in similar diseases being analysed separately, while distinct diseases are analysed in the same category. Uncertainty in cell of origin means the appropriate organ for dose response analysis is unclear. Further uncertainties arise from potential confounding or bias due to infectious causes and immunosuppression. The potential interaction between radiation and other risk factors is unknown. Combined, these uncertainties make lymphoma perhaps the most challenging malignancy to study in radiation epidemiology.
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Affiliation(s)
- Richard W Harbron
- Population Health Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Newcastle University, United Kingdom
- Barcelona Institute for Global Health, (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Elisa Pasqual
- Barcelona Institute for Global Health, (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Bakkach J, Pellegrino B, Elghazawy H, Novosad O, Agrawal S, Bennani Mechita M. Current overview and special considerations for second breast cancer in Hodgkin lymphoma survivors. Crit Rev Oncol Hematol 2020; 157:103175. [PMID: 33321295 DOI: 10.1016/j.critrevonc.2020.103175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 06/28/2020] [Accepted: 11/05/2020] [Indexed: 12/15/2022] Open
Abstract
Second breast cancer (SBC) is the most common solid cancer among Hodgkin Lymphoma (HL) female survivors. We reviewed the related modifying risk factors, radiation-induced carcinogenesis, tumors characteristics, management specificities, prevention and surveillance modalities based on current evidence. The risk of developing SBC may be influenced essentially by the age at HL treatment, follow-up latency, dose of irradiation received and the extent of irradiated field. SBCs generally develop at younger age, they are often bilateral, and exhibit more aggressive biological features and worse prognosis. No firm answer about the benefits of breast surveillance is provided by literature, but compelling evidence tends toward a clinical benefit in early detection. Increasing awareness among health providers' care and current survivors as well as the implementation of screening measures is crucial. Great efforts are ongoing in individualizing treatment strategies for future HL patients and response-adapted approaches are holding promise in prevention of these second malignancies.
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Affiliation(s)
- Joaira Bakkach
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Sciences and Techniques of Tangier, Abdelmalek Essaâdi University, Morocco.
| | | | - Hagar Elghazawy
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Egypt.
| | - Olga Novosad
- Onco-Hematology Department, National Cancer Institute of the MPH Ukraine, Kiev, Ukraine.
| | - Sanjit Agrawal
- Department of Breast Oncosurgery, Tata Medical Center, Kolkata, West Bengal, India.
| | - Mohcine Bennani Mechita
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Sciences and Techniques of Tangier, Abdelmalek Essaâdi University, Morocco.
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Faghihi Moghaddam F, Bakhshandeh M, Ghorbani M, Mofid B. Assessing the out-of-field dose calculation accuracy by eclipse treatment planning system in sliding window IMRT of prostate cancer patients. Comput Biol Med 2020; 127:104052. [PMID: 33126124 DOI: 10.1016/j.compbiomed.2020.104052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 11/18/2022]
Abstract
AIM The objective of this study was to evaluate out-of-field dose distribution calculation accuracy by the Anisotropic Analytical Algorithm (AAA), version 13.0.26, in Eclipse TPS, (Varian Medical Systems, Palo Alto, Ca, USA) for sliding window IMRT delivery technique in prostate cancer patients. MATERIALS AND METHODS Prostate IMRT plans with nine coplanar were calculated with the AAA Eclipse treatment planning system. To assess the accuracy of dose calculation predicted by the Eclipse in normal tissue and OARs located out of radiation field areas, including the rectum, bladder, right and left head of the femur, absolute organ dose value, and dose distribution were measured using the Delta4+ IMRT phantom. RESULTS In the out-of-field areas, underestimation of -0.66% in organs near the field edge to -39.63% in organs far from the field edge (2.5 and 7.3 cm respectively) occurred in the TPS calculations. The percentage of dose deviation for the femoral heads was 95.7 on average while for the organ closer to the target (rectum) it was 79.81. CONCLUSIONS AAA dosimetry algorithm (used in Eclipse TPS) showed poor dose calculation in areas beyond the treatment fields border where underestimation varies with the distance from the field edges. A significant underestimation was found for the AAA algorithm in the sliding window IMRT technique (P-value > 0.05).
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Affiliation(s)
- Fahimeh Faghihi Moghaddam
- Biomedical Engineering and Medical Physics Department, Faculty of Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohsen Bakhshandeh
- Department of Radiation Technology, Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mahdi Ghorbani
- Department of Medical Physics, Faculty of Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Bahram Mofid
- Department of Radiation Oncology, Faculty of Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Sánchez-Nieto B, Medina-Ascanio KN, Rodríguez-Mongua JL, Doerner E, Espinoza I. Study of out-of-field dose in photon radiotherapy: A commercial treatment planning system versus measurements and Monte Carlo simulations. Med Phys 2020; 47:4616-4625. [PMID: 32583441 PMCID: PMC7586840 DOI: 10.1002/mp.14356] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 01/10/2023] Open
Abstract
Purpose An accurate assessment of out‐of‐field dose is necessary to estimate the risk of second cancer after radiotherapy and the damage to the organs at risk surrounding the planning target volume. Although treatment planning systems (TPSs) calculate dose distributions outside the treatment field, little is known about the accuracy of these calculations. The aim of this work is to thoroughly compare the out‐of‐field dose distributions given by two algorithms implemented in the Monaco TPS, with measurements and full Monte Carlo simulations. Methods Out‐of‐field dose distributions predicted by the collapsed cone convolution (CCC) and Monte Carlo (MCMonaco) algorithms, built into the commercially available Monaco version 5.11 TPS, are compared with measurements carried out on an Elekta Axesse linear accelerator. For the measurements, ion chambers, thermoluminescent dosimeters, and EBT3 film are used. The BEAMnrc code, built on the EGSnrc system, is used to create a model of the Elekta Axesse with the Agility collimation system, and the space phase file generated is scored by DOSXYZnrc to generate the dose distributions (MCEGSnrc). Three different irradiation scenarios are considered: (a) a 10 × 10 cm2 field, (b) an IMRT prostate plan, and (c) a three‐field lung plan. Monaco's calculations, experimental measurements, and Monte Carlo simulations are carried out in water and/or in an ICRP110 phantom. Results For the 10 × 10 cm2 field case, CCC underestimated the dose, compared to ion chamber measurements, by 13% (differences relative to the algorithm) on average between the 5% and the ≈2% isodoses. MCMonaco underestimated the dose only from approximately the 2% isodose for this case. Qualitatively similar results were observed for the studied IMRT case when compared to film dosimetry. For the three‐field lung plan, dose underestimations of up to ≈90% for MCMonaco and ≈60% for CCC, relative to MCEGSnrc simulations, were observed in mean dose to organs located beyond the 2% isodose. Conclusions This work shows that Monaco underestimates out‐of‐field doses in almost all the cases considered. Thus, it does not describe dose distribution beyond the border of the field accurately. This is in agreement with previously published works reporting similar results for other TPSs. Analytical models for out‐of‐field dose assessment, MC simulations or experimental measurements may be an adequate alternative for this purpose.
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Affiliation(s)
- B Sánchez-Nieto
- Instituto de Física, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - K N Medina-Ascanio
- Instituto de Física, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - E Doerner
- Instituto de Física, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - I Espinoza
- Instituto de Física, Pontificia Universidad Católica de Chile, Santiago, Chile
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Radiation-induced DNA double-strand breaks in peripheral leukocytes and therapeutic response of heel spur patients treated by orthovoltage X-rays or a linear accelerator. Strahlenther Onkol 2020; 196:1116-1127. [PMID: 32651595 PMCID: PMC7686210 DOI: 10.1007/s00066-020-01662-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/22/2020] [Indexed: 11/18/2022]
Abstract
Purpose Biodosimetric assessment and comparison of radiation-induced deoxyribonucleic acid (DNA) double-strand breaks (DSBs) by γH2AX immunostaining in peripheral leukocytes of patients with painful heel spur after radiation therapy (RT) with orthovoltage X‑rays or a 6-MV linear accelerator (linac). The treatment response for each RT technique was monitored as a secondary endpoint. Patients and methods 22 patients were treated either with 140-kV orthovoltage X‑rays (n = 11) or a 6-MV linac (n = 11) with two weekly fractions of 0.5 Gy for 3 weeks. In both scenarios, the dose was prescribed to the International Commission on Radiation Units and Measurements (ICRU) dose reference point. Blood samples were obtained before and 30 min after the first RT session. γH2AX foci were quantified by immunofluorescence microscopy to assess the yield of DSBs at the basal level and after radiation exposure ex vivo or in vivo. The treatment response was assessed before and 3 months after RT using a five-level functional calcaneodynia score. Results RT for painful heel spurs induced a very mild but significant increase of γH2AX foci in patients’ leukocytes. No difference between the RT techniques was observed. High and comparable therapeutic responses were documented for both treatment modalities. This trial was terminated preliminarily after an interim analysis (22 patients randomized). Conclusion Low-dose RT for painful heel spurs with orthovoltage X‑rays or a 6-MV linac is an effective treatment option associated with a very low and comparable radiation burden to the patient, as confirmed by biodosimetric measurements.
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49
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Monte Carlo study toward the development of a radiation field to simulate secondary neutrons produced in carbon-ion radiotherapy. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2020.108787] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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50
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DeLaney TF, Yock TI, Paganetti H. Assessing second cancer risk after primary cancer treatment with photon or proton radiotherapy. Cancer 2020; 126:3397-3399. [PMID: 32426850 DOI: 10.1002/cncr.32936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/03/2020] [Accepted: 04/14/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Thomas F DeLaney
- Harvard Medical School, Boston, Massachusetts, USA.,Francis H. Burr Proton Therapy Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Center for Sarcoma and Connective Tissue Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Torunn I Yock
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Pediatric Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Harald Paganetti
- Harvard Medical School, Boston, Massachusetts, USA.,Physics Research, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
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