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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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Knežević Ž, Stolarczyk L, Ambrožová I, Caballero-Pacheco MÁ, Davídková M, De Saint-Hubert M, Domingo C, Jeleń K, Kopeć R, Krzempek D, Majer M, Miljanić S, Mojżeszek N, Romero-Expósito M, Martínez-Rovira I, Harrison RM, Olko P. Out-of-Field Doses Produced by a Proton Scanning Beam Inside Pediatric Anthropomorphic Phantoms and Their Comparison With Different Photon Modalities. Front Oncol 2022; 12:904563. [PMID: 35957900 PMCID: PMC9361051 DOI: 10.3389/fonc.2022.904563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/15/2022] [Indexed: 11/23/2022] Open
Abstract
Since 2010, EURADOS Working Group 9 (Radiation Dosimetry in Radiotherapy) has been involved in the investigation of secondary and scattered radiation doses in X-ray and proton therapy, especially in the case of pediatric patients. The main goal of this paper is to analyze and compare out-of-field neutron and non-neutron organ doses inside 5- and 10-year-old pediatric anthropomorphic phantoms for the treatment of a 5-cm-diameter brain tumor. Proton irradiations were carried out at the Cyclotron Centre Bronowice in IFJ PAN Krakow Poland using a pencil beam scanning technique (PBS) at a gantry with a dedicated scanning nozzle (IBA Proton Therapy System, Proteus 235). Thermoluminescent and radiophotoluminescent dosimeters were used for non-neutron dose measurements while secondary neutrons were measured with track-etched detectors. Out-of-field doses measured using intensity-modulated proton therapy (IMPT) were compared with previous measurements performed within a WG9 for three different photon radiotherapy techniques: 1) intensity-modulated radiation therapy (IMRT), 2) three-dimensional conformal radiation therapy (3D CDRT) performed on a Varian Clinac 2300 linear accelerator (LINAC) in the Centre of Oncology, Krakow, Poland, and 3) Gamma Knife surgery performed on the Leksell Gamma Knife (GK) at the University Hospital Centre Zagreb, Croatia. Phantoms and detectors used in experiments as well as the target location were the same for both photon and proton modalities. The total organ dose equivalent expressed as the sum of neutron and non-neutron components in IMPT was found to be significantly lower (two to three orders of magnitude) in comparison with the different photon radiotherapy techniques for the same delivered tumor dose. For IMPT, neutron doses are lower than non-neutron doses close to the target but become larger than non-neutron doses further away from the target. Results of WG9 studies have provided out-of-field dose levels required for an extensive set of radiotherapy techniques, including proton therapy, and involving a complete description of organ doses of pediatric patients. Such studies are needed for validating mathematical models and Monte Carlo simulation tools for out-of-field dosimetry which is essential for dedicated epidemiological studies which evaluate the risk of second cancers and other late effects for pediatric patients treated with radiotherapy.
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Affiliation(s)
- Željka Knežević
- Ruđer Bošković Institute, Zagreb, Croatia
- *Correspondence: Željka Knežević,
| | - Liliana Stolarczyk
- Danish Centre for Particle Therapy, Aarhus, Denmark
- Institute of Nuclear Physics, PAN, Krakow, Poland
| | - Iva Ambrožová
- Nuclear Physics Institute of the Czech Academy of Sciences, CAS, Řež, Czechia
| | | | - Marie Davídková
- Nuclear Physics Institute of the Czech Academy of Sciences, CAS, Řež, Czechia
| | | | | | - Kinga Jeleń
- Institute of Nuclear Physics, PAN, Krakow, Poland
- Tadeusz Kosciuszko Cracow University of Technology, Cracow, Poland
| | - Renata Kopeć
- Institute of Nuclear Physics, PAN, Krakow, Poland
| | | | | | | | | | - Maite Romero-Expósito
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Skandion Clinic, Uppsala, Sweden
| | | | - Roger M. Harrison
- University of Newcastle upon Tyne, Newcastle upon Tyne, United Kingdom
| | - Paweł Olko
- Institute of Nuclear Physics, PAN, Krakow, Poland
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3
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Janiak MK, Pocięgiel M, Welsh JS. Time to rejuvenate ultra-low dose whole-body radiotherapy of cancer. Crit Rev Oncol Hematol 2021; 160:103286. [PMID: 33667656 DOI: 10.1016/j.critrevonc.2021.103286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/11/2020] [Accepted: 02/27/2021] [Indexed: 12/24/2022] Open
Abstract
The results of clinical trials performed from the 1930s until the end of the 20th century in which total-body ultra-low level ionizing radiation (TB-LLR) was used demonstrate that this form of treatment can be equal or superior to other systemic anti-neoplastic modalities in terms of the rates of remissions, toxicity, and side effects. In this review, we provide the rationale for TB-LLR and analyze the results of reliable clinical trials in patients with predominantly lymphoproliferative disorders but also advanced solid cancers. The doses used in these trials did not exceed 0.1-0.2 Gy per fraction and cumulative totals ranged from 1 to 4 Gy. Based on the reviewed results we conclude that it is appropriate to revive interest in and resume clinical investigations of TB-LLR in order to refine and improve the effectiveness of such treatment, whether employed alone or in combination with other anticancer strategies.
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Affiliation(s)
- Marek K Janiak
- Military Institute of Hygiene and Epidemiology, Warsaw, Poland.
| | | | - James S Welsh
- Loyola University Chicago, Edward Hines Jr., VA Hospital, Stritch School of Medicine, Department of Radiation Oncology, Maywood, IL 601fv53, USA
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Chin S, Eccles CL, McWilliam A, Chuter R, Walker E, Whitehurst P, Berresford J, Van Herk M, Hoskin PJ, Choudhury A. Magnetic resonance-guided radiation therapy: A review. J Med Imaging Radiat Oncol 2020; 64:163-177. [PMID: 31646742 DOI: 10.1111/1754-9485.12968] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/24/2019] [Indexed: 12/11/2022]
Abstract
Magnetic resonance-guided radiation therapy (MRgRT) is a promising approach to improving clinical outcomes for patients treated with radiation therapy. The roles of image guidance, adaptive planning and magnetic resonance imaging in radiation therapy have been increasing over the last two decades. Technical advances have led to the feasible combination of magnetic resonance imaging and radiation therapy technologies, leading to improved soft-tissue visualisation, assessment of inter- and intrafraction motion, motion management, online adaptive radiation therapy and the incorporation of functional information into treatment. MRgRT can potentially transform radiation oncology by improving tumour control and quality of life after radiation therapy and increasing convenience of treatment by shortening treatment courses for patients. Multiple groups have developed clinical implementations of MRgRT predominantly in the abdomen and pelvis, with patients having been treated since 2014. While studies of MRgRT have primarily been dosimetric so far, an increasing number of trials are underway examining the potential clinical benefits of MRgRT, with coordinated efforts to rigorously evaluate the benefits of the promising technology. This review discusses the current implementations, studies, potential benefits and challenges of MRgRT.
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Affiliation(s)
- Stephen Chin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Cynthia L Eccles
- Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Alan McWilliam
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Robert Chuter
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Emma Walker
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Philip Whitehurst
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Joseph Berresford
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Marcel Van Herk
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Peter J Hoskin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Ananya Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
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Andersson M, Eckerman K, Pawel D, Almen A, Mattsson S. Improved radiation risk models applied to different patient groups in Sweden. ACTA ACUST UNITED AC 2019. [DOI: 10.21514/1998-426x-2019-12-2-44-54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- M. Andersson
- Medical Radiation Physics, Department of Translational Medicine
| | - K. Eckerman
- Center for Radiation Protection Knowledge, Oak Ridge National Laboratory
| | - D. Pawel
- U.S. Environmental Protection Agency
| | - A. Almen
- Medical Radiation Physics, Department of Translational Medicine
| | - S. Mattsson
- Medical Radiation Physics, Department of Translational Medicine
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Ardenfors O, Henry T, Gudowska I, Poludniowski G, Dasu A. Organ doses from a proton gantry-mounted cone-beam computed tomography system characterized with MCNP6 and GATE. Phys Med 2018; 53:56-61. [PMID: 30241755 DOI: 10.1016/j.ejmp.2018.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/08/2018] [Accepted: 08/12/2018] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To determine organ doses from a proton gantry-mounted cone-beam computed tomography (CBCT) system using two Monte Carlo codes and to study the influence on organ doses from different acquisition modes and repeated imaging. METHODS The CBCT system was characterized with MCNP6 and GATE using measurements of depth doses in water and spatial profiles in air. The beam models were validated against absolute dose measurements and used to simulate organ doses from CBCT imaging with head, thorax and pelvis protocols. Anterior and posterior 190° scans were simulated and the resulting organ doses per mAs were compared to those from 360° scans. The influence on organ doses from repeated imaging with different imaging schedules was also investigated. RESULTS The agreement between MCNP6, GATE and measurements with regard to depth doses and beam profiles was within 4% for all protocols and the corresponding average agreement in absolute dose validation was 4%. Absorbed doses for in-field organs from 360° scans ranged between 6 and 8 mGy, 15-17 mGy and 24-54 mGy for the head, thorax and pelvis protocols, respectively. Cumulative organ doses from repeated CBCT imaging ranged between 0.04 and 0.32 Gy for weekly imaging and 0.2-1.6 Gy for daily imaging. The anterior scans resulted in an average increase in dose per mAs of 24% to the organs of interest relative to the 360° scan, while the posterior scan showed a 37% decrease. CONCLUSIONS A proton gantry-mounted CBCT system was accurately characterized with MCNP6 and GATE. Organ doses varied greatly depending on acquisition mode, favoring posterior scans.
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Affiliation(s)
- Oscar Ardenfors
- Medical Radiation Physics, Department of Physics, Stockholm University, Stockholm, Sweden.
| | - Thomas Henry
- Medical Radiation Physics, Department of Physics, Stockholm University, Stockholm, Sweden
| | - Irena Gudowska
- Medical Radiation Physics, Department of Physics, Stockholm University, Stockholm, Sweden
| | - Gavin Poludniowski
- Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
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7
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Ardenfors O, Dasu A, Lillhök J, Persson L, Gudowska I. Out-of-field doses from secondary radiation produced in proton therapy and the associated risk of radiation-induced cancer from a brain tumor treatment. Phys Med 2018; 53:129-136. [DOI: 10.1016/j.ejmp.2018.08.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/27/2018] [Accepted: 08/30/2018] [Indexed: 02/07/2023] Open
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Lillhök J, Persson L, Andersen CE, Dasu A, Ardenfors O. RADIATION PROTECTION MEASUREMENTS WITH THE VARIANCE-COVARIANCE METHOD IN THE STRAY RADIATION FIELDS FROM PHOTON AND PROTON THERAPY FACILITIES. RADIATION PROTECTION DOSIMETRY 2018; 180:338-341. [PMID: 29036696 DOI: 10.1093/rpd/ncx194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 09/04/2017] [Indexed: 06/07/2023]
Abstract
The microdosimetric variance-covariance method was used to study the stray radiation fields from the photon therapy facility at the Technical University of Denmark and the scanned proton therapy beam at the Skandion Clinic in Uppsala, Sweden. Two TEPCs were used to determine the absorbed dose, the dose-average lineal energy, the dose-average quality factor and the dose equivalent. The neutron component measured by the detectors at the proton beam was studied through Monte Carlo simulations using the code MCNP6. In the photon beam the stray absorbed dose ranged between 0.3 and 2.4 μGy per monitor unit, and the dose equivalent between 0.4 and 9 μSv per monitor unit, depending on beam energy and measurement position. In the proton beam the stray absorbed dose ranged between 3 and 135 μGy per prescribed Gy, depending on detector position and primary proton energy.
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Affiliation(s)
- J Lillhök
- Swedish Radiation Safety Authority, Stockholm, Sweden
| | - L Persson
- Swedish Radiation Safety Authority, Stockholm, Sweden
| | - C E Andersen
- Center for Nuclear Technologies, Technical University of Denmark, Roskilde, Denmark
| | - A Dasu
- The Skandion Clinic, Uppsala, Sweden
| | - O Ardenfors
- Medical Radiation Physics, Department of Physics, Stockholm University, Stockholm, Sweden
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Ardenfors O, Gudowska I, Flejmer AM, Dasu A. Impact of irradiation setup in proton spot scanning brain therapy on organ doses from secondary radiation. RADIATION PROTECTION DOSIMETRY 2018; 180:261-266. [PMID: 30085315 DOI: 10.1093/rpd/ncy013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 01/16/2018] [Indexed: 06/08/2023]
Abstract
A Monte Carlo model of a proton spot scanning pencil beam was used to simulate organ doses from secondary radiation produced from brain tumour treatments delivered with either a lateral field or a vertex field to one adult and one paediatric patient. Absorbed doses from secondary neutrons, photons and protons and neutron equivalent doses were higher for the vertex field in both patients, but the differences were low in absolute terms. Absorbed doses ranged between 0.1 and 43 μGy.Gy-1 in both patients with the paediatric patient receiving higher doses. The neutron equivalent doses to the organs ranged between 0.5 and 141 μSv.Gy-1 for the paediatric patient and between 0.2 and 134 μSv.Gy-1 for the adult. The highest neutron equivalent dose from the entire treatment was 7 mSv regardless of field setup and patient size. The results indicate that different field setups do not introduce large absolute variations in out-of-field doses produced in patients undergoing proton pencil beam scanning of centrally located brain tumours.
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Affiliation(s)
- Oscar Ardenfors
- Medical Radiation Physics, Department of Physics, Stockholm University, Box 260, Stockholm, Sweden
| | - Irena Gudowska
- Medical Radiation Physics, Department of Physics, Stockholm University, Box 260, Stockholm, Sweden
| | - Anna Maria Flejmer
- Department of Oncology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Sánchez-Nieto B, Romero-Expósito M, Terrón JA, Irazola L, Paiusco M, Cagni E, Ghetti C, Filice S, Sánchez-Doblado F. Intensity-modulated radiation therapy and volumetric modulated arc therapy versus conventional conformal techniques at high energy: Dose assessment and impact on second primary cancer in the out-of-field region. Rep Pract Oncol Radiother 2018; 23:251-259. [PMID: 29991929 PMCID: PMC6035902 DOI: 10.1016/j.rpor.2018.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 01/19/2018] [Accepted: 04/12/2018] [Indexed: 12/22/2022] Open
Abstract
The aim of this work was to estimate peripheral neutron and photon doses associated with the conventional 3D conformal radiotherapy techniques in comparison to modern ones such as Intensity modulated radiation therapy and volumetric modulated arc therapy. Assessment in terms of second cancer incidence ought to peripheral doses was also considered. For that, a dosimetric methodology proposed by the authors has been applied beyond the region where there is no CT information and, thus, treatment planning systems do not calculate and where, nonetheless, about one third of second primary cancers occurs.
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Affiliation(s)
- Beatriz Sánchez-Nieto
- Instituto de Física, Pontificia Universidad Católica de Chile, Santiago, Chile
- Center UC Investigation in Oncology at Pontificia Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - José Antonio Terrón
- Servicio de Radiofísica, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Leticia Irazola
- Departamento de Fisiología Médica y Biofísica, Universidad de Sevilla, Sevilla, Spain
| | - Marta Paiusco
- Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | | | - Caterina Ghetti
- Servizio di Fisica Sanitaria, Azienda Ospedaliera Universitaria di Parma, Italy
| | - Silvano Filice
- Servizio di Fisica Sanitaria, Azienda Ospedaliera Universitaria di Parma, Italy
| | - Francisco Sánchez-Doblado
- Servicio de Radiofísica, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Departamento de Fisiología Médica y Biofísica, Universidad de Sevilla, Sevilla, Spain
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Elazhar H, Deschler T, Létang JM, Nourreddine A, Arbor N. Neutron track length estimator for GATE Monte Carlo dose calculation in radiotherapy. Phys Med Biol 2018; 63:125018. [PMID: 29790859 DOI: 10.1088/1361-6560/aac768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The out-of-field dose in radiation therapy is a growing concern in regards to the late side-effects and secondary cancer induction. In high-energy x-ray therapy, the secondary neutrons generated through photonuclear reactions in the accelerator are part of this secondary dose. The neutron dose is currently not estimated by the treatment planning system while it appears to be preponderant for distances greater than 50 cm from the isocenter. Monte Carlo simulation has become the gold standard for accurately calculating the neutron dose under specific treatment conditions but the method is also known for having a slow statistical convergence, which makes it difficult to be used on a clinical basis. The neutron track length estimator, a neutron variance reduction technique inspired by the track length estimator method has thus been developped for the first time in the Monte Carlo code GATE to allow a fast computation of the neutron dose in radiotherapy. The details of its implementation, as well as the comparison of its performances against the analog MC method, are presented here. A gain of time from 15 to 400 can be obtained by our method, with a mean difference in the dose calculation of about 1% in comparison with the analog MC method.
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Affiliation(s)
- H Elazhar
- Université de Strasbourg, CNRS, IPHC UMR 7178, F-67000 Strasbourg, France
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Hay JL, Baser RE, Westerman JS, Ford JS. Prevalence and Correlates of Worry About Medical Imaging Radiation Among United States Cancer Survivors. Int J Behav Med 2018; 25:569-578. [PMID: 29872990 DOI: 10.1007/s12529-018-9730-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Cancer survivors undergo lifelong surveillance regimens that involve repeated diagnostic medical imaging. As many of these diagnostic tests use ionizing radiation, which may modestly increase cancer risks, they may present a source of worry for survivors. The aims of this paper are to describe cancer survivors' level of worry about medical imaging radiation (MIR) and to identify patterns of MIR worry across subgroups defined by cancer type, other medical and demographic factors, and physician trust. METHOD This cross-sectional study used the 2012-2013 Health Information National Trends Survey of US adults conducted by the National Cancer Institute. The analysis focused on the 452 respondents identifying as cancer survivors. Weighted logistic regression analysis was used to evaluate factors associated with higher MIR worry (reporting "some" or "a lot" of MIR worry). RESULTS Nearly half (42%) of the sample reported higher worry about MIR. Unadjusted and adjusted logistic regressions indicated higher rates of MIR worry among those with lower incomes, those who self-reported poorer health, and those who completed cancer treatment within the past 10 years. Receipt of radiation treatment was associated with higher MIR worry in unadjusted analysis. CONCLUSION Worries about MIR are relatively common among cancer survivors. An accurate assessment of the rates and patterns of worry could aid efforts to improve these individuals' survivorship care and education.
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Affiliation(s)
- Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th floor, New York, NY, 10022, USA.
| | - Raymond E Baser
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joy S Westerman
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th floor, New York, NY, 10022, USA
| | - Jennifer S Ford
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th floor, New York, NY, 10022, USA
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13
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Toma-Dasu I, Wojcik A, Kjellsson Lindblom E. Risk of second cancer following radiotherapy. Phys Med 2017; 42:211-212. [DOI: 10.1016/j.ejmp.2017.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 10/14/2017] [Indexed: 11/16/2022] Open
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14
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Dasu A, Toma-Dasu I. Models for the risk of secondary cancers from radiation therapy. Phys Med 2017; 42:232-238. [DOI: 10.1016/j.ejmp.2017.02.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/10/2017] [Accepted: 02/15/2017] [Indexed: 11/25/2022] Open
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Janiak MK, Wincenciak M, Cheda A, Nowosielska EM, Calabrese EJ. Cancer immunotherapy: how low-level ionizing radiation can play a key role. Cancer Immunol Immunother 2017; 66:819-832. [PMID: 28361232 PMCID: PMC5489643 DOI: 10.1007/s00262-017-1993-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 03/22/2017] [Indexed: 12/17/2022]
Abstract
The cancer immunoediting hypothesis assumes that the immune system guards the host against the incipient cancer, but also "edits" the immunogenicity of surviving neoplastic cells and supports remodeling of tumor microenvironment towards an immunosuppressive and pro-neoplastic state. Local irradiation of tumors during standard radiotherapy, by killing neoplastic cells and generating inflammation, stimulates anti-cancer immunity and/or partially reverses cancer-promoting immunosuppression. These effects are induced by moderate (0.1-2.0 Gy) or high (>2 Gy) doses of ionizing radiation which can also harm normal tissues, impede immune functions, and increase the risk of secondary neoplasms. In contrast, such complications do not occur with exposures to low doses (≤0.1 Gy for acute irradiation or ≤0.1 mGy/min dose rate for chronic exposures) of low-LET ionizing radiation. Furthermore, considerable evidence indicates that such low-level radiation (LLR) exposures retard the development of neoplasms in humans and experimental animals. Here, we review immunosuppressive mechanisms induced by growing tumors as well as immunomodulatory effects of LLR evidently or likely associated with cancer-inhibiting outcomes of such exposures. We also offer suggestions how LLR may restore and/or stimulate effective anti-tumor immunity during the more advanced stages of carcinogenesis. We postulate that, based on epidemiological and experimental data amassed over the last few decades, whole- or half-body irradiations with LLR should be systematically examined for its potential to be a viable immunotherapeutic treatment option for patients with systemic cancer.
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Affiliation(s)
- Marek K Janiak
- Department of Radiobiology and Radiation Protection, Military Institute of Hygiene and Epidemiology, 4 Kozielska St., 01-163, Warsaw, Poland.
| | - Marta Wincenciak
- Department of Radiobiology and Radiation Protection, Military Institute of Hygiene and Epidemiology, 4 Kozielska St., 01-163, Warsaw, Poland
| | - Aneta Cheda
- Department of Radiobiology and Radiation Protection, Military Institute of Hygiene and Epidemiology, 4 Kozielska St., 01-163, Warsaw, Poland
| | - Ewa M Nowosielska
- Department of Radiobiology and Radiation Protection, Military Institute of Hygiene and Epidemiology, 4 Kozielska St., 01-163, Warsaw, Poland
| | - Edward J Calabrese
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, Morrill I, N344, University of Massachusetts, Amherst, MA, 01003, USA
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Romero-Expósito M, Domingo C, Sánchez-Doblado F, Ortega-Gelabert O, Gallego S. Experimental evaluation of neutron dose in radiotherapy patients: Which dose? Med Phys 2016; 43:360. [PMID: 26745929 DOI: 10.1118/1.4938578] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The evaluation of peripheral dose has become a relevant issue recently, in particular, the contribution of secondary neutrons. However, after the revision of the Recommendations of the International Commission on Radiological Protection, there has been a lack of experimental procedure for its evaluation. Specifically, the problem comes from the replacement of organ dose equivalent by the organ-equivalent dose, being the latter "immeasurable" by definition. Therefore, dose equivalent has to be still used although it needs the calculation of the radiation quality factor Q, which depends on the unrestricted linear energy transfer, for the specific neutron irradiation conditions. On the other hand, equivalent dose is computed through the radiation weighting factor wR, which can be easily calculated using the continuous function provided by the recommendations. The aim of the paper is to compare the dose equivalent evaluated following the definition, that is, using Q, with the values obtained by replacing the quality factor with wR. METHODS Dose equivalents were estimated in selected points inside a phantom. Two types of medical environments were chosen for the irradiations: a photon- and a proton-therapy facility. For the estimation of dose equivalent, a poly-allyl-diglicol-carbonate-based neutron dosimeter was used for neutron fluence measurements and, additionally, Monte Carlo simulations were performed to obtain the energy spectrum of the fluence in each point. RESULTS The main contribution to dose equivalent comes from neutrons with energy higher than 0.1 MeV, even when they represent the smallest contribution in fluence. For this range of energy, the radiation quality factor and the radiation weighting factor are approximately equal. Then, dose equivalents evaluated using both factors are compatible, with differences below 12%. CONCLUSIONS Quality factor can be replaced by the radiation weighting factor in the evaluation of dose equivalent in radiotherapy environments simplifying the practical procedure.
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Affiliation(s)
- M Romero-Expósito
- Grup de Recerca en Radiacions Ionizants (GRRI), Departament de Física, Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
| | - C Domingo
- Grup de Recerca en Radiacions Ionizants (GRRI), Departament de Física, Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
| | - F Sánchez-Doblado
- Departamento de Fisiología Médica y Biofísica, Universidad de Sevilla, Sevilla 41009, SpainServicio de Radiofísica, Hospital Universitario Virgen Macarena, Sevilla 41009, Spain
| | - O Ortega-Gelabert
- Grup de Recerca en Radiacions Ionizants (GRRI), Departament de Física, Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
| | - S Gallego
- Grup de Recerca en Radiacions Ionizants (GRRI), Departament de Física, Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
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17
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Ardenfors O, Josefsson D, Dasu A. Are IMRT treatments in the head and neck region increasing the risk of secondary cancers? Acta Oncol 2014; 53:1041-7. [PMID: 24983652 DOI: 10.3109/0284186x.2014.925581] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Intensity-modulated radiation therapy (IMRT) has been increasingly employed for treating head and neck (H&N) tumours due to its ability to produce isodoses suitable for the complex anatomy of the region. The aim of this study was to assess possible differences between IMRT and conformal radiation therapy (CRT) with regard to risk of radiation-induced secondary malignancies for H&N tumours. MATERIAL AND METHODS IMRT and CRT plans were made for 10 H&N adult patients and the resulting treatment planning data were used to calculate the risk of radiation-induced malignancies in four different tissues. Three risk models with biologically relevant parameters were used for calculations. The influence of scatter radiation and repeated imaging sessions has also been investigated. RESULTS The results showed that the total lifetime risks of developing radiation-induced secondary malignancies from the two treatment techniques, CRT and IMRT, were comparable and in the interval 0.9-2.5%. The risk contributions from the primary beam and scatter radiation were comparable, whereas the contribution from repeated diagnostic imaging was considerably smaller. CONCLUSION The results indicated that the redistribution of the dose characteristic to IMRT leads to a redistribution of the risks in individual tissues. However, the total levels of risk were similar between the two irradiation techniques considered.
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MESH Headings
- Adult
- Algorithms
- Diagnostic Imaging/adverse effects
- Esophagus/radiation effects
- Female
- Head and Neck Neoplasms/radiotherapy
- Humans
- Hypopharyngeal Neoplasms/radiotherapy
- Lung/radiation effects
- Male
- Neoplasms, Radiation-Induced/etiology
- Neoplasms, Second Primary/etiology
- Organs at Risk/radiation effects
- Parotid Gland/radiation effects
- Phantoms, Imaging
- Photons/therapeutic use
- Radiotherapy Planning, Computer-Assisted/methods
- Radiotherapy, Conformal/adverse effects
- Radiotherapy, Conformal/methods
- Radiotherapy, Image-Guided/adverse effects
- Radiotherapy, Image-Guided/methods
- Radiotherapy, Intensity-Modulated/adverse effects
- Radiotherapy, Intensity-Modulated/methods
- Risk
- Scattering, Radiation
- Sex Factors
- Tongue Neoplasms/radiotherapy
- Tonsillar Neoplasms/radiotherapy
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Affiliation(s)
- Oscar Ardenfors
- Medical Radiation Physics, Department of Physics, Stockholm University , Stockholm , Sweden
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