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Johnson PB, Mamalui M, Brodin P, Janssens G. Secondary cancer risk in six anatomical sites when using PAT, IMPT, and VMAT/IMRT radiotherapy. Radiother Oncol 2024; 199:110421. [PMID: 38997093 DOI: 10.1016/j.radonc.2024.110421] [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: 02/02/2024] [Revised: 07/02/2024] [Accepted: 07/05/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND AND PURPOSE Compared to intensity modulated proton therapy (IMPT), proton arc therapy (PAT) is expected to improve dose conformality, delivery efficiency, and provide a more favorable LET distribution. Alternatively, the low-dose bath is potentially spread over larger volumes, which could impact the likelihood of developing a radiation-induced, secondary cancer (SC). The goal of this study was to evaluate this risk in several anatomical sites using newly developed commercial tools. MATERIALS AND METHODS Treatment plans encompassing six anatomical sites, five patients per site, and three techniques per patient were created using RayStation. Techniques included PAT and IMPT for protons, and either volumetrically modulated radiotherapy (VMAT) or intensity modulated radiotherapy (IMRT) for photons. Risk estimates were based on the organ-equivalent dose (OED) concept using both Schneider's mechanistic dose-response model for carcinoma induction and a linear dose-response model. RESULTS With few exceptions, mean and integral dose were lowest with PAT. For protons, the factor OEDIMPT/OEDPAT ranged from 0.7 to 1.8 with both the mechanistic and linear model, while for photons OEDphoton/OEDPAT ranged from 1.5 to 10 using the mechanistic model and 1.3 to using the linear model. A strong correlation was found between mean dose and OED for organs with significant repopulation/repair (high R value) and less cell death from single hit interactions (low α value). CONCLUSION Based on results from both mechanistic and linear risk models, the transition from IMPT to PAT should not substantially affect SC risk in patients treated with proton therapy. Additionally, when using Schneider's model, the shapes of the dose-response curves can be used as a good predictor of how SC risk will respond to shifts from intermediate dose to low dose as anticipated when moving from IMPT to PAT.
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Affiliation(s)
- Perry B Johnson
- University of Florida Health Proton Therapy Institute, Jacksonville, FL, United States; University of Florida College of Medicine, Gainesville, FL, United States.
| | - Maria Mamalui
- University of Florida Health Proton Therapy Institute, Jacksonville, FL, United States; University of Florida College of Medicine, Gainesville, FL, United States
| | - Patrik Brodin
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
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2
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Kim DW, Hong CS, Son J, Kim SY, Park YI, Chung M, Chung WK, Han MC, Kim J, Kim H, Kim JS. Dosimetric analysis of six whole-breast irradiation techniques in supine and prone positions. Sci Rep 2024; 14:14347. [PMID: 38907042 PMCID: PMC11192744 DOI: 10.1038/s41598-024-65461-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 06/20/2024] [Indexed: 06/23/2024] Open
Abstract
In breast cancer radiation therapy, minimizing radiation-related risks and toxicity is vital for improving life expectancy. Tailoring radiotherapy techniques and treatment positions can reduce radiation doses to normal organs and mitigate treatment-related toxicity. This study entailed a dosimetric comparison of six different external beam whole-breast irradiation techniques in both supine and prone positions. We selected fourteen breast cancer patients, generating six treatment plans in both positions per patient. We assessed target coverage and organs at risk (OAR) doses to evaluate the impact of treatment techniques and positions. Excess absolute risk was calculated to estimate potential secondary cancer risk in the contralateral breast, ipsilateral lung, and contralateral lung. Additionally, we analyzed the distance between the target volume and OARs (heart and ipsilateral lung) while considering the treatment position. The results indicate that prone positioning lowers lung exposure in X-ray radiotherapy. However, particle beam therapies (PBTs) significantly reduce the dose to the heart and ipsilateral lung regardless of the patient's position. Notably, negligible differences were observed between arc-delivery and static-delivery PBTs in terms of target conformity and OAR sparing. This study provides critical dosimetric evidence to facilitate informed decision-making regarding treatment techniques and positions.
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Affiliation(s)
- Dong Wook Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-Ro, Seodaemun-Gu, Seoul, South Korea, 03722
| | - Chae-Seon Hong
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-Ro, Seodaemun-Gu, Seoul, South Korea, 03722.
| | - Junyoung Son
- Department of Radiation Oncology, Yongin Severance Hospital, Yongin, South Korea
| | - Se Young Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Seoul, South Korea
| | - Ye-In Park
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-Ro, Seodaemun-Gu, Seoul, South Korea, 03722
| | - Mijoo Chung
- Department of Radiation Oncology, Changwon Hanmaeum Hospital, Hanyang University College of Medicine, Changwon, South Korea
| | - Weon Kuu Chung
- Department of Radiation Oncology, Kyung Hee University Hospital at Gangdong, Seoul, South Korea
| | - Min Cheol Han
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-Ro, Seodaemun-Gu, Seoul, South Korea, 03722
| | - Jihun Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Hojin Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-Ro, Seodaemun-Gu, Seoul, South Korea, 03722
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-Ro, Seodaemun-Gu, Seoul, South Korea, 03722.
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Ghaznavi H. Comment on "Incidence risk assessment of secondary cancer due to radiotherapy of women with rectal cancer using BEIR VII, EPA, and ICRP models". Rep Pract Oncol Radiother 2024; 28:846-847. [PMID: 38515823 PMCID: PMC10954269 DOI: 10.5603/rpor.98736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/20/2023] [Indexed: 03/23/2024] Open
Affiliation(s)
- Hamid Ghaznavi
- Department of Radiology, Faculty of Paramedical Sciences, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Pursley J, Remillard K, Depauw N, Lee G, Grassberger C, Paganetti H, Efstathiou JA, Kamran SC. Radiation Therapy for Stage IIA/B Seminoma: Modeling Secondary Cancer Risk for Protons and VMAT versus 3D Photons. Cancers (Basel) 2024; 16:784. [PMID: 38398175 PMCID: PMC10886533 DOI: 10.3390/cancers16040784] [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: 01/14/2024] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
Radiation therapy (RT) is an effective treatment for stage IIA and select stage IIB seminomas. However, given the long life expectancy of seminoma patients, there are concerns about the risk of secondary cancers from RT. This study assessed differences in secondary cancer risk for stage II seminoma patients following proton pencil-beam scanning (PBS) and photon VMAT, compared to 3D conformal photon RT. Ten seminoma patients, five with a IIA staging who received 30 GyRBE and five with a IIB staging who received 36 GyRBE, had three RT plans generated. Doses to organs at risk (OAR) were evaluated, and secondary cancer risks were calculated as the Excess Absolute Risk (EAR) and Lifetime Attributable Risk (LAR). PBS reduced the mean OAR dose by 60% on average compared to 3D, and reduced the EAR and LAR for all OAR, with the greatest reductions seen for the bowel, liver, and stomach. VMAT reduced high doses but increased the low-dose bath, leading to an increased EAR and LAR for some OAR. PBS provided superior dosimetric sparing of OAR compared to 3D and VMAT in stage II seminoma cases, with models demonstrating that this may reduce secondary cancer risk. Therefore, proton therapy shows the potential to reduce acute and late side effects of RT for this population.
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Affiliation(s)
- Jennifer Pursley
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA (S.C.K.)
| | - Kyla Remillard
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA (S.C.K.)
| | - Nicolas Depauw
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA (S.C.K.)
| | - Grace Lee
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA (S.C.K.)
| | - Clemens Grassberger
- Department of Radiation Oncology, University of Washington Medical Center, Seattle, WA 98195, USA
| | - Harald Paganetti
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA (S.C.K.)
| | - Jason A. Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA (S.C.K.)
| | - Sophia C. Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA (S.C.K.)
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Wu XY, Chen M, Cao L, Li M, Chen JY. Proton Therapy in Breast Cancer: A Review of Potential Approaches for Patient Selection. Technol Cancer Res Treat 2024; 23:15330338241234788. [PMID: 38389426 PMCID: PMC10894553 DOI: 10.1177/15330338241234788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/25/2023] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
Proton radiotherapy may be a compelling technical option for the treatment of breast cancer due to its unique physical property known as the "Bragg peak." This feature offers distinct advantages, promising superior dose conformity within the tumor area and reduced radiation exposure to surrounding healthy tissues, enhancing the potential for better treatment outcomes. However, proton therapy is accompanied by inherent challenges, primarily higher costs and limited accessibility when compared to well-developed photon irradiation. Thus, in clinical practice, it is important for radiation oncologists to carefully select patients before recommendation of proton therapy to ensure the transformation of dosimetric benefits into tangible clinical benefits. Yet, the optimal indications for proton therapy in breast cancer patients remain uncertain. While there is no widely recognized methodology for patient selection, numerous attempts have been made in this direction. In this review, we intended to present an inspiring summarization and discussion about the current practices and exploration on the approaches of this treatment decision-making process in terms of treatment-related side-effects, tumor control, and cost-efficiency, including the normal tissue complication probability (NTCP) model, the tumor control probability (TCP) model, genomic biomarkers, cost-effectiveness analyses (CEAs), and so on. Additionally, we conducted an evaluation of the eligibility criteria in ongoing randomized controlled trials and analyzed their reference value in patient selection. We evaluated the pros and cons of various potential patient selection approaches and proposed possible directions for further optimization and exploration. In summary, while proton therapy holds significant promise in breast cancer treatment, its integration into clinical practice calls for a thoughtful, evidence-driven strategy. By continuously refining the patient selection criteria, we can harness the full potential of proton radiotherapy while ensuring maximum benefit for breast cancer patients.
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Affiliation(s)
- Xiao-Yu Wu
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Mei Chen
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Lu Cao
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Min Li
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jia-Yi Chen
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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Tjelta J, Ytre-Hauge K, Lyngholm E, Handeland A, Henjum H, Stokkevåg C. Dose exposure to an adult present in the treatment room during pediatric pencil beam scanning proton therapy. Acta Oncol 2023; 62:1531-1535. [PMID: 37676843 DOI: 10.1080/0284186x.2023.2254924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Johannes Tjelta
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
- Department of Physics and Technology, University of Bergen, Bergen, Norway
| | | | - Erlend Lyngholm
- Department of Physics and Technology, University of Bergen, Bergen, Norway
| | - Andreas Handeland
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
- Department of Physics and Technology, University of Bergen, Bergen, Norway
| | - Helge Henjum
- Department of Physics and Technology, University of Bergen, Bergen, Norway
| | - Camilla Stokkevåg
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
- Department of Physics and Technology, University of Bergen, Bergen, Norway
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7
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Dell'Oro M, Wilson P, Short M, Peukert D, Bezak E. Modelling the influence of radiosensitivity on development of second primary cancer in out-of-field organs following proton therapy for paediatric cranial cancer. Br J Radiol 2023; 96:20230161. [PMID: 37660473 PMCID: PMC10546440 DOI: 10.1259/bjr.20230161] [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: 02/15/2023] [Revised: 06/16/2023] [Accepted: 07/19/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVE Radiobiological modelling the risks of second primary cancer (SPC) after proton therapy (PT) for childhood cranial cancer remains largely unknown. Organ-specific dose-response risk factors such as radiosensitivity require exploration. This study compared the influence of radiosensitivity data (slope of βEAR) on children's lifetime attributable risks (LAR) of SPC development in out-of-field organs following cranial scattering and scanning PT. METHODS Out-of-field radiosensitivity parameter estimates for organs (α/β and βEAR) were sourced from literature. Physical distances for 13 out-of-field organs were measured and input into Schneider's SPC model. Sensitivity analyses were performed as a function of radiosensitivity (α/β of 1-10 Gy) and initial slope (βEAR) from Japanese/UK data to estimate the influence on the risk of radiation-induced SPC following scattering and scanning PT. RESULTS Models showed similar LAR of SPC estimates for age and sex-matched paediatric phantoms, however, for breast there was a significant increase using Japanese βEAR data. For most organs, scattering PT demonstrated a larger risk of LAR for SPC which increased with α/β. CONCLUSION Breast tissue exhibited the highest susceptibility in calculated LAR risk, demonstrating the importance for accurate data input when estimating LAR of SPC. ADVANCES IN KNOWLEDGE The findings of this study demonstrated younger female patients undergoing cranial proton therapy have a higher risk of developing second primary cancer of the breast tissue. Long-term multicenter registries are important to improve predictive radiobiological modelling studies of side effects.
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Affiliation(s)
| | | | - Michala Short
- Cancer Research Institute, University of South Australia, Adelaide, Australia
| | - Dylan Peukert
- ARC Training Centre for Integrated Operations for Complex Resources, University of Adelaide, Adelaide, Australia
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Rønde HS, Kronborg C, Høyer M, Hansen J, Bak ME, Agergaard SN, Als AB, Agerbæk M, Lauritsen J, Meidahl Petersen P, Dysager L, Kallehauge JF. Dose comparison of robustly optimized intensity modulated proton therapy (IMPT) vs IMRT and VMAT photon plans for testicular seminoma. Acta Oncol 2023; 62:1222-1229. [PMID: 37683054 DOI: 10.1080/0284186x.2023.2254925] [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: 04/14/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Patients with stage II seminoma have traditionally been treated with photons to the retroperitoneal and iliac space, which leads to a substantial dose bath to abdominal and pelvic organs at risk (OAR). As these patients are young and with excellent prognosis, reducing dose to OAR and thereby the risk of secondary cancer is of utmost importance. We compared IMPT to opposing IMRT fields and VMAT, assessing dose to OAR and both overall and organ-specific secondary cancer risk. MATERIAL AND METHODS A comparative treatment planning study was conducted on planning CT-scans from ten patients with stage II seminoma, treated with photons to a 'dog-leg' field with doses ranging from 20 to 25 Gy and a 10 Gy sequential boost to the metastatic lymph node(s). Photon plans were either 3-4 field IMRT (Eclipse) or 1-2 arc VMAT (Pinnacle). Proton plans used robust (5 mm; 3.5%) IMPT (Eclipse), multi field optimization with 3 posterior fields supplemented by 2 anterior fields at the level of the iliac vessels. Thirty plans were generated. Mean doses to OARs were compared for IMRT vs IMPT and VMAT vs IMPT. The risk of secondary cancer was calculated according to the model described by Schneider, using excess absolute risk (EAR, per 10,000 persons per year) for body outline, stomach, duodenum, pancreas, bowel, bladder and spinal cord. RESULTS Mean doses to all OARs were significantly lower with IMPT except similar kidney (IMRT) and spinal cord (VMAT) doses. The relative EAR for body outline was 0.59 for IMPT/IMRT (p < .05) and 0.33 for IMPT/VMAT (p < .05). Organ specific secondary cancer risk was also lower for IMPT except for pancreas and duodenum. CONCLUSION Proton therapy reduced radiation dose to OAR compared to both IMRT and VMAT plans, and potentially reduce the risk of secondary cancer both overall and for most OAR.
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Affiliation(s)
- Heidi S Rønde
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Camilla Kronborg
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Høyer
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Jolanta Hansen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | - Mads Agerbæk
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Lars Dysager
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Jesper F Kallehauge
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
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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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Cilla S, Deodato F, Romano C, Macchia G, Buwenge M, Boccardi M, Pezzulla D, Pierro A, Zamagni A, Morganti AG. Risk evaluation of secondary malignancies after radiotherapy of breast cancer in light of the continuous development of planning techniques. Med Dosim 2023; 48:279-285. [PMID: 37659968 DOI: 10.1016/j.meddos.2023.07.003] [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: 02/13/2023] [Revised: 05/12/2023] [Accepted: 07/26/2023] [Indexed: 09/04/2023]
Abstract
Secondary cancer risk is a significant concern for women treated with breast radiation therapy due to improved long-term survival rates. We evaluated the potential of new advanced automated planning algorithms together with hybrid techniques to minimize the excess absolute risk (EAR) for secondary cancer in various organs after radiation treatment for early staged breast cancer. Using CT data set of 25 patients, we generated 4 different radiation treatment plans of different complexity, including 3-dimensional conformal radiotherapy (3D-CRT), field-in-field (FinF), hybrid-IMRT (HMRT) and automated hybrid-VMAT (HVMAT) techniques. The organ-equivalent dose (OED) was calculated from differential dose-volume histograms on the basis of the "linear-exponential," "plateau," and "full mechanistic" dose-response models and was used to evaluate the EAR for secondary cancer in the contralateral breast (CB), contralateral lung (CL), and ipsilateral lung (IL). Statistical comparisons of data were performed by a Kruskal-Wallis analysis of variance. The planning objectives were fulfilled with all the planning techniques for both target coverage and organs-at-risk sparing. The differences in EAR for CB, CL and IL secondary tumor induction were not significant among the 4 techniques. For the CB and CL, the mean absolute difference did not reach 1 case of 10000 patient-years. For the IL, the mean absolute difference was up to 5 cases of 10,000 patient-years. In conclusion, the automated HVMAT technique allows an EAR reduction at the level of well-consolidated tangential 3D-CRT or FinF techniques, keeping all the HVMAT dosimetric improvements unchanged. On the basis of this analysis, the adoption of the HVMAT technique poses no increase in EAR and could be considered safe also for younger patients.
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Affiliation(s)
- Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital, Campobasso, Italy.
| | - Francesco Deodato
- Radiation Oncology Unit, Gemelli Molise Hospital, Campobasso, Italy; Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Carmela Romano
- Medical Physics Unit, Gemelli Molise Hospital, Campobasso, Italy
| | | | - Milly Buwenge
- Radiation Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Donato Pezzulla
- Radiation Oncology Unit, Gemelli Molise Hospital, Campobasso, Italy
| | - Antonio Pierro
- Radiology Unit, Gemelli Molise Hospital, Campobasso, Italy
| | - Alice Zamagni
- Radiation Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Experimental, Diagnostic, and Specialty Medicine-DIMES, Alma Mater Studiorum, Università di Bologna, Italy
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11
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Racka I, Majewska K, Winiecki J, Kiluk K. Hybrid planning techniques for early-stage left-sided breast cancer: dose distribution analysis and estimation of projected secondary cancer-relative risk. Acta Oncol 2023; 62:932-941. [PMID: 37516978 DOI: 10.1080/0284186x.2023.2238553] [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: 04/03/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE The purpose of this study was to evaluate three techniques of irradiation of left-sided breast cancer patients, three-dimensional conformal radiotherapy (3D-CRT), hybrid Intensity-Modulated Radiotherapy (h-IMRT), and hybrid Volumetric-Modulated Arc Therapy (h-VMAT, h-ARC), in terms of dose distribution in the planning target volume (PTV) and organs at risk (OARs). The second aim was to estimate the projected relative risk of radiation-induced secondary cancers for hybrid techniques. MATERIALS AND METHODS Three treatment plans were prepared in 3D-CRT, h-IMRT, and h-VMAT techniques for each of the 40 patients, who underwent CT simulation in deep inspiration breath-hold (DIBH). For hybrid techniques, plans were created by combining 3D-CRT and dynamic fields with an 80%/20% dose ratio for 3D-CRT and IMRT or VMAT. Cumulative dose-volume histograms were used to compare dose distributions within the PTV and OARs (heart, left anterior descending coronary artery [LAD], left and right lung [LL, RL], right breast [RB]). Projected risk ratios for secondary cancers were estimated relative to 3D-CRT using the organ equivalent dose (OED) concept for the Schneider's linear exponential, plateau, and full mechanistic dose-response model. RESULTS All plans fulfilled the PTV criterium: V95%≥95%. Compared to 3D-CRT, both hybrid techniques showed significantly better target coverage (PTV: V95%>98%, p < 0.001), and the best conformality was achieved by h-ARC plans (CI: 1.18 ± 0.09, p < 0.001). Compared to 3D-CRT and h-ARC, h-IMRT increased the average sum of monitor units (MU) over 129.9% (p < 0.001). H-ARC increased the mean dose of contralateral organs and the LL V5Gy parameter (p < 0.001). Both hybrid techniques significantly reduced the Dmax of the heart by 5 Gy. Compared to h-IMRT, h-ARC increased secondary cancer projected relative risk ratios for LL, RL, and RB by 18, 152, and 81%, respectively. CONCLUSIONS The results confirmed that both hybrid techniques provide better target quality and OARs sparing than 3D-CRT. Hybrid VMAT delivers less MU compared to hybrid IMRT but may increase the risk of radiation-induced secondary malignancies.
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Affiliation(s)
- Iga Racka
- Medical Physics Department, Prof. Franciszek Łukaszczyk Memorial Oncology Center, Bydgoszcz, Poland
| | - Karolina Majewska
- Medical Physics Department, Prof. Franciszek Łukaszczyk Memorial Oncology Center, Bydgoszcz, Poland
| | - Janusz Winiecki
- Medical Physics Department, Prof. Franciszek Łukaszczyk Memorial Oncology Center, Bydgoszcz, Poland
- Clinic of Oncology and Brachytherapy, Collegium Medicum in Bydgoszcz, Nicholas Copernicus University, Torun, Poland
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12
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Toussaint L, Indelicato DJ, Muren LP, Stokkevåg CH. Risk of second primary cancer from proton arc therapy of pediatric brain tumors. Phys Imaging Radiat Oncol 2023; 27:100480. [PMID: 37655121 PMCID: PMC10465935 DOI: 10.1016/j.phro.2023.100480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 09/02/2023] Open
Abstract
Proton arc therapy (PAT) is currently explored for clinical implementation, despite its associated low-dose bath. This study therefore aimed at evaluating the risk of radiation-induced second primary cancer (SPC) for PAT in pediatric brain tumor patients. Two brain-specific models for SPC induction were applied in five cases to compare volumetric modulated arc therapy (VMAT), intensity modulated proton therapy (IMPT) and PAT surrogate plans. The PAT integral dose was reduced by a median of 29% compared to VMAT, and 17% compared to IMPT. For both models, the estimated SPC risks were consistently the lowest for PAT.
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Affiliation(s)
- Laura Toussaint
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Daniel J Indelicato
- Department of Radiation Oncology, University of Florida Health Proton Therapy Institute, Jacksonville, FL, USA
| | - Ludvig P Muren
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Camilla H Stokkevåg
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
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13
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Aoyama T, Shimizu H, Koide Y, Kitagawa T, Tachibana H, Suzuki K, Kodaira T. Estimation of the risk of secondary cancer in rectum and bladder after radiation therapy for prostate cancer using a feasibility dose-volume histogram. Phys Imaging Radiat Oncol 2023; 27:100468. [PMID: 37520638 PMCID: PMC10384607 DOI: 10.1016/j.phro.2023.100468] [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: 03/13/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Abstract
We investigated the risk of secondary cancers in rectum and bladder for prostate cancer radiotherapy using a feasibility assessment tool. We calculated the risk of secondary cancer by generating a dose-volume histogram based on an ideal dose falloff function (f-value). This study found a smaller f-value was associated with a lower secondary cancer risk in the rectum but a higher risk in the bladder. The study suggests setting the f-value at 0-0.1 as the optimization goal for the rectum and 0.4 for the bladder is reasonable and feasible for reducing the risk of secondary cancer and other adverse events.
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Affiliation(s)
- Takahiro Aoyama
- Department of Radiation Oncology, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Aichi 464-8681, Japan
| | - Hidetoshi Shimizu
- Department of Radiation Oncology, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Aichi 464-8681, Japan
| | - Yutaro Koide
- Department of Radiation Oncology, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Aichi 464-8681, Japan
| | - Tomoki Kitagawa
- Department of Radiation Oncology, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Aichi 464-8681, Japan
| | - Hiroyuki Tachibana
- Department of Radiation Oncology, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Aichi 464-8681, Japan
| | - Kojiro Suzuki
- Department of Radiology, Aichi Medical University, 1-1 Yazako-karimata, Nagakute, Aichi 480-1195 Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Aichi 464-8681, Japan
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14
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Huang Y, Gong C, Luo M, Yuan X, Ding S, Wang X, Zhang Y. Comparative dosimetric and radiobiological assessment of left-sided whole breast and regional nodes with advanced radiotherapy techniques. JOURNAL OF RADIATION RESEARCH 2023:rrad045. [PMID: 37315943 DOI: 10.1093/jrr/rrad045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/26/2023] [Indexed: 06/16/2023]
Abstract
The aim of this study was to analyze the dosimetric and radiobiologic differences of the left-sided whole breast and regional nodes in intensity-modulated radiotherapy (IMRT), volume-modulated arc therapy (VMAT), and helical tomotherapy (HT). The IMRT, VMAT, and HT plans in this study were generated for thirty-five left-sided breast cancer patients after breast-conserving surgery (BCS). The planning target volume (PTV) included the whole breast and supraclavicular nodes. PTV coverage, homogeneity index (HI), conformity index (CI), dose to organs at risk (OARs), secondary cancer complication probability (SCCP), and excess absolute risk (EAR) were used to evaluate the plans. Compared to IMRT, the VMAT and HT plans resulted in higher PTV coverage and homogeneity. The VMAT and HT plans also delivered a lower mean dose to the ipsilateral lung (9.19 ± 1.36 Gy, 9.48 ± 1.17 Gy vs. 11.31 ± 1.42 Gy) and heart (3.99 ± 0.86 Gy, 4.48 ± 0.62 Gy vs. 5.53 ± 1.02 Gy) and reduced the V5Gy, V10Gy, V20Gy, V30Gy, and V40Gy of the ipsilateral lung and heart. The SCCP and EAR for the ipsilateral lung were reduced by 3.67%, 3.09% in VMAT, and 22.18%, 19.21% in HT, respectively. While were increased for the contralateral lung and breast. This study showed that VMAT plans provide a more homogeneous dose distribution to the PTV, minimizing exposure to ipsilateral structures and significantly reducing SCCP and EAR, and slightly increasing dose to contralateral structures. Overall, the VMAT plan can be considered a beneficial technique for BCS patients whose PTV includes the whole breast and regional nodes.
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Affiliation(s)
- Yuling Huang
- Department of Radiation Oncology, Jiangxi Cancer Hospital, 519 East Beijing Road, Qingshanhu District, Nanchang, Jiangxi 330029, PR China
- Department of Radiation Oncology, The Second Affiliated Hospital of Nanchang, Nanchang, Jiangxi 330029, PR China
| | - Changfei Gong
- Department of Radiation Oncology, Jiangxi Cancer Hospital, 519 East Beijing Road, Qingshanhu District, Nanchang, Jiangxi 330029, PR China
- Department of Radiation Oncology, The Second Affiliated Hospital of Nanchang, Nanchang, Jiangxi 330029, PR China
| | - Mingming Luo
- Department of Radiation Oncology, Jiangxi Cancer Hospital, 519 East Beijing Road, Qingshanhu District, Nanchang, Jiangxi 330029, PR China
- Department of Radiation Oncology, The Second Affiliated Hospital of Nanchang, Nanchang, Jiangxi 330029, PR China
| | - Xingxing Yuan
- Department of Radiation Oncology, Jiangxi Cancer Hospital, 519 East Beijing Road, Qingshanhu District, Nanchang, Jiangxi 330029, PR China
- Department of Radiation Oncology, The Second Affiliated Hospital of Nanchang, Nanchang, Jiangxi 330029, PR China
| | - Shenggou Ding
- Department of Radiation Oncology, Jiangxi Cancer Hospital, 519 East Beijing Road, Qingshanhu District, Nanchang, Jiangxi 330029, PR China
- Department of Radiation Oncology, The Second Affiliated Hospital of Nanchang, Nanchang, Jiangxi 330029, PR China
| | - Xiaoping Wang
- Department of Radiation Oncology, Jiangxi Cancer Hospital, 519 East Beijing Road, Qingshanhu District, Nanchang, Jiangxi 330029, PR China
- Department of Radiation Oncology, The Second Affiliated Hospital of Nanchang, Nanchang, Jiangxi 330029, PR China
| | - Yun Zhang
- Department of Radiation Oncology, Jiangxi Cancer Hospital, 519 East Beijing Road, Qingshanhu District, Nanchang, Jiangxi 330029, PR China
- Department of Radiation Oncology, The Second Affiliated Hospital of Nanchang, Nanchang, Jiangxi 330029, PR China
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Zhang Q, Zeng Y, Peng Y, Yu H, Zhang S, Wu S. Critical Evaluation of Secondary Cancer Risk After Breast Radiation Therapy with Hybrid Radiotherapy Techniques. BREAST CANCER (DOVE MEDICAL PRESS) 2023; 15:25-38. [PMID: 36714379 PMCID: PMC9882622 DOI: 10.2147/bctt.s383369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/05/2022] [Indexed: 01/24/2023]
Abstract
Background As hybrid radiotherapy technique can effectively balance dose distribution between targets and organs, it is necessary to evaluate the late effects related to radiotherapy. The aim of the study was to calculate and provide individual estimates of the risks for hybrid radiotherapy techniques in breast cancer patients. Methods Whole-breast irradiation was performed in 43 breast cancer patients by using 3D conformal, intensity-modulated and hybrid techniques. The excess absolute risk (EAR), lifetime attributable risk (LAR) and normal tissue complication probability (NTCP) were calculated to estimate risks in organs. The risk variability in contralateral breast was assessed by using the patient's anatomic parameters. Results Compared with IMRT and FinF, hybrid techniques achieved satisfactory dose distribution and comparable or lower estimated risks in organs. The LAR was estimated to be up to 0.549% for contralateral lung with advantages of tangential techniques over H-VMAT. For ipsilateral lung, the LAR was estimated to be up to 9.021%, but lower in H-VMAT and FinF without significant difference. The risk of thyroid was negligible in overall estimation. For contralateral breast, the LAR was estimated to be up to 0.865% with advantages of MH-IMRT and H-VMAT over TF-IMRT. The fraction of individual variability could be explained by using anatomic parameters of minimum breast distance (MBD) and minimum target concave angle (θMTCA). NTCP for all analyzed endpoints was significantly higher in TF-IMRT relative to FinF and hybrid techniques, while TH-IMRT and H-VMAT were presenting lower toxicity risk. However, MH-IMRT presented a higher probability of toxicity in lung. For most cases, H-VMAT demonstrated a benefit for contralateral breast, heart and lung sparing. Conclusion The optimal treatment should be performed individually according to anatomic parameters and balances between EAR and NTCP. Individual assessment may assist in achieving optimal balances between targets and organs as well as supporting clinical decision-making processes.
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Affiliation(s)
- Quanbin Zhang
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Yu Zeng
- Department of Stomatology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Yingying Peng
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Hui Yu
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, People’s Republic of China
| | - Shuxu Zhang
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, People’s Republic of China,Correspondence: Shuxu Zhang; Shuyu Wu, Email ;
| | - Shuyu Wu
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, People’s Republic of China,Correspondence: Shuxu Zhang; Shuyu Wu, Email ;
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Baseline cardiac risk profile determines radiation-induced cardiac toxicity in patients with mid-lower esophageal cancer. JOURNAL OF RADIOTHERAPY IN PRACTICE 2023. [DOI: 10.1017/s146039692200036x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Abstract
Background:
The radiotherapy techniques are evolving. Besides optimal tumour coverage, considering organs at risk (OAR) is pertinent to radiation oncologists. In mid-lower esophageal cancer (MLEC) radiotherapy, heart is the main OAR. Studies on excess absolute risk (EAR) of cardiovascular disease (CVD) in MLEC radiotherapy are limited in the main literature. Therefore, this study was conducted to estimate the EAR of CVD in patients with MLEC treated with the intensity-modulated radiation therapy (IMRT) technique.
Results:
Family history of heart disease and smoking increased the EAR of CVD significantly compared to the cholesterol and high-sensitivity C-reactive protein. The 10-year EAR of the high-risk group was more than four times of the low-risk group at all ages. In the low-risk group, EAR of CVD after radiotherapy of esophageal cancer can increase by up to 9·1%, while in the high-risk group, EAR increased by 34·89%.
Conclusions:
Adding the baseline CVD risk factors improved the estimation of EAR of heart disease after MLEC radiotherapy with the IMRT technique.
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Racka I, Majewska K, Winiecki J. Three-dimensional conformal radiotherapy (3D-CRT) vs. volumetric modulated arc therapy (VMAT) in deep inspiration breath-hold (DIBH) technique in left-sided breast cancer patients-comparative analysis of dose distribution and estimation of projected secondary cancer risk. Strahlenther Onkol 2023; 199:90-101. [PMID: 35943553 DOI: 10.1007/s00066-022-01979-2] [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: 12/23/2021] [Accepted: 07/07/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE The purpose of this study was to compare two techniques of irradiation of left-sided breast cancer patients who underwent breast-conserving surgery, three-dimensional conformal radiotherapy technique (3D-CRT) and volumetric modulated arc therapy (VMAT), in terms of dose distribution in the planning target volume (PTV) and organs at risk (OARs). The second aim of the study was estimation of the projected risk of radiation-induced secondary cancer for both radiotherapy techniques. MATERIALS AND METHODS For 25 patients who underwent CT simulation in deep inspiration breath-hold (DIBH), three treatment plans were generated: one using a three-dimensional conformal radiotherapy technique and two using volumetric modulated arc therapy. First VMAT-DIBH geometry consisted of three partial arcs (ARC-DIBH 3A) and second consisted of four partial arcs (ARC-DIBH 4A). Cumulative dose-volume histograms (DVHs) were used to compare dose distributions within the PTV and OARs (heart, left anterior descending coronary artery [LAD], ipsilateral and contralateral lung [IL, CL], and contralateral breast [CB]). Normal tissue complication probabilities (NTCPs) and organ equivalent doses (OEDs) were calculated using the differential DVHs. Excess absolute risks (EARs) for second cancers were estimated using Schneider's full mechanistic dose-response model. RESULTS All plans fulfilled the criterium for PTV V95% ≥ 95%. The PTV coverage, homogeneity, and conformity indices were significantly better for VMAT-DIBH. VMAT showed a significantly increased mean dose and V5Gy for all OARs, but reduced LAD Dmax by 15 Gy. For IL, CL, and CB, the 3D-CRT DIBH method achieved the lowest values of EAR: 28.38 per 10,000 PYs, 2.55 per 10,000 PYs, and 4.48 per 10,000 PYs (p < 0.001), compared to 40.29 per 10,000 PYs, 15.62 per 10,000 PYs, and 23.44 per 10,000 PYs for ARC-DIBH 3A plans and 41.12 per 10,000 PYs, 15.59 per 10,000 PYs, and 22.73 per 10,000 PYs for ARC-DIBH 4A plans. Both techniques provided negligibly low NTCPs for all OARs. CONCLUSION The study shows that VMAT-DIBH provides better OAR sparing against high doses. However, the large low-dose-bath (≤ 5 Gy) is still a concern due to the fact that a larger volume of normal tissues exposed to lower doses may increase a radiation-induced risk of secondary cancer.
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Affiliation(s)
- Iga Racka
- Medical Physics Department, Prof. Franciszek Łukaszczyk Memorial Oncology Centre in Bydgoszcz, Bydgoszcz, Poland.
| | - Karolina Majewska
- Medical Physics Department, Prof. Franciszek Łukaszczyk Memorial Oncology Centre in Bydgoszcz, Bydgoszcz, Poland
| | - Janusz Winiecki
- Medical Physics Department, Prof. Franciszek Łukaszczyk Memorial Oncology Centre in Bydgoszcz, Bydgoszcz, Poland.,Clinic of Oncology and Brachytherapy, Collegium Medicum in Bydgoszcz, Nicholas Copernicus University in Torun, Bydgoszcz, Poland
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3D-CRT, IMRT and VMAT for flank irradiation due to pediatric Wilms tumor: A comparative planning study with XCAT phantoms. Phys Med 2022; 103:89-97. [DOI: 10.1016/j.ejmp.2022.10.002] [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: 03/10/2022] [Revised: 06/02/2022] [Accepted: 10/07/2022] [Indexed: 11/17/2022] Open
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Assessment of Radiation-Induced Bladder and Bowel Cancer Risks after Conventionally and Hypo-Fractionated Radiotherapy for the Preoperative Management of Rectal Carcinoma. J Pers Med 2022; 12:jpm12091442. [PMID: 36143227 PMCID: PMC9503780 DOI: 10.3390/jpm12091442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/29/2022] [Indexed: 11/25/2022] Open
Abstract
Preoperative management of rectal carcinoma can be performed by employing either conventionally or hypo-fractionated Radiotherapy (CFRT or HFRT, respectively), delivered by Intensity Modulated Radiotherapy (IMRT) or Volumetric Modulated Arc Therapy (VMAT) plans, employing 6 MV or 10 MV photon beams. This study aims to dosimetrically and radiobiologically compare all available approaches, with emphasis on the risk of radiation-induced second cancer to the bladder and bowel. Computed Tomography (CT) scans and relevant radiotherapy contours from 16 patients were anonymized and analyzed retrospectively. For each case, CFRT of 25 × 2 Gy and HFRT of 5 × 5 Gy were both considered. IMRT and VMAT plans using 6 MV and 10 MV photons were prepared. Plan optimization was performed, considering all clinically used plan quality indices and dose–volume constraints for the critical organs. Resulting dose distributions were analyzed and compared. Moreover, the Lifetime Attributable Risk (LAR) for developing radiation-induced bladder and bowel malignancies were assessed using a non-linear mechanistic model, assuming patient ages at treatment of 45, 50, 55 and 60 years. All 128 plans created were clinically acceptable. Risk of second bladder cancer reached 0.26% for HFRT (5 × 5 Gy) and 0.19% for CFRT (25 × 2 Gy) at the age of 45. Systematically higher risks were calculated for HFRT (5 × 5 Gy) as compared to CFRT (25 × 2 Gy), with 6 MV photons resulting in slightly increased LAR, as well. Similar or equal bowel cancer risks were calculated for all techniques and patient ages investigated (range 0.05–0.14%). This work contributes towards radiotherapy treatment protocol selection criteria for the preoperative irradiation of rectal carcinoma. However, more studies are needed to establish the associated radiation-induced risk of each RT protocol.
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Vogel M, Gade J, Timm B, Schürmann M, Auerbach H, Nüsken F, Rübe C, Melchior P, Dzierma Y. Comparison of Breast Cancer Radiotherapy Techniques Regarding Secondary Cancer Risk and Normal Tissue Complication Probability - Modelling and Measurements Using a 3D-Printed Phantom. Front Oncol 2022; 12:892923. [PMID: 35965556 PMCID: PMC9365503 DOI: 10.3389/fonc.2022.892923] [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: 03/09/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Radiotherapy after breast-conserving therapy is a standard postoperative treatment of breast cancer, which can be carried out with a variety of irradiation techniques. The treatment planning must take into consideration detrimental effects on the neighbouring organs at risk-the lung, the heart, and the contralateral breast, which can include both short- and long-term effects represented by the normal tissue complication probability and secondary cancer risk. Patients and Methods In this planning study, we investigate intensity-modulated (IMRT) and three-dimensional conformal (3D-CRT) radiotherapy techniques including sequential or simultaneously integrated boosts as well as interstitial multicatheter brachytherapy boost techniques of 38 patients with breast-conserving surgery retrospectively. We furthermore develop a 3D-printed breast phantom add-on to allow for catheter placement and to measure the out-of-field dose using thermoluminescent dosimeters placed inside an anthropomorphic phantom. Finally, we estimate normal tissue complication probabilities using the Lyman-Kutcher-Burman model and secondary cancer risks using the linear non-threshold model (out-of-field) and the model by Schneider et al. (in-field). Results The results depend on the combination of primary whole-breast irradiation and boost technique. The normal tissue complication probabilities for various endpoints are of the following order: 1%-2% (symptomatic pneumonitis, ipsilateral lung), 2%-3% (symptomatic pneumonitis, whole lung), and 1%-2% (radiation pneumonitis grade ≥ 2, whole lung). The additional relative risk of ischemic heart disease ranges from +25% to +35%. In-field secondary cancer risk of the ipsilateral lung in left-sided treatment is around 50 per 10,000 person-years for 20 years after exposure at age 55. Out-of-field estimation of secondary cancer risk results in approximately 5 per 10,000 person-years each for the contralateral lung and breast. Conclusions In general, 3D-CRT shows the best risk reduction in contrast to IMRT. Regarding the boost concepts, brachytherapy is the most effective method in order to minimise normal tissue complication probability and secondary cancer risk compared to teletherapy boost concepts. Hence, the 3D-CRT technique in combination with an interstitial multicatheter brachytherapy boost is most suitable in terms of risk avoidance for treating breast cancer with techniques including boost concepts.
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Affiliation(s)
- Marc Vogel
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg, Germany
| | - Jonas Gade
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg, Germany
| | - Bernd Timm
- Siemens Healthcare GmbH, Technical Service, Erlangen, Germany
| | - Michaela Schürmann
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg, Germany
| | - Hendrik Auerbach
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg, Germany
| | - Frank Nüsken
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg, Germany
| | - Christian Rübe
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg, Germany
| | - Patrick Melchior
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg, Germany
| | - Yvonne Dzierma
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Centre, Homburg, Germany
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Total-Body Irradiation Is Associated With Increased Incidence of Mesenchymal Neoplasia in a Radiation Late Effects Cohort of Rhesus Macaques (Macaca mulatta). Int J Radiat Oncol Biol Phys 2022; 113:661-674. [PMID: 35361520 PMCID: PMC9250621 DOI: 10.1016/j.ijrobp.2022.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 02/04/2022] [Accepted: 02/13/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE Cancer is a severe delayed effect of acute radiation exposure. Total-body irradiation has been associated with an increased risk of solid cancer and leukemia in Japanese atomic bomb survivors, and secondary malignancies, such as sarcoma, are a serious consequence of cancer radiation therapy. The radiation late effects cohort (RLEC) of rhesus macaques (Macaca mulatta) is a unique resource of more than 200 animals for studying the long-term consequences of total-body irradiation in an animal model that closely resembles humans at the genetic and physiologic levels. METHODS AND MATERIALS Using clinical records, clinical imaging, histopathology, and immunohistochemistry, this retrospective study characterized the incidence of neoplasia in the RLEC. RESULTS Since 2007, 61 neoplasms in 44 of 239 irradiated animals were documented (18.4% of the irradiated population). Only 1 neoplasm was diagnosed among the 51 nonirradiated controls of the RLEC (2.0%). The most common malignancies in the RLEC were sarcomas (38.3% of diagnoses), which are rare neoplasms in nonirradiated macaques. The most common sarcomas included malignant nerve sheath tumors and malignant glomus tumors. Carcinomas were less common (19.7% of diagnoses), and consisted primarily of renal cell and hepatocellular carcinomas. Neoplasia occurred in most major body systems, with the skin and subcutis being the most common site (40%). RNA analysis showed similarities in transcriptional profiles between RLEC and human malignant nerve sheath tumors. CONCLUSIONS This study indicates that total-body irradiation is associated with an increased incidence of neoplasia years following irradiation, at more than double the incidence described in aging, nonirradiated animals, and promotes tumor histotypes that are rarely observed in nonirradiated, aging rhesus macaques.
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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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Xia C, Qin L, Wang Y, Yao L, Shia B, Wu SY. Risk factors and specific cancer types of second primary malignancies in patients with breast cancer receiving adjuvant radiotherapy: a case-control cohort study based on the SEER database. Am J Cancer Res 2022; 12:2744-2756. [PMID: 35812050 PMCID: PMC9251704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/14/2022] [Indexed: 06/15/2023] Open
Abstract
Patients with breast cancer can survive and live a long, cancer-free life; however, late complications of treatment, such as second primary malignancies (SPMs), have emerged as a competing cause of death and morbidity. We conducted a long-term population-based cohort study to identify the risk factors for SPMs and specific secondary cancer types after various latency periods of irradiated breast cancer. Cox proportional hazards regression was used to calculate the hazard ratio (HR) and 95% confidence interval (95% CI) for independent risk factors for SPM. We also calculated the HR of each specific cancer type and the latency time to specific SPMs. The risk of SPM was statistically significantly higher in patients with adjuvant RT than in patients without adjuvant RT (adjusted HR [aHR]: 1.105, 95% CI: 1.013-1.206). Compared with the control group, the case group had significantly increased risks of contralateral breast cancer (aHR: 1.268, 95% CI: 1.112-1.445), lung cancer (aHR: 1.218, 95% CI: 1.049-1.565), and urinary system cancer (aHR: 1.702, 95% CI: 1.140-2.543). Adjuvant RT for breast cancer increases the risk of SPM. Contralateral breast cancer, lung cancer, and bladder cancer were significant SPMs after breast RT, although the cumulative risk of SPM was low, at approximately 6, 10, and 13 cancers per 1000 women with irradiated breasts at latency periods of 5, 10, and 15 years, respectively, after breast RT.
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Affiliation(s)
- Chuanxin Xia
- Chinese Academy of International Trade and Economic CooperationDongcheng, Beijing, China
| | - Lei Qin
- School of Statistics, University of International Business and EconomicsBeijing, China
| | - Yinzhi Wang
- School of Statistics, University of International Business and EconomicsBeijing, China
| | - Ling Yao
- Chinese Academy of International Trade and Economic CooperationDongcheng, Beijing, China
| | - Benchang Shia
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic UniversityNew Taipei City, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic UniversityNew Taipei City, Taiwan
| | - Szu-Yuan Wu
- Graduate Institute of Business Administration, College of Management, Fu Jen Catholic UniversityNew Taipei City, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic UniversityNew Taipei City, Taiwan
- Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia UniversityTaichung, Taiwan
- Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai HospitalYilan, Taiwan
- Division of Radiation Oncology, Lo-Hsu Medical Foundation, Lotung Poh-Ai HospitalYilan, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia UniversityTaichung, Taiwan
- Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical UniversityTaipei, Taiwan
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Hassan IM, Attalla EM, El-Gohary MI. Impact of 3D conformal and Intensity Modulated Radiotherapy on secondary cancer risk for patients with early prostate cancer. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2022. [DOI: 10.1016/j.jrras.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Romero-Expósito M, Toma-Dasu I, Dasu A. Determining Out-of-Field Doses and Second Cancer Risk From Proton Therapy in Young Patients—An Overview. Front Oncol 2022; 12:892078. [PMID: 35712488 PMCID: PMC9197425 DOI: 10.3389/fonc.2022.892078] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Proton therapy has the potential to provide survival and tumor control outcomes comparable and frequently superior to photon therapy. This has led to a significant concern in the medical physics community on the risk for the induction of second cancers in all patients and especially in younger patients, as they are considered more radiosensitive than adults and have an even longer expected lifetime after treatment. Thus, our purpose is to present an overview of the research carried out on the evaluation of out-of-field doses linked to second cancer induction and the prediction of this risk. Most investigations consisted of Monte Carlo simulations in passive beam facilities for clinical scenarios. These works established that equivalent doses in organs could be up to 200 mSv or 900 mSv for a brain or a craniospinal treatment, respectively. The major contribution to this dose comes from the secondary neutrons produced in the beam line elements. Few works focused on scanned-beam facilities, but available data show that, for these facilities, equivalent doses could be between 2 and 50 times lower. Patient age is a relevant factor in the dose level, especially for younger patients (by means of the size of the body) and, in addition, in the predicted risk by models (due to the age dependence of the radiosensitivity). For risks, the sex of the patient also plays an important role, as female patients show higher sensitivity to radiation. Thus, predicted risks of craniospinal irradiation can range from 8% for a 15-year-old male patient to 58% for a 2-year-old female patient, using a risk model from a radiological protection field. These values must be taken with caution due to uncertainties in risk models, and then dosimetric evaluation of stray radiation becomes mandatory in order to complement epidemiological studies and be able to model appropriate dose–response functions for this dose range. In this sense, analytical models represent a useful tool and some models have been implemented to be used for young patients. Research carried out so far confirmed that proton beam therapy reduces the out-of-field doses and second cancer risk. However, further investigations may be required in scanned-beam delivery systems.
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Affiliation(s)
- Maite Romero-Expósito
- The Skandion Clinic, Uppsala, Sweden
- Oncology Pathology Department, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Maite Romero-Expósito,
| | - Iuliana Toma-Dasu
- Oncology Pathology Department, Karolinska Institutet, Stockholm, Sweden
- Medical Radiation Physics, Stockholm University, Stockholm, Sweden
| | - Alexandru Dasu
- The Skandion Clinic, Uppsala, Sweden
- Medical Radiation Sciences, Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
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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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Dell'Oro M, Short M, Wilson P, Peukert D, Hua CH, Merchant TE, Bezak E. Lifetime attributable risk of radiation induced second primary cancer from scattering and scanning proton therapy - A model for out-of-field organs of paediatric patients with cranial cancer. Radiother Oncol 2022; 172:65-75. [DOI: 10.1016/j.radonc.2022.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/28/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
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Bi S, Zhu R, Dai Z. Dosimetric and radiobiological comparison of simultaneous integrated boost radiotherapy for early stage right side breast cancer between three techniques: IMRT, hybrid IMRT and hybrid VMAT. Radiat Oncol 2022; 17:60. [PMID: 35346264 PMCID: PMC8962055 DOI: 10.1186/s13014-022-02009-2] [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: 06/27/2021] [Accepted: 02/13/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose This study aimed at evaluating the clinical impact of full intensity-modulated radiotherapy (IMRT), hybrid IMRT (H-IMRT) and hybrid volumetric-modulated arc therapy (H-VMAT) for early-stage breast cancer with simultaneous integrated boost (SIB), in terms of plan quality and second cancer risk (SCR). Methods Three different plans were designed in full IMRT, hybrid IMRT, and hybrid VMAT for each of twenty patients with early-stage breast cancer. Target quality, organs at risk (OARs) sparing, and SCR were compared among the three plans for each case. Results In compared with H-IMRT, IMRT plans showed deterioration in terms of D2% of SIB, V10 of ipsilateral lung, and excess absolute risk (EAR) to contralateral lung (C-Lung) and esophagus. D2% and the homogeneity index (HI) of SIB, V5 of ipsilateral lung (I-Lung), the Dmean of the esophagus, the EAR to C-Lung and the esophagus with hybrid VMAT dramatically increased by 0.63%, 10%, 17.99%, 149.27%, 230.41%, and 135.29%, respectively (p = 0.024; 0.025; 0.046; 0.011; 0.000; 0.014). Dmean of the heart, the EAR to contralateral breast (C-Breast) and C-Lung by full IMRT was significantly decreased in comparison to the H-VMAT (4.67%, p = 0.033, 26.76%, p = 0.018; 48.05%, p = 0.036). Conclusion The results confirmed that H-IMRT could achieve better target quality and OARs sparing than IMRT and H-VMAT for SIB radiotherapy of early-stage right breast cancer. H-IMRT was the best treatment option, while H-VMAT performed the worst among the three plans in terms of SCR to peripheral OARs.
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Affiliation(s)
- Suyan Bi
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Rui Zhu
- Department of Oncology, Yunyang County People's Hospital, Chongqing, 404500, China
| | - Zhitao Dai
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China.
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Jones DA, Candio P, Shakir R, Ntentas G, Ramroth J, Gray AM, Cutter DJ. Informing radiotherapy decisions in stage I/IIa Hodgkin lymphoma: modeling life expectancy using radiation dosimetry. Blood Adv 2022; 6:909-919. [PMID: 34872107 PMCID: PMC8945315 DOI: 10.1182/bloodadvances.2021006254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/14/2021] [Indexed: 11/23/2022] Open
Abstract
In recent randomized trials, omitting consolidative radiotherapy (RT) in early-stage Hodgkin lymphoma (ESHL) increased relapses. However, decades of follow-up are required to observe whether lower initial disease control is compensated by reduced risk of late effects. Extrapolation beyond trial follow-up is therefore necessary to inform current treatment decisions. To this end, we developed a microsimulation model to estimate lifetime quality-adjusted life years (QALYs) after combined modality treatment (CMT) or chemotherapy-alone for stage I/IIa ESHL. For CMT, the model included risks of breast and lung cancer, coronary heart disease, and ischemic stroke. Comparative outcomes were assessed for a clinically relevant range of example patients differing by age, sex, smoking status, and representative organs at risk (OAR) radiation doses informed by the RAPID trial. Analysis was performed with and without a 3.5% discount rate on future health. Smoking status had a large effect on optimal treatment choice. CMT was superior for nearly all never smoker example patients regardless of age, sex, and OAR doses. At a maximum, CMT produced a 1.095 (95% CI: 1.054-1.137) gain in undiscounted QALYs for a 20-year-old male never smoker with unilateral neck disease. In contrast, current smokers could substantially gain from chemotherapy-alone treatment. Again at a maximum, a 20-year-old male current smoker with bilateral neck and whole mediastinum involvement gained 3.500 (95% CI: 3.400 to 3.600) undiscounted QALYs with chemotherapy-alone treatment. Overall, CMT was more favorable the younger the patient, when future health discounting was included, and in never smokers.
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Affiliation(s)
| | | | - Rebecca Shakir
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Georgios Ntentas
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Guy’s and St Thomas’ NHS Foundation Trust, Department of Medical Physics, London, United Kingdom; and
| | - Johanna Ramroth
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | | | - David J. Cutter
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Oxford Cancer and Haematology Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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The Role of Ionizing Radiation for Diagnosis and Treatment against COVID-19: Evidence and Considerations. Cells 2022; 11:cells11030467. [PMID: 35159277 PMCID: PMC8834503 DOI: 10.3390/cells11030467] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 02/06/2023] Open
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic continues to spread worldwide with over 260 million people infected and more than 5 million deaths, numbers that are escalating on a daily basis. Frontline health workers and scientists diligently fight to alleviate life-threatening symptoms and control the spread of the disease. There is an urgent need for better triage of patients, especially in third world countries, in order to decrease the pressure induced on healthcare facilities. In the struggle to treat life-threatening COVID-19 pneumonia, scientists have debated the clinical use of ionizing radiation (IR). The historical literature dating back to the 1940s contains many reports of successful treatment of pneumonia with IR. In this work, we critically review the literature for the use of IR for both diagnostic and treatment purposes. We identify details including the computed tomography (CT) scanning considerations, the radiobiological basis of IR anti-inflammatory effects, the supportive evidence for low dose radiation therapy (LDRT), and the risks of radiation-induced cancer and cardiac disease associated with LDRT. In this paper, we address concerns regarding the effective management of COVID-19 patients and potential avenues that could provide empirical evidence for the fight against the disease.
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Banaei A, Hashemi B, Bakhshandeh M. Estimating cancer risks due to whole lungs low dose radiotherapy with different techniques for treating COVID-19 pneumonia. Radiat Oncol 2022; 17:10. [PMID: 35057839 PMCID: PMC8771186 DOI: 10.1186/s13014-021-01971-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 12/20/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Low dose radiotherapy (LDRT) of whole lungs with photon beams is a novel method for treating COVID-19 pneumonia. This study aimed to estimate cancer risks induced by lung LDRT for different radiotherapy delivery techniques. METHOD Four different radiotherapy techniques, including 3D-conformal with anterior and posterior fields (3D-CRT AP-PA), 3D-conformal with 8 coplanar fields (3D-CRT 8 fields), eight fields intensity-modulated radiotherapy (IMRT), and volumetric modulated arc therapy using 2 full arcs (VMAT) were planned on the CT images of 32 COVID-19 patients with the prescribed dose of 1 Gy to the lungs. Organ average and maximum doses, and PTV dose distribution indexes were compared between different techniques. The radiation-induced cancer incidence and cancer-specific mortality, and cardiac heart disease risks were estimated for the assessed techniques. RESULTS In IMRT and VMAT techniques, heart (mean and max), breast (mean, and max), and stomach (mean) doses and also maximum dose in the body were significantly lower than the 3D-CRT techniques. The calculated conformity indexes were similar in all the techniques. However, the homogeneity indexes were lower (i.e., better) in intensity-modulated techniques (P < 0.03) with no significant differences between IMRT and VMAT plans. Lung cancer incident risks for all the delivery techniques were similar (P > 0.4). Cancer incidence and mortality risks for organs located closer to lungs like breast and stomach were higher in 3D-CRT techniques than IMRT or VMAT techniques (excess solid tumor cancer incidence risks for a 30 years man: 1.94 ± 0.22% Vs. 1.68 ± 0.17%; and women: 6.66 ± 0.81% Vs. 4.60 ± 0.43%: cancer mortality risks for 30 years men: 1.63 ± 0.19% Vs. 1.45 ± 0.15%; and women: 3.63 ± 0.44% Vs. 2.94 ± 0.23%). CONCLUSION All the radiotherapy techniques had low cancer risks. However, the overall estimated risks induced by IMRT and VMAT radiotherapy techniques were lower than the 3D-CRT techniques and can be used clinically in younger patients or patients having greater concerns about radiation induced cancers.
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Affiliation(s)
- Amin Banaei
- Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Al-Ahmad and Chamran Cross, 1411713116 Tehran, Iran
| | - Bijan Hashemi
- Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Al-Ahmad and Chamran Cross, 1411713116 Tehran, Iran
| | - Mohsen Bakhshandeh
- Department of Radiology Technology, Faculty of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Rosenbrock J, Baues C, Vasquez-Torres A, Clivio A, Fogliata A, Borchmann P, Marnitz S, Cozzi L. Volumetric modulated arc therapy versus intensity-modulated proton therapy in the irradiation of infra diaphragmatic Hodgkin Lymphoma in female patients. Acta Oncol 2022; 61:81-88. [PMID: 34596491 DOI: 10.1080/0284186x.2021.1986230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the role of infra diaphragmatic intensity-modulated proton therapy (IMPT) compared to volumetric modulated arc therapy (VMAT) for female Hodgkin Lymphoma (HL) patients and to estimate the risk of secondary cancer and ovarian failure. METHODS A comparative treatment planning study was performed on 14 patients, and the results were compared according to conventional dose-volume metrics. In addition, estimates of the excess absolute risk (EAR) of secondary cancer induction were determined for the bowel, the bladder and the rectum. For the ovaries, the risk of ovarian failure was estimated. RESULTS The dosimetric findings demonstrate the equivalence between VMAT and IMPT in terms of target coverage. A statistically significant reduction of the mean and near-to-maximum doses was proven for the organs at risk. The EAR ratio estimated for IMPT to VMAT was 0.51 ± 0.32, 0.32 ± 0.35 and 0.05 ± 0.11 for the bowel, bladder and rectum, respectively. Concerning the risk of ovarian failure for the chronologic age ranging from 18 to 46 years, the expected net loss in fertility years ranged from 4.8 to 3.0 years for protons and 12.0 to 5.7 years for photons. CONCLUSION This in-silico study confirmed the beneficial role of IMPT from a dosimetric point of view. Mathematical models suggested that the use of protons might be further advantageous due to the expected reduction of the risk of secondary cancer induction and its milder impact on the reduction of fertility.
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Affiliation(s)
- Johannes Rosenbrock
- Department of Radiation Oncology, CyberKnife and Radiation Therapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christian Baues
- Department of Radiation Oncology, CyberKnife and Radiation Therapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Andres Vasquez-Torres
- Department of Radiation Oncology, CyberKnife and Radiation Therapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Antonella Fogliata
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
| | - Peter Borchmann
- German Hodgkin Study Group, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Biomedical Sciences, Humanitas University, Milan-Rozzano, Italy
| | - Simone Marnitz
- Department of Radiation Oncology, CyberKnife and Radiation Therapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Luca Cozzi
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital and Cancer Center, Milan-Rozzano, Italy
- Department of Hematology and Oncology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Radiation-induced tumors and secondary malignancies following radiotherapy. VOJNOSANIT PREGL 2022. [DOI: 10.2298/vsp201210017d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Byskov CS, Hansen CR, Dahlrot RH, Haldbo-Classen L, Haslund CA, Kjær-Kristoffersen F, Kristensen TO, Lassen-Ramshad Y, Lukacova S, Muhic A, Nyström PW, Weber B, Kallehauge JF. Treatment plan comparison of proton vs photon radiotherapy for lower-grade gliomas. Phys Imaging Radiat Oncol 2021; 20:98-104. [PMID: 34888422 PMCID: PMC8637131 DOI: 10.1016/j.phro.2021.11.008] [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: 07/09/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 12/04/2022] Open
Abstract
Background and purpose Patients with lower-grade gliomas are long-term survivors after radiotherapy and may benefit from the reduced dose to normal tissue achievable with proton therapy. Here, we aimed to quantify differences in dose to the uninvolved brain and contralateral hippocampus and compare the risk of radiation-induced secondary cancer for photon and proton plans for lower-grade glioma patients. Materials and methods Twenty-three patients were included in this in-silico planning comparative study and had photon and proton plans calculated (50.4 Gy(RBE = 1.1), 28 Fx) applying similar dose constraints to the target and organs at risk. Automatically calculated photon plans were generated with a 3 mm margin from clinical target volume (CTV) to planning target volume. Manual proton plans were generated using robust optimisation on the CTV. Dose metrics of organs at risk were compared using population mean dose-volume histograms and Wilcoxon signed-rank test. Secondary cancer risk per 10,000 persons per year (PPY) was estimated using dose-volume data and a risk model for secondary cancer induction. Results CTV coverage (V95%>98%) was similar for the two treatment modalities. Mean dose (Dmean) to the uninvolved brain was significantly reduced from 21.5 Gy (median, IQR 17.1–24.4 Gy) with photons compared to 10.3 Gy(RBE) (8.1–13.9 Gy(RBE)) with protons. Dmean to the contralateral hippocampus was significantly reduced from 6.5 Gy (5.4–11.7 Gy) with photons to 1.5 Gy(RBE) (0.4–6.8 Gy(RBE)) with protons. The estimated secondary cancer risk was reduced from 6.7 PPY (median, range 3.3–10.4 PPY) with photons to 3.0 PPY (1.3–7.5 PPY) with protons. Conclusion A significant reduction in mean dose to uninvolved brain and contralateral hippocampus was found with proton planning. The estimated secondary cancer risk was reduced with proton therapy.
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Affiliation(s)
- Camilla S Byskov
- Dept of Oncology, Aarhus University Hospital, Aarhus, Denmark.,Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Christian R Hansen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark.,Dept of Oncology, Odense University Hospital, Odense, Denmark.,Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - Rikke H Dahlrot
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark.,Dept of Oncology, Odense University Hospital, Odense, Denmark.,Inst of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | | | | | | | | | - Slávka Lukacova
- Dept of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Aida Muhic
- Dept of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Petra W Nyström
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark.,Dept of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Britta Weber
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper F Kallehauge
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark.,Dept of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Loap P, Vitolo V, Barcellini A, De Marzi L, Mirandola A, Fiore MR, Vischioni B, Jereczek-Fossa BA, Girard N, Kirova Y, Orlandi E. Hadrontherapy for Thymic Epithelial Tumors: Implementation in Clinical Practice. Front Oncol 2021; 11:738320. [PMID: 34707989 PMCID: PMC8543015 DOI: 10.3389/fonc.2021.738320] [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: 07/08/2021] [Accepted: 09/21/2021] [Indexed: 12/04/2022] Open
Abstract
Radiation therapy is part of recommendations in the adjuvant settings for advanced stage or as exclusive treatment in unresectable thymic epithelial tumors (TETs). However, first-generation techniques delivered substantial radiation doses to critical organs at risk (OARs), such as the heart or the lungs, resulting in noticeable radiation-induced toxicity. Treatment techniques have significantly evolved for TET irradiation, and modern techniques efficiently spare normal surrounding tissues without negative impact on tumor coverage and consequently local control or patient survival. Considering its dosimetric advantages, hadrontherapy (which includes proton therapy and carbon ion therapy) has proved to be worthwhile for TET irradiation in particular for challenging clinical situations such as cardiac tumoral involvement. However, clinical experience for hadrontherapy is still limited and mainly relies on small-size proton therapy studies. This critical review aims to analyze the current status of hadrontherapy for TET irradiation to implement it at a larger scale.
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Affiliation(s)
- Pierre Loap
- Department of Radiation Oncology, Institut Curie, Paris, France.,Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Viviana Vitolo
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Amelia Barcellini
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Ludovic De Marzi
- Department of Radiation Oncology, Institut Curie, Paris, France.,Institut Curie, Paris Sciences & Lettres (PSL) Research University, University Paris Saclay, laboratoire d'Imagerie Translationnelle en Oncologie, Institut National de la Santé et de la Recherche Médicale (INSERM LITO), Orsay, France
| | - Alfredo Mirandola
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Maria Rosaria Fiore
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Barbara Vischioni
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Division of Radiotherapy, Istituto Europeo di Oncologia (IEO) European Institute of Oncology Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Nicolas Girard
- Institut du Thorax Curie Montsouris, Paris, France.,Department of Medical Oncology, Institut Curie, Paris, France.,University Paris Saint-Quentin, Versailles, France
| | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Ester Orlandi
- Radiation Oncology Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
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Lideståhl A, Johansson G, Siegbahn A, Lind PA. Estimated Risk of Radiation-Induced Cancer after Thymoma Treatments with Proton- or X-ray Beams. Cancers (Basel) 2021; 13:cancers13205153. [PMID: 34680302 PMCID: PMC8533682 DOI: 10.3390/cancers13205153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022] Open
Abstract
Simple Summary Thymic tumors, i.e., thymomas and thymic carcinomas, are rare tumors that derive from the remnant of the thymus gland. Although surgery is the first treatment of choice, some patients will be treated with radiotherapy. For many patients the prognosis is good, hence it is important to avoid treatment related complications such as radiation-induced secondary malignancies. Radiotherapy can be delivered with different techniques and with different particles. In the present study, we compare the calculated (estimated) risks for secondary malignancies after treatment of thymic tumors with two different photon (x-ray) radiotherapy techniques or with proton beam therapy. We use a commonly used radiobiological model to calculate the risks for radiation induced secondary malignancies for each treatment modality. In conclusion, proton beam therapy was shown to provide the potential for reducing the risk of secondary malignancies, compared to photon radiotherapy, after treatment of thymic tumors. Abstract We compared the calculated risks of radiation-induced secondary malignant neoplasms (SMNs) for patients treated for thymic tumors with 3D-CRT, IMRT, or single-field uniform dose (SFUD) proton beam therapy (PBT) using the pencil beam scanning (PBS) technique. A cancer-induction model based on the organ equivalent dose (OED) concept was used. For twelve patients, treated with 3D-CRT for thymic tumors, alternative IMRT and SFUD plans were retrospectively prepared. The resulting DVHs for organs at risk (OARs) were extracted and used to estimate the risk of SMNs. The OED was calculated using a mechanistic model for carcinoma induction. Two limit cases were considered; the linear-exponential model, in which the repopulation/repair of the cells is neglected, and the plateau model, in which full repopulation/repair of the irradiated cells is assumed. The calculated risks for SMNs for the different radiation modalities and dose-relation models were used to calculate relative risks, which were compared pairwise. The risks for developing SMNs were reduced for all OARs, and for both dose-relation models, if SFUD was used, compared to 3D-CRT and IMRT. In conclusion, PBS shows a potential benefit to reduce the risk of SMNs compared to 3D-CRT and IMRT in the treatment of thymic tumors.
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Affiliation(s)
- Anders Lideståhl
- Department of Oncology-Pathology, Karolinska Institutet, 17177 Stockholm, Sweden
- Correspondence:
| | - Gracinda Johansson
- Department of Oncology, Södersjukhuset, 11883 Stockholm, Sweden; (G.J.); (A.S.)
| | - Albert Siegbahn
- Department of Oncology, Södersjukhuset, 11883 Stockholm, Sweden; (G.J.); (A.S.)
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, 17177 Stockholm, Sweden;
| | - Pehr A. Lind
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, 17177 Stockholm, Sweden;
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Figlia V, Simonetto C, Eidemüller M, Naccarato S, Sicignano G, De Simone A, Ruggieri R, Mazzola R, Matuschek C, Bölke E, Pazos M, Niyazi M, Belka C, Alongi F, Corradini S. Mammary Chain Irradiation in Left-Sided Breast Cancer: Can We Reduce the Risk of Secondary Cancer and Ischaemic Heart Disease with Modern Intensity-Modulated Radiotherapy Techniques? Breast Care (Basel) 2021; 16:358-367. [PMID: 34602941 DOI: 10.1159/000509779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/29/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction The aim of the present study was to estimate the impact of the addition of internal mammary chain (IMC) irradiation in node-positive left-sided breast cancer (BC) patients undergoing regional nodal irradiation (RNI) and comparatively evaluate excess relative and absolute risks of radiation-induced lung cancer/BC and ischaemic heart disease for intensity-modulated radiotherapy (IMRT) versus 3D conformal radiotherapy (3D-CRT). Methods Four treatment plans were created (3D-CRT and IMRT -/+ IMC) for each of the 10 evaluated patients, and estimates of excess relative risk (ERR) and 10-year excess absolute risk (EAR) were calculated for radiation-induced lung cancer/BC and coronary events using linear, linear-exponential and plateau models. Results The addition of IMC irradiation to RNI significantly increased the dose exposure of the heart, lung and contralateral breast using both techniques, increasing ERR for secondary lung cancer (58 vs. 44%, p = 0.002), contralateral BC (49 vs. 31%, p = 0.002) and ischaemic heart disease (41 vs. 27%, p = 0.002, IMRT plans). IMRT significantly reduced the mean cardiac dose and mean lung dose as compared to 3D-CRT, decreasing ERR for major coronary events (64% 3D-CRT vs. 41% IMRT, p = 0.002) and ERR for secondary lung cancer (75 vs. 58%, p = 0.004) in IMC irradiation, without a significant impact on secondary contralateral BC risks. Conclusion Although IMC irradiation has been shown to increase survival rates in node-positive BC patients, it increased dose exposure of organs at risk in left-sided BC, resulting in significantly increased risks for secondary lung cancer/contralateral BC and ischaemic heart disease. In this setting, the adoption of IMRT seems advantageous when compared to 3D-CRT.
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Affiliation(s)
- Vanessa Figlia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | | | - Markus Eidemüller
- Institute of Radiation Medicine, Helmholtz Center Munich, Munich, Germany
| | - Stefania Naccarato
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Gianluisa Sicignano
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Antonio De Simone
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Ruggero Ruggieri
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Rosario Mazzola
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy
| | - Christiane Matuschek
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Edwin Bölke
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Montserrat Pazos
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Italy.,University of Brescia, Brescia, Italy
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
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Yoshimura T, Tamori H, Morii Y, Hashimoto T, Shimizu S, Ogasawara K. Cost-effectiveness analysis using lifetime attributable risk of proton beam therapy for pediatric medulloblastoma in Japan. JOURNAL OF RADIATION RESEARCH 2021:rrab077. [PMID: 34590123 DOI: 10.1093/jrr/rrab077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/26/2021] [Indexed: 06/13/2023]
Abstract
Compared to conventional X-ray therapy, proton beam therapy (PBT) has more clinical and physical advantages such as irradiation dose reduction to normal tissues for pediatric medulloblastoma. However, PBT is expensive. We aimed to compare the cost-effectiveness of PBT for pediatric medulloblastoma with that of conventional X-ray therapy, while focusing on radiation-induced secondary cancers, which are rare, serious and negatively affect a patient's quality of life (QOL). Based on a systematic review, a decision tree model was used for the cost-effectiveness analysis. This analysis was performed from the perspective of health care payers; the cost was estimated from medical fees. The target population was pediatric patients with medulloblastoma below 14 years old. The time horizon was set at 7.7 years after medulloblastoma treatment. The primary outcome was the incremental cost-effectiveness ratio (ICER), which was defined as the ratio of the difference in cost and lifetime attributable risk (LAR) between conventional X-ray therapy and PBT. The discount rate was set at 2% annually. Sensitivity analyses were performed to model uncertainty. Cost and LAR in conventional X-ray therapy and PBT were Japanese yen (JPY) 1 067 608 and JPY 2436061 and 42% and 7%, respectively. The ICER was JPY 3856398/LAR. In conclusion, PBT is more cost-effective than conventional X-ray therapy in reducing the risk of radiation-induced secondary cancers in pediatric medulloblastoma. Thus, our constructed ICER using LAR is one of the valid indicators for cost-effectiveness analysis in radiation-induced secondary cancer.
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Affiliation(s)
- Takaaki Yoshimura
- Department of Health Sciences and Technology, Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan
- Department of Medical Physics, Hokkaido University Hospital, Sapporo 060-0812, Japan
| | - Honoka Tamori
- Graduate School of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan
| | - Yasuhiro Morii
- Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Wako 060-0812, Japan
| | - Takayuki Hashimoto
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo 060-0812, Japan
| | - Shinichi Shimizu
- Department of Medical Physics, Hokkaido University Hospital, Sapporo 060-0812, Japan
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo 060-0812, Japan
| | - Katsuhiko Ogasawara
- Department of Health Sciences and Technology, Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan
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Zhang Y, Huang Y, Ding S, Yuan X, Shu Y, Liang J, Mao Q, Jiang C, Li J. A dosimetric and radiobiological evaluation of VMAT following mastectomy for patients with left-sided breast cancer. Radiat Oncol 2021; 16:171. [PMID: 34488817 PMCID: PMC8422660 DOI: 10.1186/s13014-021-01895-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/26/2021] [Indexed: 02/08/2023] Open
Abstract
Background To compare the dosimetric, normal tissue complication probability (NTCP), secondary cancer complication probabilities (SCCP), and excess absolute risk (EAR) differences of volumetric modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT) for left-sided breast cancer after mastectomy. Methods and materials Thirty patients with left-sided breast cancer treated with post-mastectomy radiation therapy (PMRT) were randomly enrolled in this study. Both IMRT and VMAT treatment plans were created for each patient. Planning target volume (PTV) doses for the chest wall and internal mammary nodes, PTV1, and PTV of the supraclavicular nodes, PTV2, of 50 Gy were prescribed in 25 fractions. The plans were evaluated based on PTV1 and PTV2 coverage, homogeneity index (HI), conformity index, conformity number (CN), dose to organs at risk, NTCP, SCCP, EAR, number of monitors units, and beam delivery time. Results VMAT resulted in more homogeneous chest wall coverage than did IMRT. The percent volume of PTV1 that received the prescribed dose of VMRT and IMRT was 95.9 ± 1.2% and 94.5 ± 1.6%, respectively (p < 0.001). The HI was 0.11 ± 0.01 for VMAT and 0.12 ± 0.02 for IMRT, respectively (p = 0.001). The VMAT plan had better conformity (CN: 0.84 ± 0.02 vs. 0.78 ± 0.04, p < 0.001) in PTV compared with IMRT. As opposed to IMRT plans, VMAT delivered a lower mean dose to the ipsilateral lung (11.5 Gy vs 12.6 Gy) and heart (5.2 Gy vs 6.0 Gy) and significantly reduced the V5, V10, V20, V30, and V40 of the ipsilateral lung and heart; only the differences in V5 of the ipsilateral lung did not reach statistical significance (p = 0.409). Although the volume of the ipsilateral lung and heart encompassed by the 2.5 Gy isodose line (V2.5) was increased by 6.7% and 7.7% (p < 0.001, p = 0.002), the NTCP was decreased by 0.8% and 0.6%, and SCCP and EAR were decreased by 1.9% and 0.1% for the ipsilateral lung. No significant differences were observed in the contralateral lung/breast V2.5, V5, V10, V20, mean dose, SCCP, and EAR. Finally, VMAT reduced the number of monitor units by 31.5% and the treatment time by 71.4%, as compared with IMRT. Conclusions Compared with IMRT, VMAT is the optimal technique for PMRT patients with left-sided breast cancer due to better target coverage, a lower dose delivered, NTCP, SCCP, and EAR to the ipsilateral lung and heart, similar doses delivered to the contralateral lung and breast, fewer monitor units and a shorter delivery time.
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Affiliation(s)
- Yun Zhang
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China
| | - Yuling Huang
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China
| | - Shenggou Ding
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China
| | - Xingxing Yuan
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China
| | - Yuxian Shu
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China
| | - Jinhui Liang
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China
| | - Qingfeng Mao
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China
| | - Chunling Jiang
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China. .,Medical College of Nanchang University, Nanchang, Jangxi, 330031, People's Republic of China. .,Key Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal Carcinoma Nanchang, Jiangxi, 330029, People's Republic of China.
| | - Jingao Li
- Department of Radiation Oncology, Jiangxi Cancer Hospital of Nanchang University, Nanchang, Jiangxi, 330029, People's Republic of China.,Medical College of Nanchang University, Nanchang, Jangxi, 330031, People's Republic of China.,Key Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal Carcinoma Nanchang, Jiangxi, 330029, People's Republic of China
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Hufnagl A, Scholz M, Friedrich T. Modeling Radiation-Induced Neoplastic Cell Transformation In Vitro and Tumor Induction In Vivo with the Local Effect Model. Radiat Res 2021; 195:427-440. [PMID: 33760917 DOI: 10.1667/rade-20-00160.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 02/22/2021] [Indexed: 11/03/2022]
Abstract
Ionizing radiation induces DNA damage to cycling cells which, if left unrepaired or misrepaired, can cause cell inactivation or heritable, viable mutations. The latter can lead to cell transformation, which is thought to be an initial step of cancer formation. Consequently, the study of radiation-induced cell transformation promises to offer insights into the general properties of radiation carcinogenesis. As for other end points, the effectiveness in inducing cell transformation is elevated for radiation qualities with high linear energy transfer (LET), and the same is true for cancer induction. In considering DNA damage as a common cause of both cell death and transformations, a worthwhile approach is to apply mathematical models for the relative biological effectiveness (RBE) of cell killing to also assess the carcinogenic potential of high-LET radiation. In this work we used an established RBE model for cell survival and clinical end points, the local effect model (LEM), to estimate the transformation probability and the carcinogenic potential of ion radiation. The provided method consists of accounting for the competing processes of cell inactivation and induction of transformations or carcinogenic events after radiation exposure by a dual use of the LEM. Correlations between both processes inferred by the number of particle impacts to individual cells were considered by summing over the distribution of hits that individual cells receive. RBE values for cell transformation in vitro were simulated for three independent data sets, which were also used to gauge the approach. The simulations reflect the general RBE systematics both in magnitude and in energy and LET dependence. To challenge the developed method, in vivo carcinogenesis was investigated using the same concepts, where the probability for cancer induction within an irradiated organ was derived from the probability of finding carcinogenic events in individual cells. The predictions were compared with experimental data of carcinogenesis in Harderian glands of mice. Again, the developed method shows the same characteristics as the experimental data. We conclude that the presented method is helpful to predictively assess RBE for both neoplastic cell transformation and tumor induction after ion exposure within a wide range of LET values. The theoretical concept requires a non-linear component in the photon dose response for carcinogenic end points as a precondition for the observed enhanced effects after ion exposure, thus contributing to a long debate in epidemiology. Future work will use the method for assessing cancer induction in radiation therapy and exposure scenarios frequently discussed in radiation protection.
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Affiliation(s)
- Antonia Hufnagl
- 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
| | - Thomas Friedrich
- GSI Helmholtz Centre for Heavy Ion Research, Department of Biophysics, Darmstadt, Germany
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Current Situation of Proton Therapy for Hodgkin Lymphoma: From Expectations to Evidence. Cancers (Basel) 2021; 13:cancers13153746. [PMID: 34359647 PMCID: PMC8345146 DOI: 10.3390/cancers13153746] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 11/17/2022] Open
Abstract
Consolidative radiation therapy (RT) is of prime importance for early-stage Hodgkin lymphoma (HL) management since it significantly increases progression-free survival (PFS). Nevertheless, first-generation techniques, relying on large irradiation fields, delivered significant radiation doses to critical organs-at-risk (OARs, such as the heart, to the lung or the breasts) when treating mediastinal HL; consequently, secondary cancers, and cardiac and lung toxicity were substantially increased. Fortunately, HL RT has drastically evolved and, nowadays, state-of-the-art RT techniques efficiently spare critical organs-at-risks without altering local control or overall survival. Recently, proton therapy has been evaluated for mediastinal HL treatment, due to its possibility to significantly reduce integral dose to OARs, which is expected to limit second neoplasm risk and reduce late toxicity. Nevertheless, clinical experience for this recent technique is still limited worldwide. Based on current literature, this critical review aims to examine the current practice of proton therapy for mediastinal HL irradiation.
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Sitathanee C, Tangboonduangjit P, Dhanachai M, Suntiwong S, Yongvithisatid P, Rutchantuk S, Changkaew P, Watjiranon R, Khachonkham S, Boonkitticharoen V. Secondary cancer risk from modern external-beam radiotherapy of prostate cancer patients: Impact of fractionation and dose distribution. JOURNAL OF RADIATION RESEARCH 2021; 62:707-717. [PMID: 33993271 PMCID: PMC8273793 DOI: 10.1093/jrr/rrab038] [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] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/10/2021] [Indexed: 06/12/2023]
Abstract
Modern radiotherapy (RT) uses altered fractionation, long beam-on time and image-guided procedure. This study aimed to compare secondary cancer risk (SCR) associated with primary field, scatter/leakage radiations and image-guided procedure in prostate treatment using intensity-modulated RT (IMRT), CyberKnife stereotactic body RT (CK-SBRT) in relative to 3-dimensional conformal RT (3D-CRT). Prostate plans were generated for 3D-CRT, IMRT (39 fractions of 2 Gy), and CK-SBRT (five fractions of 7.25 Gy). Excess absolute risk (EAR) was calculated for organs in the primary field using Schneider's mechanistic model and concept of organ equivalent dose (OED) to account for dose inhomogeneity. Doses from image-guided procedure and scatter/leakage radiations were determined by phantom measurements. The results showed that hypofractionation relative to conventional fractionation yielded lower SCR for organs in primary field (p ≤ 0.0001). SCR was further modulated by dose-volume distribution. For organs near the field edge, like the rectum and pelvic bone, CK-SBRT plan rendered better risk profiles than IMRT and 3D-CRT because of the absence of volume peak in high dose region (relative risk [RR]: 0.65, 0.22, respectively, p ≤ 0.0004). CK-SBRT and IMRT generated more scatter/leakage and imaging doses than 3D-CRT (p ≤ 0.0002). But primary field was the major contributor to SCR. EAR estimates (risk contributions, primary field: scatter/leakage radiations: imaging procedure) were 7.1 excess cases per 104 person-year (PY; 3.64:2.25:1) for CK-SBRT, 9.93 (7.32:2.33:1) for IMRT and 8.24 (15.99:2.35:1) for 3D-CRT (p ≤ 0.0002). We conclude that modern RT added more but small SCR from scatter/leakage and imaging doses. The primary field is a major contributor of risk which can be mitigated by the use of hypofractionation.
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Affiliation(s)
- Chomporn Sitathanee
- Corresponding author. Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand, E-mail:
| | - Puangpen Tangboonduangjit
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Mantana Dhanachai
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Sawanee Suntiwong
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Pornpan Yongvithisatid
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Sukanya Rutchantuk
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Pimolpun Changkaew
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Rattana Watjiranon
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Suphalak Khachonkham
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Vipa Boonkitticharoen
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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Taylor S, Lim P, Ahmad R, Alhadi A, Harris W, Rompokos V, D'Souza D, Gaze M, Gains J, Veiga C. Risk of radiation-induced second malignant neoplasms from photon and proton radiotherapy in paediatric abdominal neuroblastoma. Phys Imaging Radiat Oncol 2021; 19:45-52. [PMID: 34307918 PMCID: PMC8295851 DOI: 10.1016/j.phro.2021.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/28/2021] [Accepted: 06/18/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND AND PURPOSE State-of-the-art radiotherapy modalities have the potential of reducing late effects of treatment in childhood cancer survivors. Our aim was to investigate the carcinogenic risk associated with 3D conformal (photon) radiation (3D-CRT), intensity modulated arc therapy (IMAT) and pencil beam scanning proton therapy (PBS-PT) in the treatment of paediatric abdominal neuroblastoma. MATERIALS AND METHODS The risk of radiation-induced second malignant neoplasm (SMN) was estimated using the concept of organ equivalent dose (OED) for eleven organs (lungs, rectum, colon, stomach, small intestine, liver, bladder, skin, central nervous system (CNS), bone, and soft tissues). The risk ratio (RR) between radiotherapy modalities and lifetime absolute risks (LAR) were reported for twenty abdominal neuroblastoma patients (median, 4y; range, 1-9y) historically treated with 3D-CRT that were also retrospectively replanned for IMAT and PBS-PT. RESULTS The risk of SMN due to primary radiation was reduced in PBS-PT against 3D-CRT and IMAT for most patients and organs. The RR across all organs ranged from 0.38 ± 0.22 (bladder) to 0.98 ± 0.04 (CNS) between PBS-PT and IMAT, and 0.12 ± 0.06 (rectum and bladder) to 1.06 ± 0.43 (bone) between PBS-PT and 3D-CRT. The LAR for most organs was within 0.01-1% (except the colon) with a cumulative risk of 21 ± 13%, 35 ± 14% and 35 ± 16% for PBS-PT, IMAT and 3D-CRT, respectively. CONCLUSIONS PBS-PT was associated with the lowest risk of radiation-induced SMN compared to IMAT and 3D-CRT in abdominal neuroblastoma treatment. Other clinical endpoints and plan robustness should also be considered for optimal plan selection.
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Affiliation(s)
- Sophie Taylor
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Pei Lim
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Reem Ahmad
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Ammar Alhadi
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - William Harris
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Vasilis Rompokos
- Radiotherapy Physics Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Derek D'Souza
- Radiotherapy Physics Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mark Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jennifer Gains
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Catarina Veiga
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
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Affiliation(s)
- Sanusi Umar
- Department of Medicine, University of California at Los Angeles, Los Angeles, California.,Dr. U Hair and Skin Clinic, Manhattan Beach, California.,Harbor-UCLA Department of Medicine, Dermatology Division, Torrance, California
| | - Chad R Sila
- Harbor-UCLA Radiation Department of Oncology, Torrance, California
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Mazonakis M, Lyraraki E, Tolia M, Damilakis J. Risk for second bladder and rectal malignancies from cervical cancer irradiation. J Appl Clin Med Phys 2021; 22:103-109. [PMID: 34021692 PMCID: PMC8292701 DOI: 10.1002/acm2.13274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 12/03/2022] Open
Abstract
The objective of this study was to estimate the risk of developing second malignancies to partially in‐field organs from volumetric modulated arc therapy (VMAT) of cervical cancer and to compare the above risks with those from the conventional three‐dimensional conformal radiotherapy (3D‐CRT). Seventeen consecutive patients with uterine cervix carcinoma were selected. VMAT and 3D‐CRT plans were generated with 6 and 10 MV photons, respectively. The prescribed tumor dose was 45 Gy given in 25 fractions. Differential dose‐volume histogram data from the treatment plans were obtained for the partially in‐field organs such as bladder and rectum. These data were used to estimate the patient‐specific lifetime attributable risk (LAR) for bladder and rectal cancer induction with a non‐linear model based on a mixture of plateau and bell‐shaped dose–response relationships. The estimated risks per 10000 people were compared with the baseline risks for unexposed population. The patient‐specific rectal cancer risk estimates from VMAT were significantly lower than those from 3D‐CRT (P = 0.0144). The LARs for developing bladder malignancies from VMAT were significantly high compared to those from conventional irradiation (P = 0.0003). The mean difference between the patient‐specific LARs for radiation‐induced bladder and rectal malignancies as derived from 3D‐CRT and VMAT plans was 6.6% and 2.0%, respectively. The average LAR for developing bladder and rectal malignant diseases due to VMAT was 9.2 × 10‐4 and 43.7 × 10‐4, respectively. The corresponding risks following 3D‐CRT were 8.6 × 10‐4 and 44.6 × 10‐4. These average risks showed that pelvic irradiation increases the baseline probability for cancer induction by 12.6‐19.1%. The differences in the second cancer risks associated with the VMAT and 3D‐CRT for cervical cancer were found to be small. Both treatment techniques resulted in considerable increased probabilities for developing bladder and rectal malignancies relative to those of unirradiated population.
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Affiliation(s)
- Michalis Mazonakis
- Department of Medical Physics, Faculty of Medicine, University of Crete, Crete, Greece
| | - Efrosyni Lyraraki
- Department of Radiotherapy and Oncology, University Hospital of Iraklion, Iraklion, Crete, Greece
| | - Maria Tolia
- Department of Radiotherapy and Oncology, University Hospital of Iraklion, Iraklion, Crete, Greece
| | - John Damilakis
- Department of Medical Physics, Faculty of Medicine, University of Crete, Crete, Greece
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Veiga C, Lim P, Anaya VM, Chandy E, Ahmad R, D'Souza D, Gaze M, Moinuddin S, Gains J. Atlas construction and spatial normalisation to facilitate radiation-induced late effects research in childhood cancer. Phys Med Biol 2021; 66. [PMID: 33735848 PMCID: PMC8112163 DOI: 10.1088/1361-6560/abf010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/18/2021] [Indexed: 11/12/2022]
Abstract
Reducing radiation-induced side effects is one of the most important challenges in paediatric cancer treatment. Recently, there has been growing interest in using spatial normalisation to enable voxel-based analysis of radiation-induced toxicities in a variety of patient groups. The need to consider three-dimensional distribution of doses, rather than dose-volume histograms, is desirable but not yet explored in paediatric populations. In this paper, we investigate the feasibility of atlas construction and spatial normalisation in paediatric radiotherapy. We used planning computed tomography (CT) scans from twenty paediatric patients historically treated with craniospinal irradiation to generate a template CT that is suitable for spatial normalisation. This childhood cancer population representative template was constructed using groupwise image registration. An independent set of 53 subjects from a variety of childhood malignancies was then used to assess the quality of the propagation of new subjects to this common reference space using deformable image registration (i.e. spatial normalisation). The method was evaluated in terms of overall image similarity metrics, contour similarity and preservation of dose-volume properties. After spatial normalisation, we report a dice similarity coefficient of 0.95 ± 0.05, 0.85 ± 0.04, 0.96 ± 0.01, 0.91 ± 0.03, 0.83 ± 0.06 and 0.65 ± 0.16 for brain and spinal canal, ocular globes, lungs, liver, kidneys and bladder. We then demonstrated the potential advantages of an atlas-based approach to study the risk of second malignant neoplasms after radiotherapy. Our findings indicate satisfactory mapping between a heterogeneous group of patients and the template CT. The poorest performance was for organs in the abdominal and pelvic region, likely due to respiratory and physiological motion and to the highly deformable nature of abdominal organs. More specialised algorithms should be explored in the future to improve mapping in these regions. This study is the first step toward voxel-based analysis in radiation-induced toxicities following paediatric radiotherapy.
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Affiliation(s)
- Catarina Veiga
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Pei Lim
- Department of Oncology, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Virginia Marin Anaya
- Radiotherapy Physics Services, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Edward Chandy
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom.,UCL Cancer Institute, University College London, London, United Kingdom
| | - Reem Ahmad
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Derek D'Souza
- Radiotherapy Physics Services, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Mark Gaze
- Department of Oncology, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Syed Moinuddin
- Radiotherapy, University College London Hospital NHS Foundation Trust, London, United Kingdom
| | - Jennifer Gains
- Department of Oncology, University College London Hospital NHS Foundation Trust, London, United Kingdom
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Lifetime radiation-induced sarcoma risk in patients subjected to IMRT or VMAT for uterine cervix carcinoma. Phys Eng Sci Med 2021; 44:573-579. [PMID: 33909230 DOI: 10.1007/s13246-021-01002-5] [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: 11/25/2020] [Accepted: 04/14/2021] [Indexed: 01/08/2023]
Abstract
This study was conducted to estimate the lifetime radiation-induced bone and soft tissue sarcoma risks from intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) for uterine cervix carcinoma. 13 cervical cancer patients were included. The bone and soft tissue structures were defined on patients' treatment planning computed tomography (CT) scans. Both CT-based IMRT and VMAT plans with 6 MV photons delivering 45 Gy to the target site were designed for each patient. The organ equivalent dose (OED) and the lifetime attributable risk (LAR) for developing bone or soft tissue sarcoma were estimated using treatment planning data and a non-linear mechanistic model. The estimation method did not consider the survival rates following radiotherapy and the use of brachytherapy treatments. The patient-specific OEDs of the bone structure from IMRT and VMAT were 2.33-2.83 and 2.34-2.82 Gy, respectively. The corresponding values for the soft tissue structure were 1.27-1.70 and 1.32-1.73 Gy. An insignificant difference was found between the patient-specific OEDs and the directly proportional sarcoma risks (bone: P = 0.07; soft tissue: P = 0.38). The LAR for the development of a bone sarcoma varied from 0.05 to 0.16% by the patient's age during irradiation and the applied treatment delivery technique. The corresponding LAR range for radiation-induced soft-tissue sarcoma was 0.08-0.27%. The above LARs resulted in a relative risk of more than 1.20 indicating that IMRT or VMAT may lead to a considerable risk increase of developing bone or soft tissue sarcoma exceeding 20% in respect to the current incidence of these malignancies in unexposed population.
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Timlin C, Loken J, Kruse J, Miller R, Schneider U. Comparing second cancer risk for multiple radiotherapy modalities in survivors of hodgkin lymphoma. Br J Radiol 2021; 94:20200354. [PMID: 33237825 PMCID: PMC8506169 DOI: 10.1259/bjr.20200354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To assess if excess absolute risk (EAR) of radiation-induced solid cancer can be used to rank radiotherapy plans for treatment of Hodgkin lymphoma (HL) in a statistically significant way. METHODS EAR models, calibrated with data from the Life Span Study and HL survivors, have been incorporated into a voxelised risk-calculation software, which is used to compare four treatment modalities planned for five virtual HL patients. Organ-specific parameters are generated repeatedly in a Monte Carlo fashion to model their uncertainties. This in turn enables a quantitative estimation of the EAR uncertainties. RESULTS Parameter-driven uncertainties on total EAR are around 13%, decreasing to around 2-5% for relative EAR comparisons. Total EAR estimations indicate that intensity modulated proton therapy decreases the average risk by 40% compared to the intensity modulated radiation therapy plan, 28% compared to the volumetric modulated arc therapy plan whereas the three-dimensional conformal radiation therapy plan is equivalent within the uncertainty. CONCLUSION Relative EAR is a useful metric for distinguishing between radiotherapy plans in terms of second cancer risk. ADVANCES IN KNOWLEDGE Relative EAR is not dominated by model or parameter uncertainties and can be used to guide the choice of radiotherapy for HL patients.
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Affiliation(s)
- Claire Timlin
- Particle Therapy Cancer Research Institute, University of Oxford, Oxford, UK
| | - James Loken
- Particle Therapy Cancer Research Institute, University of Oxford, Oxford, UK
| | | | | | - Uwe Schneider
- Department of Physics, University of Zurich and Radiotherapy Hirslanden, Zurich, Switzerland
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Mazonakis M, Kachris S, Damilakis J. VMAT for prostate cancer with 6-MV and 10-MV photons: Impact of beam energy on treatment plan quality and model-based secondary cancer risk estimates. Mol Clin Oncol 2021; 14:89. [PMID: 33767858 DOI: 10.3892/mco.2021.2251] [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: 06/29/2020] [Accepted: 11/20/2020] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to examine the effect of the photon beam energy on the volumetric modulated arc therapy (VMAT) plan quality for prostate cancer and on the risk of secondary carcinogenesis. Separate VMAT plans with 6-MV and 10-MV photons were created for 11 low-risk patients with prostate cancer. The prescribed tumor dose was 70 Gy delivered in 28 fractions. The normal tissue integral dose and parameters associated with planning target volume and organs at risk were determined by the treatment planning data. A non-linear mechanistic model considering the effects of tumor dose fractionation and cell proliferation was employed for estimating the patient-specific lifetime attributable risk (LAR) for bladder and rectal cancer induction. Data from differential dose-volume histograms were used for these risk assessments. The mean values of the planning parameters from 6-MV treatment plans differed by 0.2-3.4% from those associated with irradiation using 10-MV photons. The LAR range for developing secondary bladder malignancies varied between 0.041 and 0.129% by the patient under investigation and the beam energy used. The corresponding range for the appearance of rectal malignant diseases was 0.047-0.153%. The mean percentage difference between the bladder cancer risks from VMAT with 6-MV and 10-MV photons was 2.6±2.3%. The corresponding difference for secondary rectal malignancies was 0.7±0.6%. Therefore, VMAT for prostate cancer with both 6-MV and 10-MV photons leads to clinically equivalent treatment plans and to similar secondary bladder and rectal cancer risks.
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Affiliation(s)
- Michalis Mazonakis
- Department of Medical Physics, Faculty of Medicine, University of Crete, 71003 Iraklion, Greece
| | - Stefanos Kachris
- Department of Radiotherapy and Oncology, University Hospital of Iraklion, 71110 Iraklion, Greece
| | - John Damilakis
- Department of Medical Physics, Faculty of Medicine, University of Crete, 71003 Iraklion, Greece
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Suzuki S, Kato T, Murakami M. Impact of lifetime attributable risk of radiation-induced secondary cancer in proton craniospinal irradiation with vertebral-body-sparing for young pediatric patients with medulloblastoma. JOURNAL OF RADIATION RESEARCH 2021; 62:186-197. [PMID: 33341899 PMCID: PMC7948862 DOI: 10.1093/jrr/rraa118] [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] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/31/2020] [Indexed: 06/12/2023]
Abstract
We used the method proposed by Schneider et al. Theor Biol Med Model 2011;8:27, to clarify how the radiation-induced secondary cancer incidence rate changes in patients after proton craniospinal irradiation (CSI) without and with vertebral-body-sparing (VBS). Eight patients aged 3-15 years who underwent proton CSI were enrolled in the study. For each case, two types of plan without and with VBS in the target were compared. The prescribed doses were assumed to be 23.4 Gy relative biological effectiveness (RBE) and 36 Gy (RBE). Using the dose-volume histograms of the two plans, the lifetime attributable risk (LAR) was calculated by both methods for each patient based on the dose data calculated using an XiO-M treatment planning system. Eight organs were analyzed as follows: lung, colon, stomach, small intestine, liver, bladder, thyroid and bone. When the prescribed dose used was 23.4 Gy (RBE), the average LAR differences and the average number needed to treat (NNT) between proton CSI without and with VBS were 4.04 and 24.8, respectively, whereas the average LAR difference and the average NNT were larger at 8.65 and 11.6, respectively, when the prescribed dose of 36 Gy (RBE) was used. The LAR for radiation-induced secondary cancer was significantly lower in proton CSI with VBS than without VBS in pediatric patients, especially for the colon, lung, stomach and thyroid. The results of this study could serve as reference data when considering how much of vertebral bodies should be included when performing proton CSI according to age in clinical settings.
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Affiliation(s)
- Shunsuke Suzuki
- Corresponding author. Hokkaido Ohno Memorial Hospital, 2-16-1 Miyanosawa, Nishi-ku, Sapporo City, Hokkaido, 063-0052, Japan. Tel: +81-011-665-0020;
| | - Takahiro Kato
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
- Preparing Section for New Faculty of Medical Science, Fukushima Medical University, Fukushima, Japan
| | - Masao Murakami
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
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