Assessing the risk of second malignancies after modern radiotherapy

Newhauser, Wayne D.; Durante, Marco

doi:10.1038/nrc3069

Cited by 333 publications

(275 citation statements)

References 98 publications

(114 reference statements)

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“…In addition, according to Dorr and Herrmann, 31 , 32 the majority of second cancers are induced within the penumbra of radiotherapy. Moreover, some papers reported that second cancers occurred in the low‐dose region, especially in pediatric patients 33 , 34 , 35 . Thus, the low dose should be delivered accurately and evaluated strictly.…”

Section: Discussionmentioning

confidence: 99%

Gamma analysis dependence on specified low‐dose thresholds for VMAT QA

Song

Kim

Park

et al. 2015

J Applied Clin Med Phys

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The American Association of Physicists in Medicine Task Group 119 instructed institutions to use a low‐dose threshold of 10% or a region of interest determined by the jaw setting when they collected gamma analysis quality assurance (QA) data for the planar dose distribution. However, there are no clinical data to quantitatively demonstrate the impact of the low‐dose threshold on the gamma index. Therefore, we performed a gamma analysis with various low‐dose thresholds in the range of 0% to 15% according to both global and local normalization and different acceptance criteria (3%/3 mm, 2%/2 mm, and 1%/1 mm). A total of 30 treatment plans — 10 head and neck, 10 brain, and 10 prostate cancer cases — were randomly selected from the Varian Eclipse treatment planning system (TPS). For the gamma analysis, a calculated portal image was acquired through a portal dose calculation algorithm in the Eclipse TPS, and a measured portal image was obtained using an electronic portal‐imaging device. Then, the gamma analysis was performed using the Portal Dosimetry software (Varian Medical Systems, Palo Alto, CA). The gamma passing rate (%GP) for the global normalization decreased as the low‐dose threshold increased, and all low‐dose thresholds led to %GP values above 95% for both the 3%/3 mm and 2%/2 mm criteria. However, for the local normalization, %GP for a low‐dose threshold of 10% was 7.47%, 10.23%, and 6.71% greater than the low‐dose threshold of 0% for head and neck, brain, and prostate for the 3%/3 mm criteria, respectively. The results indicate that applying the low‐dose threshold to global normalization does not have a critical impact on patient‐specific QA results. However, in the local normalization, the low‐dose threshold level should be carefully selected because the excluded low‐dose points could cause the average %GP to increase rapidly.PACS number: 87.55.Qr

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Section: Discussionmentioning

confidence: 99%

Gamma analysis dependence on specified low‐dose thresholds for VMAT QA

Song

Kim

Park

et al. 2015

J Applied Clin Med Phys

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“…Scanned particle therapy can produce sharp dose gradients with a finite range of the beam and can thus provide higher normal tissue sparing. This reduces both side effects as well as the risk of secondary cancer [Newhauser and Durante, 2011]. Treatment of lung tumors with particles is still challenging due to interplay and radiological path length changes [Bert and Durante, 2011].…”

Section: Summary and Discussionmentioning

confidence: 99%

In silico comparison of photons versus carbon ions in single fraction therapy of lung cancer

et al. 2016

Self Cite

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Stereotactic body image guided radiation therapy (SBRT) shows excellent results for the local control of early stage lung cancer. However, not all patients are eligible for SBRT, and advanced stage treatment is less successful and often associated with severe side effects. Scanned carbon ion therapy (PT) can deliver more conformal dose likely benefiting these patient groups.Therefore an in silico trial was conducted on early and advanced stage patients to identify potential advantages of PT. The patients were treated with SBRT at Champalimaud Center for the Unknown, Lisbon (Portugal). PT plans were simulated on 4DCTs, and rescanning was investigated for motion mitigation in 4D-dose calculations. A dedicated strategy for 4D intensity modulated particle therapy (IMPT) was developed and applied for advanced stage patients with multiple lesions. For clinically valid and reliable results the deformable image registrationnecessary for 4D-dose calculation -a quality assurance tool was developed and applied in the study.The results showed that target coverage was comparable in SBRT and PT, while PT delivered significantly lower doses to most critical structures, especially the heart, lungs, and esophagus.A highly complex case of advanced stage lung cancer could be treated in a single fraction of 24 Gy with PT, while SBRT could not deliver the full ablative dose treatment due to an excessive heart dose. The mean heart dose was reduced from 10 Gy to 0.8 Gy with PT for this specific patient.

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“…The role of RIBEs on secondary cancer risk has been considered for some time in relation to low dose environmental exposures and out-of-field regions in radiotherapy (63,64). Attempts to attribute additional cancer risk to these effects have remained challenging as current empirical models of secondary cancer risk do not address specific mechanisms such as in vivo signalling effects.…”

Section: Implications For Radiotherapy and Cancer Riskmentioning

confidence: 99%

Bystander Signalling: Exploring Clinical Relevance Through New Approaches and New Models

Butterworth¹,

McMahon²,

Hounsell³

et al. 2013

Clinical Oncology

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Classical radiation biology research has centred on nuclear DNA as the main target of radiation induced damage. Over the past two decades, this has been challenged by a significant amount of scientific evidence clearly demonstrating radiation induced cell signalling effects to have important roles in mediating overall radiobiological response. These effects, generally termed radiation induced bystander effects (RIBEs) have challenged the traditional DNA targeted theory in radiation biology Key wordsbystander effect, in vivo, ionising radiation, microbeam SearchesArticles cited in this manuscript were sourced through a literature search on the Medline/Pubmed database using the search terms 'radiation', bystander' 'in vivo' and 'microbeam'. Full articles were retrieved when the abstract was deemed relevant. The bibliographies of retrieved papers were also searched and relevant articles included.

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Assessing the risk of second malignancies after modern radiotherapy

Cited by 333 publications

References 98 publications

Gamma analysis dependence on specified low‐dose thresholds for VMAT QA

Gamma analysis dependence on specified low‐dose thresholds for VMAT QA

In silico comparison of photons versus carbon ions in single fraction therapy of lung cancer

Bystander Signalling: Exploring Clinical Relevance Through New Approaches and New Models

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