Intensity Modulated Radiation Therapy and Second Cancer Risk in Adults

Filippi, Andrea Riccardo; Vanoni, Valentina; Meduri, Bruno; Cozzi, Luca; Scorsetti, Marta; Ricardi, Umberto; Lohr, Frank

doi:10.1016/j.ijrobp.2017.09.039

Cited by 33 publications

(27 citation statements)

References 43 publications

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“…The full model by Schneider et al [12] has the intuitive plausibility that high doses leading to cell kill would not be expected to be as cancerogenetic as lower doses resulting only in DNA damage without cell death. However, this hypothesis is not unanimously adopted, as some studies have also supported a linear relationship (compare Filippi et al for a recent review [13]).…”

Section: Discussionmentioning

confidence: 99%

Imaging dose and secondary cancer risk in image-guided radiotherapy of pediatric patients

et al. 2018

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BackgroundDaily image-guided radiotherapy (IGRT) can contribute to cover extended body volumes with low radiation dose. The effect of additional imaging dose on secondary cancer development is modelled for a collective of children with Morbus Hodgkin.MethodsEleven radiotherapy treatment plans from pediatric patients with Hodgkin’s lymphoma were retrospectively analyzed, including imaging dose from scenarios using different energies (kV/MV) and planar/cone-beam computed tomography (CBCT) techniques. In addition to assessing the effect of imaging dose on organs at risk, the excess average risk (EAR) for developing a secondary carcinoma of the lung or breast was modelled.ResultsAlthough the variability between the patients is relatively large due to the different target volumes, the additional EAR due to imaging can be consistently determined. For daily 6MV CBCT, the EAR for developing a secondary cancer at age 50 is over 3 cases per 104 PY (patient-years) for the female breast and 0.7–0.8 per 104 PY for the lungs. This can be decreased by using only planar images (< 1 per 104 PY for the breast and 0.1 for the lungs). Similar values are achieved by daily 360° kV CBCT (0.44–0.57 per 104 PY for the breast and 0.08 per 104 PY for the lungs), which is again reduced for daily 200° kV CBCT (0.02 per 104 PY for the lungs and 0.07–0.08 per 104 PY for the breast). These values increase if an older attained age is considered (e.g., for 70 years, by a factor of four for the lungs).ConclusionsDaily imaging can be performed with an additional secondary cancer risk of less than 1 per 104 PY if kV CBCT is applied. If MV modalities must be chosen, a similar EAR can be achieved with planar images. A further reduction in risk is possible if the imaging geometry allows for sparing of the breast by a partial rotation underneath the patient.

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Section: Discussionmentioning

confidence: 99%

Imaging dose and secondary cancer risk in image-guided radiotherapy of pediatric patients

et al. 2018

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“…The irradiation technique can have an impact as dose distribution is modified, reducing the proportion of parenchyma receiving therapeutic doses (30 Gy, as was the case with the AP-PA approach) but increasing the proportion receiving doses below 5 Gy. The risk of carcinogenesis at fractionated low-dose radiation is difficult to model; however, most studies converge on a linear relationship, with apparent reduction at low-dose given the partial exposure [5,6,[73][74][75].…”

Section: Breastsmentioning

confidence: 99%

“…5 IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy. 6 Università di Brescia, Brescia, Italy. 7 Policlinico di Modena, Modena, Italy.…”

Section: Fundingunclassified

“…Several comparative planning studies for mediastinal lymphomas, including secondary cancer risk modeling, have been conducted over the last decade [4]. Recent modeling studies partially overturned this hypothesis, assuming for low-dose a slight risk of second malignancy induction with fractionated radiotherapy in adults [5,6]. The second-generation comparative planning studies have further optimized heart sparing, adopting various technical solutions.…”

Section: Introductionmentioning

confidence: 99%

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Fondazione Italiana Linfomi (FIL) expert consensus on the use of intensity-modulated and image-guided radiotherapy for Hodgkin’s lymphoma involving the mediastinum

et al. 2020

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Aim: Advances in therapy have resulted in improved cure rates and an increasing number of long-term Hodgkin's lymphoma (HL) survivors. However, radiotherapy (RT)-related late effects are still a significant issue, particularly for younger patients with mediastinal disease (secondary cancers, heart diseases). In many Centers, technological evolution has substantially changed RT planning and delivery. This consensus document aims to analyze the current knowledge of Intensity-Modulated Radiation Therapy (IMRT) and Image-Guided Radiation Therapy (IGRT) for mediastinal HL and formulate practical recommendations based on scientific evidence and expert opinions. Methods: A dedicated working group was set up within the Fondazione Italiana Linfomi (FIL) Radiotherapy Committee in May 2018. After a first meeting, the group adopted a dedicated platform to share retrieved articles and other material. Two group coordinators redacted a first document draft, that was further discussed and finalized in two subsequent meetings. Topics of interest were: 1) Published data comparing 3D-conformal radiotherapy (3D-CRT) and IMRT 2) dose objectives for the organs at risk 3) IGRT protocols and motion management.

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“…The typical dose values per fraction are in the range of 2.2 to 2.75 Gy, unlike conventional therapy with 2Gy fractions. The IMRT thus allows to decrease the time of treatment and also allows can obtain similar tumor response than conventional fractionation in tumors of the head and neck [9].…”

Section: Introductionmentioning

confidence: 99%

Intensity Modulated Radiotherapy (IMRT) in the Planning of Hypofractionated Treatment in Head and Neck Tumors

Morales¹,

Moreno²

2018

IJCM

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Head and neck cancer (HNCC) is the sixth most common cancer with an incidence of approximately 600,000 cases per year and 300,000 annual deaths worldwide 1y2. In Cuba, cancer of the larynx is the fourth cause in incidence, being the fourth cause of cancer death in men. Radiotherapy constitutes an important modality in the control of these tumors and the Intensity Modulated Radiotherapy (IMRT) is a new advance in this field. With it, it is possible to improve dose distribution, decreasing the dose in adjacent healthy tissues and escalating dose in tumor. In this work we present 33 patients of National Institute of Oncology and Radiobiology in Cuba (INOR), in whom the IMRT was used as a treatment technique with a hypofractionation of the dose. Their response was observed at the end of the treatment and one month later. 56% (19) of the patients had a complete response to treatment at the primary site of the tumor and neck. 10% (3) had no response, progressed. 11 of the patients had no response at the lymph node site at the end of treatment, 8 of these 11 had complete remission one month after radiotherapy ended.

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Intensity Modulated Radiation Therapy and Second Cancer Risk in Adults

Cited by 33 publications

References 43 publications

Imaging dose and secondary cancer risk in image-guided radiotherapy of pediatric patients

Imaging dose and secondary cancer risk in image-guided radiotherapy of pediatric patients

Fondazione Italiana Linfomi (FIL) expert consensus on the use of intensity-modulated and image-guided radiotherapy for Hodgkin’s lymphoma involving the mediastinum

Intensity Modulated Radiotherapy (IMRT) in the Planning of Hypofractionated Treatment in Head and Neck Tumors

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