Relative Biological Effectiveness of Neutrons for Cancer Induction and Other Late Effects: A Review of Radiobiological Data

Engels, Hilde; Wambersie, André

doi:10.1007/978-3-642-78774-4_3

Cited by 23 publications

(11 citation statements)

References 56 publications

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“…After fast neutron therapy, the risk of secondary cancer induction has been estimated to be approximately 10-20 times greater than after photon therapy. 81 Carbon ions have an estimated RBE similar to neutrons. However, this risk estimate may be reduced by a factor of at least 3 due to the decreased integral dose.…”

Section: Radiation-induced Second Malignanciesmentioning

confidence: 99%

Current status of radiotherapy with proton and light ion beams

Greco

Wolden

2007

Cancer

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Several model studies have shown potential clinical advantages with charged particles (protons and light ions) compared with 3D-conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) in many disease sites. The newly developed intensity-modulated proton therapy (IMPT) often yields superior dose distributions to photon IMRT, with the added advantage of a significant reduction in the volume of healthy normal tissues exposed to low-to-medium doses. Initially, the major emphasis in clinical research for proton and light ion therapy was dose escalation for inherently radioresistant tumors, or for lesions adjacent to critical normal structures that constrained the dose that could be safely delivered with conventional x-ray therapy. Since the advent of IMRT the interest in particle therapy has gradually shifted toward protocols aimed at morbidity reduction. Lately the emphasis has mostly been placed on the potential for reduced risk of radiation-induced carcinogenesis with protons. Compared with 3D-CRT, a 2-fold increase has been theoretically estimated with the use of IMRT due to the larger integral volumes. In the pediatric setting, due to a higher inherent susceptibility of tissues, the risk could be significant, and the benefits of protons have been strongly emphasized in the literature. There is a significant expansion of particle therapy facilities around the world. Increasing public awareness of the potential benefits of particle therapy and wider accessibility for patients require that treating physicians stay abreast of the clinical indications of this radiotherapy modality. The article reviews the available literature for various disease sites in which particle therapy has traditionally been considered to offer clinical advantages and to highlight current lines of clinical research. The issue of radiation-induced second malignancies is examined in the light of the controversial epidemiological evidence available. The cost-effectiveness of particle therapy is also discussed. Cancer 2007;109: 1227-38. 2007 American Cancer Society.KEYWORDS: radiotherapy, proton therapy, light ions, intensity modulated radiotherapy, second cancers. C harged particles (protons and light ions) have a finite range in tissues. The interaction probability to cause ionization increases as they lose velocity traversing through tissues, so that a peak of dose occurs at a depth proportional to the energy of each particle. Beyond this peak no further dose deposition occurs. This phenomenon was described by William Bragg over 100 years ago.1 The dose peak may be 'spread out' to achieve a plateau of uniform dose to precisely cover the target while sparing adjacent normal structures. Passively scattered beams of a certain aperture can be produced by means of range-shifting modulators of variable thickness providing spread-out Bragg peaks (SOBP) for clinical use. The recent introduction of the spot scanning method represents a major advance in particle therapy.2 In this method, small pencil beams of a certain

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Section: Radiation-induced Second Malignanciesmentioning

confidence: 99%

Current status of radiotherapy with proton and light ion beams

Greco

Wolden

2007

Cancer

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“…The low LET of photon RT for these superficial tumors most likely accounted for the poor local control 2. On the contrary, neutron beam RT had a superior radiobiological effectiveness (RBE) versus photon beam, with reports by Batterman et al providing some of the earliest evidence for its use with unresectable salivary gland tumors 3. Based upon these results, as well as numerous non-randomized studies, the RTOG-MRC performed a landmark phase III trial comparing photon and neutron RT for unresectable salivary gland tumors.…”

Section: Introductionmentioning

confidence: 99%

Results of photon radiotherapy for unresectable salivary gland tumors: is neutron radiotherapy’s local control superior?

Spratt¹,

Salgado²,

Riaz³

et al. 2014

Radiology and Oncology

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BackgroundThe results of RTOG-MRC randomized trial of photon (n=15) versus neutron (n=17) therapy in the 1980’s reported an improved local control (LC) with neutron radiotherapy for unresectable salivary gland tumors. Due to increased severe toxicity with neutron radiotherapy and the paucity of neutron-therapy centers, we analyzed our institution’s results of photon radiotherapy for unresectable salivary gland tumors.Patients and methodsFrom 1990 to 2009, 27 patients with unresectable salivary gland cancer underwent definitive photon radiotherapy at our institution. Nodal involvement on presentation was found in 9 patients. Median dose of radiotherapy was 70 Gy. Chemotherapy was given to 18 patients, most being platinum-based regimens. Local control (LC), locoregional control (LRC), distant metastasis-free survival (DMFS), overall survival (OS), and toxicity outcomes were assessed.ResultsWith a median follow-up of 52.4 months, the 2/5-year actuarial LC was 69% (95%CI ± 21.0%)/55% (± 24.2%), LRC was 65% (± 21.4%)/47% (± 21.6%), and DMFS was 71% (± 21.8%)/51% (± 22.8%), respectively using competing risk analysis. The median OS was 25.7 months, and the 2/5-year OS rates were 50% (± 19.0%)/29% (± 16.6%), respectively. Higher histologic grade was significant for an increased rate of DM (intermediate grade vs. low grade, p=0.04, HR 7.93; high grade vs. low grade, p=0.01, HR 13.50). Thirteen (48%) patient’s experienced acute grade 3 toxicity. Late grade 3 toxicity occurred in three (11%) patients.ConclusionsOur data compares favorably to neutron radiotherapy with fewer late complications. Photon radiotherapy is an acceptable alternative to neutron radiotherapy in patients who present with unresectable salivary gland tumors.

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“…In fact, increasing numbers of patients with second malignancies have recently been observed among long survivors of paediatric cancer [6,7]. Age of initial cancer onset, genetic predisposition and the nature of the treatment itself have been nominated as causative factors for a second tumour [8][9][10]. Therefore, the elucidation of the genotoxic effects induced by chemotherapy is relevant in order to identify the degree of cancer risk as well as to minimise the risk of a second neoplasm.…”

Section: Introductionmentioning

confidence: 99%

DNA damage in lymphocytes and buccal mucosa cells of children with malignant tumours undergoing chemotherapy

et al. 2008

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The aim of the present study was to evaluate DNA damage (micronucleus) in cytokinesis-blocked lymphocytes and exfoliated buccal mucosa cells from children with malignant tumours and under chemotherapy. Micronucleated cells (MNCs) were assessed from children before and during chemotherapy. A total of 21 healthy children (controls), matched for gender and age, were used as control. The results pointed out higher frequencies of micronucleated lymphocytes in children with malignant tumour before any therapy when compared to healthy probands. Furthermore an increase of micronucleated lymphocytes during chemotherapy was detected when compared to the data obtained before chemotherapy. No statistically significant increases of MNCs were noticed in buccal mucosa cells at any of the timepoints evaluated. Taken together, these data indicate that the presence of malignant tumours may increase the frequency of DNA damage in circulating lymphocytes, these cells being more sensitive for detecting chromosome aberrations caused by anti-cancer drugs.

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Relative Biological Effectiveness of Neutrons for Cancer Induction and Other Late Effects: A Review of Radiobiological Data

Cited by 23 publications

References 56 publications

Current status of radiotherapy with proton and light ion beams

Current status of radiotherapy with proton and light ion beams

Results of photon radiotherapy for unresectable salivary gland tumors: is neutron radiotherapy’s local control superior?

DNA damage in lymphocytes and buccal mucosa cells of children with malignant tumours undergoing chemotherapy

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