Are IMRT treatments in the head and neck region increasing the risk of secondary cancers?

Ardenfors, Oscar; Josefsson, Dan; Daşu, Alexandru

doi:10.3109/0284186x.2014.925581

Cited by 26 publications

(12 citation statements)

References 29 publications

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“…However, more recent data suggest that older models may overestimate the risk at low doses and underestimate the risk at high doses when the exposure is fractionated 7,8,18,19 . In fact, newer models have suggested that second cancer risk after IMRT is not increased and may even be reduced, 8,20‐22 such as for head and neck cancer, 23 which we also observed. In one of the few studies to date, a Surveillance, Epidemiology, and End Results (SEER)‐Medicare analysis found no difference in second cancers after prostate cancer treatment with IMRT versus 3DCRT 10 .…”

Section: Discussionsupporting

confidence: 51%

Second cancer risk after primary cancer treatment with three‐dimensional conformal, intensity‐modulated, or proton beam radiation therapy

Xiang

Chang

Pollom

2020

Cancer

117

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Background The comparative risks of a second cancer diagnosis are uncertain after primary cancer treatment with 3‐dimensional conformal radiotherapy (3DCRT), intensity‐modulated radiotherapy (IMRT), or proton beam radiotherapy (PBRT). Methods Pediatric and adult patients with a first cancer diagnosis between 2004 and 2015 who received 3DCRT, IMRT, or PBRT were identified in the National Cancer Database from 9 tumor types: head and neck, gastrointestinal, gynecologic, lymphoma, lung, prostate, breast, bone/soft tissue, and brain/central nervous system. The diagnosis of second cancer was modeled using multivariable logistic regression adjusting for age, follow‐up duration, radiotherapy (RT) dose, chemotherapy, sociodemographic variables, and other factors. Propensity score matching also was used to balance baseline characteristics. Results In total, 450,373 patients were identified (33.5% received 3DCRT, 65.2% received IMRT, and 1.3% received PBRT) with median follow‐up of 5.1 years after RT completion and a cumulative follow‐up period of 2.54 million person‐years. Overall, the incidence of second cancer diagnosis was 1.55 per 100 patient‐years. In a comparison between IMRT versus 3DCRT, there was no overall difference in the risk of second cancer (adjusted odds ratio [OR], 1.00; 95% CI, 0.97‐1.02; P = .75). By comparison, PBRT had an overall lower risk of second cancer versus IMRT (adjusted OR, 0.31; 95% CI, 0.26‐0.36; P < .0001). Results within each tumor type generally were consistent in the pooled analyses and also were maintained in propensity score‐matched analyses. Conclusions The risk of a second cancer diagnosis was similar after IMRT versus 3DCRT, whereas PBRT was associated with a lower risk of second cancer risk. Future work is warranted to determine the cost‐effectiveness of PBRT and to identify the population best suited for this treatment.

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Section: Discussionsupporting

confidence: 51%

Second cancer risk after primary cancer treatment with three‐dimensional conformal, intensity‐modulated, or proton beam radiation therapy

Xiang

Chang

Pollom

2020

Cancer

117

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“…In a study by Ardenfors et al, differences in SCR between IMRT and conformal RT were assessed for head and neck cancers. 26 Their results showed that the risk was similar between the 2 techniques. They suggested that the dose redistribution characteristic of IMRT resulted in a redistribution of the risk of SCR among individual tissues.…”

Section: Discussionmentioning

confidence: 95%

Radiation-induced secondary malignancies for nasopharyngeal carcinoma: a pilot study of patients treated via IMRT or VMAT

Lee¹,

Lan²,

Chao³

et al. 2018

CMAR

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BackgroundPatients treated with radiotherapy are at risk of developing a second cancer during their lifetime, which can directly impact treatment decision-making and patient management. The aim of this study was to qualify and compare the secondary cancer risk (SCR) after intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) in nasopharyngeal carcinoma (NPC) patients.Patients and methodsWe analyzed the treatment plans of a cohort of 10 NPC patients originally treated with IMRT or VMAT. Dose distributions in these plans were used to calculate the organ equivalent dose (OED) with Schneider’s full model. Analyses were applied to the brain stem, spinal cord, oral cavity, pharynx, parotid glands, lung, mandible, healthy tissue, and planning target volume.ResultsWe observed that the OED-based risks of SCR were slightly higher for the oral cavity and mandible when VMAT was used. No significant difference was found in terms of the doses to other organs, including the brain stem, parotids, pharynx, submandibular gland, lung, spinal cord, and healthy tissue. In the NPC cohort, the lungs were the organs that were most sensitive to radiation-induced cancer.ConclusionVMAT afforded superior results in terms of organ-at-risk-sparing compared with IMRT. Most OED-based second cancer risks for various organs were similar when VMAT and IMRT were employed, but the risks for the oral cavity and mandible were slightly higher when VMAT was used.

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“…Another aspect of relevance for the cancer risks from modern RT techniques is the use of image‐guidance techniques employing ionizing radiation. Risk evaluations accounting simultaneously for primary radiation and imaging doses have shown that the additional risk due to repeated imaging is in fact very small 44 . Such doses were not available for the patients used retrospectively for this study, and therefore we did not include the impact of image‐guided radiotherapy on secondary cancer risk.…”

Section: Discussionmentioning

confidence: 99%

Estimation of secondary cancer risk after radiotherapy in high‐risk prostate cancer patients with pelvic irradiation

Haciislamoglu

Güngör

Aydin

et al. 2020

J Applied Clin Med Phys

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We aimed to estimate the risk of secondary cancer after radiotherapy (RT) in high‐risk prostate cancer (HRPC) patients with pelvic irradiation. Computed tomography data of five biopsy‐proven HRPC patients were selected for this study. Two different planning target volumes (PTV1 and PTV2) were contoured for each patient. The PTV1 included the prostate, seminal vesicles, and pelvic lymphatics, while the PTV2 included only the prostate and seminal vesicles. The prescribed dose was 54 Gy for the PTV1 with a sequential boost (24 Gy for the PTV2). Intensity‐modulated RT (IMRT) and volumetric modulated arc therapy (VMAT) techniques were used to generate treatment plans with 6 and 10 MV photon energies with the flattening filter (FF) or flattening filter‐free (FFF) irradiation mode. The excess absolute risks (EARs) were calculated and compared for the bladder, rectum, pelvic bone, and soft tissue based on the linear‐exponential, plateau, full mechanistic, and specific mechanistic sarcoma dose‐response model. According to the models, all treatment plans resulted in similar risks of secondary bladder or rectal cancer and pelvic bone or soft tissue sarcoma except for the estimated risk of the bladder according to the full mechanistic model using IMRT(6MV;FF) technique compared with VMAT techniques with FFF options. The overall estimation of EAR indicated that the radiation‐induced cancer risk due to RT in HRPC was lower for bladder than the rectum. EAR values ranged from 1.47 to 5.82 for bladder and 6.36 to 7.94 for rectum, depending on the dose–response models used. The absolute risks of the secondary pelvic bone and soft tissue sarcoma were small for the plans examined. We theoretically predicted the radiation‐induced secondary cancer risk in HRPC patients with pelvic irradiation. Nevertheless, prospective clinical trials, with larger patient cohorts with a long‐term follow‐up, are needed to validate these model predictions.

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Are IMRT treatments in the head and neck region increasing the risk of secondary cancers?

Abstract: The results indicated that the redistribution of the dose characteristic to IMRT leads to a redistribution of the risks in individual tissues. However, the total levels of risk were similar between the two irradiation techniques considered.

Cited by 26 publications

References 29 publications

Second cancer risk after primary cancer treatment with three‐dimensional conformal, intensity‐modulated, or proton beam radiation therapy

Second cancer risk after primary cancer treatment with three‐dimensional conformal, intensity‐modulated, or proton beam radiation therapy

Radiation-induced secondary malignancies for nasopharyngeal carcinoma: a pilot study of patients treated via IMRT or VMAT

Estimation of secondary cancer risk after radiotherapy in high‐risk prostate cancer patients with pelvic irradiation

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