Assessment of radiation-induced second cancer risks in proton therapy and IMRT for organs inside the primary radiation field

Paganetti, Harald; Athar, B; Moteabbed, M.; Adams, Judith; Schneider, Uwe; Yock, Torunn I.

doi:10.1088/0031-9155/57/19/6047

Cited by 99 publications

(74 citation statements)

References 58 publications

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“…Preliminary results from a cohort study of 558 patients treated with proton radiation from 1973 to 2001 at the Harvard Cyclotron Laboratory, Cambridge, MA, showed a trend towards a reduced risk of second malignancies, consistent with the reduced integral dose to the normal tissue. 112 Voxel-phantom models able to predict the second cancer risk in different organs ( Figure 10) with different treatment modalities are now available 113,114 and could guide the choice of the oncologists in defining the best treatment options for paediatric patients. The epidemiological data used in these models are, however, insufficient and the uncertainty is consequently very high.…”

Section: Late Effectsmentioning

confidence: 99%

New challenges in high-energy particle radiobiology

Durante

2014

BJR

123

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Densely ionizing radiation has always been a main topic in radiobiology. In fact, a-particles and neutrons are sources of radiation exposure for the general population and workers in nuclear power plants. More recently, high-energy protons and heavy ions attracted a large interest for two applications: hadrontherapy in oncology and space radiation protection in manned space missions. For many years, studies concentrated on measurements of the relative biological effectiveness (RBE) of the energetic particles for different end points, especially cell killing (for radiotherapy) and carcinogenesis (for late effects). Although more recently, it has been shown that densely ionizing radiation elicits signalling pathways quite distinct from those involved in the cell and tissue response to photons. The response of the microenvironment to charged particles is therefore under scrutiny, and both the damage in the target and non-target tissues are relevant. The role of individual susceptibility in therapy and risk is obviously a major topic in radiation research in general, and for ion radiobiology as well. Particle radiobiology is therefore now entering into a new phase, where beyond RBE, the tissue response is considered. These results may open new applications for both cancer therapy and protection in deep space.Biological effects of densely ionizing radiation have been studied since the beginning of radiobiology. As a matter of fact, a-particles deliver the main contribution to the background radiation dose on Earth, owing to inhalation of the indoor radon.1 Neutrons have also been extensively studied because of protection of workers in nuclear power plants; use of fast neutrons in radiotherapy; and of the exposure of the survivors of the atomic bomb in Hiroshima and Nagasaki, where a neutron component was added to g-rays. Bacq and Alexander 2 already elegantly described the radiobiology of a-particles and neutrons in their 1955 seminal book.More recently, radiobiology research has focused on highenergy protons and heavy ions, mostly for two reasons: charged particle therapy (CPT) in oncology and radiation protection in manned space missions. In both cases, charged particles at energies .100 MeV n 21 are involved. The characteristic depth-dose distribution with the sharp Bragg peak at the end of the range can be exploited for killing tumours; on the other hand, densely ionizing radiation can effectively delay tissue morbidity. Notwithstanding the many differences in exposure conditions, CPT and space radiation protection share several research topics, including individual sensitivity, non-targeted effects, late stochastic effects and so forth.3 Research in these fields requires large high-energy accelerators and is often performed by the same research groups with a common interest in particle radiobiology. Research is rapidly moving forward owing to the diffusion of CPT centres in the USA, Europe, and Asia 4 and to the growing interest in manned space exploration, now a priority for all space agencies, 5 but wi...

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Section: Late Effectsmentioning

confidence: 99%

New challenges in high-energy particle radiobiology

Durante

2014

BJR

123

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“…In order to quantitatively assess the effect of both variables on proton dose distributions, the use of a combined dose and range criteria is necessary. Differences in HU values for the same phantom using two different CT scanners are known to cause a range uncertainty in the 1%–3% range 11, 12. Dose, range, and stopping power are strongly correlated in proton beams.…”

Section: Discussionmentioning

confidence: 99%

“…The mean CT value of each plug for a particular CT scanner and scan technique is then correlated with that stopping power. The accuracy of the chemical composition, the stopping powers, of each of those elements, and also the noise in the CT value will affect the accuracy of the stopping power 11, 12. The uncertainties in the stopping power as it relates to the CT values can lead to uncertainties in the calculated range.…”

Section: Introductionmentioning

confidence: 99%

Commissioning an in‐room mobile CT for adaptive proton therapy with a compact proton system

Oliver

Zeidan

Meeks

et al. 2018

J Applied Clin Med Phys

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PurposeTo describe the commissioning of AIRO mobile CT system (AIRO) for adaptive proton therapy on a compact double scattering proton therapy system.MethodsA Gammex phantom was scanned with varying plug patterns, table heights, and mAs on a CT simulator (CT Sim) and on the AIRO. AIRO‐specific CT‐stopping power ratio (SPR) curves were created with a commonly used stoichiometric method using the Gammex phantom. A RANDO anthropomorphic thorax, pelvis, and head phantom, and a CIRS thorax and head phantom were scanned on the CT Sim and AIRO. Clinically realistic treatment plans and nonclinical plans were generated on the CT Sim images and subsequently copied onto the AIRO CT scans for dose recalculation and comparison for various AIRO SPR curves. Gamma analysis was used to evaluate dosimetric deviation between both plans.Results AIRO CT values skewed toward solid water when plugs were scanned surrounded by other plugs in phantom. Low‐density materials demonstrated largest differences. Dose calculated on AIRO CT scans with stoichiometric‐based SPR curves produced over‐ranged proton beams when large volumes of low‐density material were in the path of the beam. To create equivalent dose distributions on both data sets, the AIRO SPR curve's low‐density data points were iteratively adjusted to yield better proton beam range agreement based on isodose lines. Comparison of the stoichiometric‐based AIRO SPR curve and the “dose‐adjusted” SPR curve showed slight improvement on gamma analysis between the treatment plan and the AIRO plan for single‐field plans at the 1%, 1 mm level, but did not affect clinical plans indicating that HU number differences between the CT Sim and AIRO did not affect dose calculations for robust clinical beam arrangements.ConclusionBased on this study, we believe the AIRO can be used offline for adaptive proton therapy on a compact double scattering proton therapy system.

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“…Ours were five field setups. A reduction in the number of fields and therefore, volume of healthy tissue irradiated, could lower the patient's risk of RSC using IMRT [31][32][33][34] .…”

Section: Discussionmentioning

confidence: 99%

The need for individualized studies to compare radiogenic second cancer (RSC) risk in proton versus photon Hodgkin Lymphoma patient treatments

et al. 2016

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For Hodgkin Lymphoma (HL), proton therapy has been shown to potentially reduce therapeutic dose to healthy tissue and therefore the risk of developing a radiogenic second cancer (RSC) relative to photon therapy. Currently, commercial treatment planning systems (TPS) do not account for stray radiation doses for these treatments and their risks of late effects. Treatment plans were created and therapeutic doses were calculated with commercial TPSs for the breast, lung, and thyroid of nine HL patients. Stray dose contributions were added by thermoluminescent dosimeter (TLD) measurements in an anthropomorphic phantom for the intensity modulated radiation therapy (IMRT) treatments and personalized Monte Carlo simulations for the proton treatments. The mean relative risk ( ) of developing a RSC following HL treatment with proton therapies was then calculated and compared to photon IMRT, and reported with the metric ratio of relative risk (RRR). Results showed generally lower RSC risks after proton therapy than photon IMRT when averaged over all patients in the cohort for the breast ( = 0.84±0.03), lung ( = 0.77±0.03), and thyroid ( = 0.83±0.05), but were not universal across all patients examined. Our findings revealed that it is important to include stray dose contributions when comparing the RSC risks for different HL treatment techniques and demonstrated the importance of personalized dose and risk calculations for modern HL radiotherapy.

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Assessment of radiation-induced second cancer risks in proton therapy and IMRT for organs inside the primary radiation field

Cited by 99 publications

References 58 publications

New challenges in high-energy particle radiobiology

New challenges in high-energy particle radiobiology

Commissioning an in‐room mobile CT for adaptive proton therapy with a compact proton system

The need for individualized studies to compare radiogenic second cancer (RSC) risk in proton versus photon Hodgkin Lymphoma patient treatments

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