Cancer risk assessment in modern radiotherapy workflow with medical big data

Abstract

Modern radiotherapy (RT) is being enriched by big digital data and intensive technology. Multimodality image registration, intelligence-guided planning, real-time tracking, image-guided RT (IGRT), and automatic follow-up surveys are the products of the digital era. Enormous digital data are created in the process of treatment, including benefits and risks. Generally, decision making in RT tries to balance these two aspects, which is based on the archival and retrieving of data from various platforms. However, modern risk-based analysis shows that many errors that occur in radiation oncology are due to failures in workflow. These errors can lead to imbalance between benefits and risks. In addition, the exact mechanism and dose–response relationship for radiation-induced malignancy are not well understood. The cancer risk in modern RT workflow continues to be a problem. Therefore, in this review, we develop risk assessments based on our current knowledge of IGRT and provide strategies for cancer risk reduction. Artificial intelligence (AI) such as machine learning is also discussed because big data are transforming RT via AI.

Effectiveness of Image-Guided Radiotherapy in Adjuvant Radiotherapy on Survival for Localized Breast Cancer: A Population-Based Analysis

“…8 Our results revealed that IGRT in adjuvant CFRT for localized breast cancer patients did not lead to worse overall survival or other outcomes. So it might be safe to use IGRT (usually via x-ray) regardless of the theoretical concern in cardiovascular disease or secondary cancer, 33,34 at least for selected patients with significant setup errors. However, it should be noted the radiotherapy setting and technique in prostate cancer radiotherapy in that RCT 8 was different vs the one for breast cancer in the current study [curative/definitive vs preventive/adjuvant].…”

<p>Estimation of radiotherapy modalities for patients with stage I-II nasal natural killer T-Cell lymphoma</p>

“…The second cancer exists highly for patients who received RT, which have demonstrated by numerous clinical studies, and usually occur in volumes receiving total dose irradiation or nearby areas radiated with the doses from 2 to 50 Gy 31,32. Thyroid is known to have a low dose threshold for radiation-induced cancer, which is as low as 0.05 Gy in children and young adults 33,34. Hence, in RT treatment, second cancer for thyroid or other organs may be affected by out-of-field dose, which is likely to be highly associated with treatment facility due to leakage and scattering from head and accessories 35.…”

Risks in Oncology and Radiation Therapy

“…Most of the errors are discovered in setup/treatment and during follow-up. There are still errors that are not covered by regular QA checks so individual clinics should perform a risk analysis of their own practice, classifying and learning from mistakes, to determine appropriate testing frequencies that maximize physicist time efficiency and patient treatment quality and to improve existing processes or implement new workflows [43]. The detection of errors is essential in the RT process as it minimizes the risk of repetition, activates mechanisms of correction, and instills in the staff a drive to improve the quality of daily activities.…”

“…Modern risk-based analyses show that many errors occurring in radiation oncology are due to failures in workflow [43,48]. Medical imaging is crucial to RT; its application, referred to as IGRT, encompasses tumor diagnosis, staging, prognosis, treatment planning, radiation targeting, and follow-up care [49].…”

“…This can be compensated for with the use of four-dimensional CT (4DCT) or instruments like "breath holding" that are able to facilitate the delivery of RT to a dynamic target rather than to a static volume. Tumor motion management has been a part of the IGRT effort and it markedly impacts radiation dose and volume of irradiated, normal tissue, as well as secondary cancer risk (SMN) [43].…”