Estimation of risk of radiation-induced carcinogenesis in adolescents with nasopharyngeal cancer treated using sliding window IMRT

Sharma, Shilpi; Upreti, Ritu Raj; Laskar, Siddhartha; Tambe, Chandrashekhar M; Deshpande, Deepak D.; Shrivastava, Shyam K.; Dinshaw, Ketayun A.

doi:10.1016/j.radonc.2007.11.019

Cited by 25 publications

(13 citation statements)

References 14 publications

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“…[23][24][25] In general, cancer patients are also more prone to developing second malignancies. 26,27 Furthermore, when selecting a treatment option, understanding physiologic characteristics of the lesion can be helpful for treatment optimization. Lesion sensitivity to radiation therapy and chemotherapy, for example, is often a consideration in the management of metastatic lesions.…”

Section: Discussionmentioning

confidence: 99%

Characterizing Hypervascular and Hypovascular Metastases and Normal Bone Marrow of the Spine Using Dynamic Contrast-Enhanced MR Imaging

Khadem¹,

Karimi²,

Peck³

et al. 2012

AJNR Am J Neuroradiol

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Section: Discussionmentioning

confidence: 99%

Characterizing Hypervascular and Hypovascular Metastases and Normal Bone Marrow of the Spine Using Dynamic Contrast-Enhanced MR Imaging

Khadem¹,

Karimi²,

Peck³

et al. 2012

AJNR Am J Neuroradiol

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“…These two factors can potentially increase the risk of radiation-induced carcinogenesis, particularly in children and long-term survivors [27][28][29][30][31]. Very recently, Sharma et al [32] proposed the use of age-and gender-specific risk coefficients for estimating the risk of radiation-induced carcinogenesis. We have not attempted to estimate the risk of radiationinduced carcinogenesis for CSI in this study, but plan to do so in a subsequent report after enrolling more patients.…”

Section: Discussionmentioning

confidence: 99%

High-precision radiotherapy for craniospinal irradiation: evaluation of three-dimensional conformal radiotherapy, intensity-modulated radiation therapy and helical TomoTherapy

Sharma¹,

Gupta²,

Jalali³

et al. 2009

BJR

109

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ABSTRACT. This study aimed to establish the feasibility of intensity-modulated radiation therapy (IMRT) in craniospinal irradiation (CSI) using conventional linear accelerator (IMRT_LA) and compare it dosimetrically with helical TomoTherapy (IMRT_ Tomo) and three-dimensional conformal radiotherapy (3DCRT). CT datasets of four previously treated patients with medulloblastoma were used to generate 3DCRT, IMRT_ LA and IMRT_Tomo plans. A CSI dose of 35 Gy was prescribed to the planning target volume (PTV). IMRT_LA plans for tall patients were generated using an intensity feathering technique. All plans were compared dosimetrically using standardised parameters. The mean volume of each PTV receiving at least 95% of the prescribed dose (V 95% ) was .98% for all plans. All plans resulted in a comparable dose homogeneity index (DHI) for PTV_brain. For PTV_spine, IMRT_Tomo achieved the highest mean DHI of 0.96, compared with 0.91 for IMRT_LA and 0.84 for 3DCRT. The best dose conformity index was achieved by IMRT_Tomo for PTV_brain (0.96) and IMRT_LA for PTV_spine (0.83). The IMRT_Tomo plan was superior in terms of reduction of the maximum, mean and integral doses to almost all organs at risk (OARs). It also reduced the volume of each OAR irradiated to various dose levels, except for the lowest dose volume. The beam-on time was significantly longer in IMRT_Tomo. In conclusion, IMRT_Tomo for CSI is technically easier and potentially dosimetrically favourable compared with IMRT_LA and 3DCRT. IMRT for CSI can also be realised on a conventional linear accelerator even for spinal lengths exceeding maximum allowable field sizes. The longer beam-on time in IMRT_Tomo raises concerns about intrafraction motion and whole-body integral doses.

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“…Moreover, IMRT uses a larger number of monitor units (MUs) compared with conventional CRT, leading to an increase in the amount of low‐dose radiation received by the rest of the body. This raises the concern of secondary radiation‐induced malignancy, which is of particular relevance to young patients or those with long future life expectancies 12, 13…”

Section: Introductionmentioning

confidence: 99%

Dosimetric benefits of intensity‐modulated radiotherapy and volumetric‐modulated arc therapy in the treatment of postoperative cervical cancer patients

Deng

Han

Chen³

et al. 2016

J Applied Clin Med Phys

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As the advantage of using complex volumetric‐modulated arc therapy (VMAT) in the treatment of gynecologic cancer has not yet been fully determined, the purpose of this study was to investigate the dosimetric advantages of VMAT by comparing directly with whole pelvic conformal radiotherapy (CRT) and intensity‐modulated radiotherapy (IMRT) in the treatment of 15 postoperative cervical cancer patients. Four‐field CRT, seven‐field IMRT, and two‐arc VMAT plans were generated for each patient with identical objective functions to achieve clinically acceptable dose distribution. Target coverage and OAR sparing differences were investigated through dose‐volume histogram (DVH) analysis. Nondosimtric differences between IMRT and VMAT were also compared. Target coverage presented by V95% were 88.9% ± 3.8%, 99.9% ± 0.07%, and 99.9% ± 0.1% for CRT, IMRT, and VMAT, respectively. Significant differences on conformal index (CI) and conformal number (CN) were observed with CIs of 0.37 ± 0.07, 0.55 ± 0.04, 0.61 ± 0.04, and CNs of 0.33 ± 0.06, 0.55 ± 0.04, 0.60 ± 0.04 for CRT, IMRT, and VMAT, respectively. IMRT and VMAT decreased the dose to bladder and rectum significantly compared with CRT. No significant differences on the Dmean, V45, and V30 of small bowel were observed among CRT, IMRT, and VMAT. However, VMAT (10.4 ± 4.8 vs. 19.8 ± 11.0, P = 0.004) and IMRT (12.3 ± 5.0 vs. 19.8 ± 11.0, P = 0.02) decreased V40, increased the Dmax of small bowel and the irradiation dose to femoral heads compared with CRT. VMAT irradiated less dose to bladder, rectum, small bowel and larger volume of health tissue with a lower dose (V5 and V10) compared with IMRT, although the differences were not statistical significant. In conclusion, VMAT and IMRT showed significant dosimetric advantages both on target coverage and OAR sparing compared with CRT in the treatment of postoperative cervical cancer. However, no significant difference between IMRT and VMAT was observed except for slightly better dose conformity, slightly less MU, and significant shorter delivery time achieved for VMAT.

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Estimation of risk of radiation-induced carcinogenesis in adolescents with nasopharyngeal cancer treated using sliding window IMRT

Cited by 25 publications

References 14 publications

Characterizing Hypervascular and Hypovascular Metastases and Normal Bone Marrow of the Spine Using Dynamic Contrast-Enhanced MR Imaging

Characterizing Hypervascular and Hypovascular Metastases and Normal Bone Marrow of the Spine Using Dynamic Contrast-Enhanced MR Imaging

High-precision radiotherapy for craniospinal irradiation: evaluation of three-dimensional conformal radiotherapy, intensity-modulated radiation therapy and helical TomoTherapy

Dosimetric benefits of intensity‐modulated radiotherapy and volumetric‐modulated arc therapy in the treatment of postoperative cervical cancer patients

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