Frequency Distribution of Second Solid Cancer Locations in Relation to the Irradiated Volume Among 115 Patients Treated for Childhood Cancer

Diallo, Ibrahima; Haddy, Nadia; Adjadj, Élisabeth; Samand, Akhtar; Quiniou, É.; Chavaudra, J.; Alziar, I.; Perret, N.; Guérin, Sylvie; Lefkopoulos, Dimitri; Vathaire, Florent de

doi:10.1016/j.ijrobp.2009.01.040

Cited by 187 publications

(164 citation statements)

References 35 publications

(38 reference statements)

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“…In addition, according to Dorr and Herrmann, 31 , 32 the majority of second cancers are induced within the penumbra of radiotherapy. Moreover, some papers reported that second cancers occurred in the low‐dose region, especially in pediatric patients 33 , 34 , 35 . Thus, the low dose should be delivered accurately and evaluated strictly.…”

Section: Discussionmentioning

confidence: 99%

Gamma analysis dependence on specified low‐dose thresholds for VMAT QA

Song

Kim

Park

et al. 2015

J Applied Clin Med Phys

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The American Association of Physicists in Medicine Task Group 119 instructed institutions to use a low‐dose threshold of 10% or a region of interest determined by the jaw setting when they collected gamma analysis quality assurance (QA) data for the planar dose distribution. However, there are no clinical data to quantitatively demonstrate the impact of the low‐dose threshold on the gamma index. Therefore, we performed a gamma analysis with various low‐dose thresholds in the range of 0% to 15% according to both global and local normalization and different acceptance criteria (3%/3 mm, 2%/2 mm, and 1%/1 mm). A total of 30 treatment plans — 10 head and neck, 10 brain, and 10 prostate cancer cases — were randomly selected from the Varian Eclipse treatment planning system (TPS). For the gamma analysis, a calculated portal image was acquired through a portal dose calculation algorithm in the Eclipse TPS, and a measured portal image was obtained using an electronic portal‐imaging device. Then, the gamma analysis was performed using the Portal Dosimetry software (Varian Medical Systems, Palo Alto, CA). The gamma passing rate (%GP) for the global normalization decreased as the low‐dose threshold increased, and all low‐dose thresholds led to %GP values above 95% for both the 3%/3 mm and 2%/2 mm criteria. However, for the local normalization, %GP for a low‐dose threshold of 10% was 7.47%, 10.23%, and 6.71% greater than the low‐dose threshold of 0% for head and neck, brain, and prostate for the 3%/3 mm criteria, respectively. The results indicate that applying the low‐dose threshold to global normalization does not have a critical impact on patient‐specific QA results. However, in the local normalization, the low‐dose threshold level should be carefully selected because the excluded low‐dose points could cause the average %GP to increase rapidly.PACS number: 87.55.Qr

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Section: Discussionmentioning

confidence: 99%

Gamma analysis dependence on specified low‐dose thresholds for VMAT QA

Song

Kim

Park

et al. 2015

J Applied Clin Med Phys

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“…However, if many of these same patients were treated with modern linear accelerators that are able to deliver more conformal radiation doses, would the risk of radiation-induced gliomas remain elevated? A recent retrospective study of 4,581 pediatric cancer patients in France treated with radiation indicates that many secondary malignancies actually occur in lower dose areas [25]. Specifically, 31% of secondary malignancies (14% in the CNS) occurred in volumes that received < 2.5 Gy.…”

Section: Epidemiology Of Radiation-induced Gliomas [Pediatric]mentioning

confidence: 99%

“…Since low-dose radiation on the edge of treatment fields is critically important to secondary cancer development [25], numerous studies have focused on radiation leakage from linear accelerators heads, scatter from multi-leaf collimators, and production of nuclear particles at high photon energies [35-37]. Methods suggested to mitigate this unnecessary radiation include shielding units for linear accelerator leakage, moving multi-leaf collimators to the field edge instead of fully retracting them, and using lower energy photon energies (~ 6 mV) to prevent neutron production.…”

Section: Five-year Viewmentioning

confidence: 99%

Strategy for surveying the proteome using affinity proteomics and mass spectrometry

2009

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Radiation-induced gliomas represent a relatively rare but well-characterized entity in the neuro-oncologic literature. Extensive retrospective cohort data in pediatric populations after therapeutic intracranial radiation show a clearly increased risk in glioma incidence that is both patient age- and radiation dose/volume-dependent. Data in adults are more limited but show heightened risk in certain groups exposed to radiation. In both populations, there is no evidence linking increased risk associated with routine exposure to diagnostic radiation. At the molecular level, recent studies have found distinct genetic differences between radiation-induced gliomas and their spontaneously-occurring counterparts. Clinically, there is understandable reluctance on the part of clinicians to re-treat patients due to concern for cumulative neurotoxicity. However, available data suggest that aggressive intervention can lead to improved outcomes in patients with radiation-induced gliomas.

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“…The incidence of these secondary malignancies depends on the delivered dose distribution, size of the irradiated volume, dose, and dose rate, along with other patient‐specific factors. ( 2 ) Diallo et al ( 3 ) found that the majority of these second cancers arise in the margin of the irradiated region or the “beam‐bordering” region (from 2.5 cm inside to 5 cm outside of the irradiated volume) and that a sizeable number of cancers developed at distant sites far outside of the treatment field. In order to estimate the risk of developing a secondary malignancy, as well as to better understand the dose‐carcinogenic effect relationship, accurate knowledge of the dose distribution delivered to the patient is required, especially in the beam‐bordering region and out‐of‐field region.…”

Section: Introductionmentioning

confidence: 99%

Accuracy and sources of error of out‐of field dose calculations by a commercial treatment planning system for intensity‐modulated radiation therapy treatments

Huang

Followill

Wang

et al. 2013

J Applied Clin Med Phys

112

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Although treatment planning systems are generally thought to have poor accuracy for out‐of‐field dose calculations, little work has been done to quantify this dose calculation inaccuracy for modern treatment techniques, such as intensity‐ modulated radiation therapy (IMRT), or to understand the sources of this inaccuracy. The aim of this work is to evaluate the accuracy of out‐of‐field dose calculations by a commercial treatment planning system (TPS), Pinnacle3 v.9.0, for IMRT treatment plans. Three IMRT plans were delivered to anthropomorphic phantoms, and out‐of‐field doses were measured using thermoluminescent detectors (TLDs). The TLD‐measured dose was then compared to the TPS‐calculated dose to quantify the accuracy of TPS calculations at various distances from the field edge and out‐of‐field anatomical locations of interest (i.e., radiosensitive organs). The individual components of out‐of‐field dose (patient scatter, collimator scatter, and head leakage) were also calculated in Pinnacle and compared to Monte Carlo simulations for a 10×10 cm2 field. Our results show that the treatment planning system generally underestimated the out‐of‐field dose and that this underestimation worsened (accuracy decreased) for increasing distances from the field edge. For the three IMRT treatment plans investigated, the TPS underestimated the dose by an average of 50%. Our results also showed that collimator scatter was underestimated by the TPS near the treatment field, while all components of out‐of‐field dose were severely underestimated at greater distances from the field edge. This study highlights the limitations of commercial treatment planning systems in calculating out‐of‐field dose and provides data about the level of accuracy, or rather inaccuracy, that can be expected for modern IMRT treatments. Based on our results, use of the TPS‐reported dose could lead to an underestimation of secondary cancer induction risk, as well as poor clinical decision‐making for pregnant patients or patients with implantable cardiac pacemakers and defibrillators.PACS numbers: 87.53.Bn; 7.55.D‐

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Frequency Distribution of Second Solid Cancer Locations in Relation to the Irradiated Volume Among 115 Patients Treated for Childhood Cancer

Cited by 187 publications

References 35 publications

Gamma analysis dependence on specified low‐dose thresholds for VMAT QA

Gamma analysis dependence on specified low‐dose thresholds for VMAT QA

Strategy for surveying the proteome using affinity proteomics and mass spectrometry

Accuracy and sources of error of out‐of field dose calculations by a commercial treatment planning system for intensity‐modulated radiation therapy treatments

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