The risk of developing a second cancer after receiving craniospinal proton irradiation

Newhauser, Wayne D.; Fontenot, Jonas D.; Mahajan, Anita; Kornguth, David; Stovall, Marilyn; Zheng, Yuanshui; Taddei, Phillip J.; Mirković, Dragan; Mohan, Radhe; Cox, James D.; Woo, Shiao Y.

doi:10.1088/0031-9155/54/8/002

Cited by 160 publications

(200 citation statements)

References 40 publications

(75 reference statements)

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“…These measurements showed that in fact high neutron doses are delivered with a passive scatter system, but the difference in neutron doses between passive scatter and dynamic delivery is not as significant as previously stated which agrees with previous studies in the literature (8,10,11) . A possible limitation of this work when comparing neutron doses to those reported in the literature measured in dynamic systems is that contrary to what is done clinically the absorbed dose was not prescribed to a volume.…”

Section: A Pé Rez-andú Jar Et Alsupporting

confidence: 92%

Microdosimetric measurements for neutron-absorbed dose determination during proton therapy

Perez‐Andujar

DeLuca

Thornton³

et al. 2012

Radiation Protection Dosimetry

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This work presents microdosimetric measurements performed at the Midwest Proton Radiotherapy Institute in Bloomington, Indiana, USA. The measurements were done simulating clinical setups with a water phantom and for a variety of stopping targets. The water phantom was irradiated by a proton spread out Bragg peak (SOBP) and by a proton pencil beam. Stopping target measurements were performed only for the pencil beam. The targets used were made of polyethylene, brass and lead. The objective of this work was to determine the neutron-absorbed dose for a passive and active proton therapy delivery, and for the interactions of the proton beam with materials typically in the beam line of a proton therapy treatment nozzle. Neutron doses were found to be higher at 458 8 8 8 8 and 908 8 8 8 8 from the beam direction for the SOBP configuration by a factor of 1.1 and 1.3, respectively, compared with the pencil beam. Meanwhile, the pencil beam configuration produced neutron-absorbed doses 2.2 times higher at 08 8 8 8 8 than the SOBP. For stopping targets, lead was found to dominate the neutronabsorbed dose for most angles due to a large production of low-energy neutrons emitted isotropically.

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Section: A Pé Rez-andú Jar Et Alsupporting

confidence: 92%

Microdosimetric measurements for neutron-absorbed dose determination during proton therapy

Perez‐Andujar

DeLuca

Thornton³

et al. 2012

Radiation Protection Dosimetry

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“…Several studies have been published concerning the risk of secondary malignancies after radiation of the cranio-spinal axis for patients with medulloblastoma using different combinations of treatment techniques and analysis methods (10,(32)(33)(34)(35)(36). To compare the risks for secondary malignancy calculated in this study with those previously reported, the respective values from the 3D-CRT, HT, and VMAT treatment modalities were obtained.…”

Section: Comparison To Previously Published Studiesmentioning

confidence: 99%

“…There are a few studies, which have been conducted focusing on these secondary malignancy risks for pediatric patients treated with CSI therapy (10,(32)(33)(34)(35)(36). However, these studies mainly consist of a small number of patients and many of the studies focus on the use of proton therapy for CSI.…”

Section: Introductionmentioning

confidence: 99%

“…Also, according to the results of previous publications, there are contradicting findings reported about which modality can best reduce the risk for secondary malignancies. While most of the data does validate the decreased risk using proton therapy, different studies have found that traditional 3D-CRT modalities have lower risks than the more advanced IMRT modalities (10,33), whereas others have reported the opposite as a conclusion (32,34), who used higher prescription doses (36 Gy). The results of this work may provide new information on the debate for the use of conventional and newer technologies in radiation therapy of childhood CSI.…”

Section: Introductionmentioning

confidence: 99%

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Pediatric Cranio-spinal Axis Irradiation

Myers

Mavroidis

Komisopoulos

et al. 2015

Technol Cancer Res Treat

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Pediatric cranio-spinal axis irradiation (CSI) is a valuable treatment for many central nervous system (CNS) diseases, but due to the life expectancies and quality of life expectations for children, the minimization of the risk for radiation-induced secondary malignancies must be a high priority. This study compared the estimated CSI-induced secondary malignancy risks of three radiation therapy modalities using three different models. Twenty-four (n 5 24) pediatric patients previously treated with CSI for tumors of the CNS were planned using three different treatment modalities: three-dimensional conformal radiation therapy (3D-CRT), volume modulated arc therapy (VMAT), and Tomotherapy. Each plan was designed to deliver 23.4 Gy (1.8 Gy/fraction) to the target which was defined as the entire brain and spinal column with a 0.7 cm expansion. The mean doses as well as the dose volume histograms (DVH) of specific organs were analyzed for secondary malignancy risk according to three different methods: the effective dose equivalent (EDE), the excess relative risk (ERR), and the linear quadratic (LQ) models. Using the EDE model, the average secondary risk was highest for the 3D-CRT plans (37.60%), compared to VMAT (28.05%) and Tomotherapy (27.90%). The ERR model showed similarly that the 3D-CRT plans had considerably higher risk (10.84%) than VMAT and Tomotherapy, which showed almost equal risks (7.05 and 7.07%, respectively). The LQ model requires organ-specific cell survival parameters, which for the lungs, heart, and breast relevant values were found and applied. The lung risk for secondary malignancy was found to be 1.00, 1.96, and 2.07% for 3D-CRT, VMAT, and Tomotherapy, respectively. The secondary cancer risk for breast was estimated to be 0.09, 0.21, and 0.27% and for heart it was 9.75, 6.02 and 6.29% for 3D-CRT, VMAT, and Tomotherapy, respectively. Based on three methods of secondary malignancy estimation, the 3D-CRT plans produced highest radiationinduced secondary malignancy risk, and the VMAT and Tomotherapy plans had nearly equal risk. Pediatric patients must be treated with reducing long term sequelae as a priority.

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“…Simulations of CSI with both passively scattered and scanned-beam proton therapies reveal that the risk of secondary cancer is lower than conventional and intensity modulated photon therapies even when neutrons are taken into account [74].…”

Section: Risk Of Radiation Induced Second Malignancymentioning

confidence: 99%

Proton Radiotherapy for Childhood Tumors: an Overview of Early Clinical Results

MacDonald¹

2013

J Nucl Med Radiat Ther

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Radiation therapy (RT) is an important part of a multidisciplinary treatment for many pediatric tumors and has been integral to the improvement in disease control seen over the past few decades. However, long-term survivors experience late morbidity related to RT. Proton radiation therapy is an emerging type of radiotherapy that can mitigate the incidence of acute and late side effects by minimizing the dose of radiation to normal tissues with a significant reduction of integral dose compared with photons. Furthermore, true clinical advantages are now being measured and published in the medical literature, showing both excellent disease control rates and reduction of late effects. The purpose of this review is to summarize the early clinical outcomes after proton radiotherapy in childhood available in the literature.

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The risk of developing a second cancer after receiving craniospinal proton irradiation

Cited by 160 publications

References 40 publications

Microdosimetric measurements for neutron-absorbed dose determination during proton therapy

Microdosimetric measurements for neutron-absorbed dose determination during proton therapy

Pediatric Cranio-spinal Axis Irradiation

Proton Radiotherapy for Childhood Tumors: an Overview of Early Clinical Results

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