Uncomplicated and Cancer-Free Control Probability (UCFCP): A new integral approach to treatment plan optimization in photon radiation therapy

Sánchez‐Nieto, B.; Romero-Expósito, Maite; Terrón, José A.; Sánchez‐Doblado, F.

doi:10.1016/j.ejmp.2017.03.025

Cited by 14 publications

(15 citation statements)

References 36 publications

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“…For that, the concept of uncomplicated and cancer-free control probability (UCFCP) has been recently proposed. 2 This approach requires further knowledge about the carcinogenic potential and deterministic effects of the out-of-field radiation doses, which in turn has to be accurately assessed. Unfortunately, this latter is a complex task, 3 and there is no established and reliable method to be currently used in the clinical routine, which poses unique challenges to clinical medical physicists.…”

Section: Introductionmentioning

confidence: 99%

“…In order to optimize the outcome, treatment regimes must be improved to not only maximize the probability of local tumor control but also to minimize the probability of radio‐induced effects to normal tissues (including the risk of cancer induction). For that, the concept of uncomplicated and cancer‐free control probability (UCFCP) has been recently proposed 2 . This approach requires further knowledge about the carcinogenic potential and deterministic effects of the out‐of‐field radiation doses, which in turn has to be accurately assessed.…”

Section: Introductionmentioning

confidence: 99%

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Study of out‐of‐field dose in photon radiotherapy: A commercial treatment planning system versus measurements and Monte Carlo simulations

et al. 2020

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Purpose: An accurate assessment of out-of-field dose is necessary to estimate the risk of second cancer after radiotherapy and the damage to the organs at risk surrounding the planning target volume. Although treatment planning systems (TPSs) calculate dose distributions outside the treatment field, little is known about the accuracy of these calculations. The aim of this work is to thoroughly compare the out-of-field dose distributions given by two algorithms implemented in the Monaco TPS, with measurements and full Monte Carlo simulations. Methods: Out-of-field dose distributions predicted by the collapsed cone convolution (CCC) and Monte Carlo (MC Monaco) algorithms, built into the commercially available Monaco version 5.11 TPS, are compared with measurements carried out on an Elekta Axesse linear accelerator. For the measurements, ion chambers, thermoluminescent dosimeters, and EBT3 film are used. The BEAMnrc code, built on the EGSnrc system, is used to create a model of the Elekta Axesse with the Agility collimation system, and the space phase file generated is scored by DOSXYZnrc to generate the dose distributions (MC EGSnrc). Three different irradiation scenarios are considered: (a) a 10 × 10 cm 2 field, (b) an IMRT prostate plan, and (c) a three-field lung plan. Monaco's calculations, experimental measurements, and Monte Carlo simulations are carried out in water and/or in an ICRP110 phantom. Results: For the 10 × 10 cm 2 field case, CCC underestimated the dose, compared to ion chamber measurements, by 13% (differences relative to the algorithm) on average between the 5% and the ≈2% isodoses. MC Monaco underestimated the dose only from approximately the 2% isodose for this case. Qualitatively similar results were observed for the studied IMRT case when compared to film dosimetry. For the three-field lung plan, dose underestimations of up to ≈90% for MC Monaco and ≈60% for CCC, relative to MC EGSnrc simulations, were observed in mean dose to organs located beyond the 2% isodose. Conclusions: This work shows that Monaco underestimates out-of-field doses in almost all the cases considered. Thus, it does not describe dose distribution beyond the border of the field accurately. This is in agreement with previously published works reporting similar results for other TPSs. Analytical models for out-of-field dose assessment, MC simulations or experimental measurements may be an adequate alternative for this purpose.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Study of out‐of‐field dose in photon radiotherapy: A commercial treatment planning system versus measurements and Monte Carlo simulations

et al. 2020

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“…In radiotherapy, estimation of radiation induced cancer risks can be divided into two dose regions named medium dose (region positioned between 5-50% isodose lines) and low dose regions (regions lower than the 5% of the prescription dose) (39). Radiobiological factors at cellular level including DNA mutations, cell survival, cell repair and repopulation which occur during fractionated exposures must be considered in a comprehensive model which incorporates the induction of cancers in medium dose regions.…”

Section: Discussionmentioning

confidence: 99%

Estimating Cancer Risks Due to Whole Lungs Low Dose Radiotherapy With Different Techniques for Treating COVID-19 Pneumonia

Banaei

Hashemi

Bakhshandeh

2021

Preprint

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Background: Low dose radiotherapy (LDRT) of whole lungs with photon beams is a novel under evaluation method for treating COVID-19 pneumonia. The purpose of this study was to estimate the cancer risks induced by lung LDRT as the only radiation side effects at low doses for different radiotherapy delivery techniques.Method: Four different radiotherapy techniques including 3D-conformal with anterior and posterior fields (3D-CRT AP-PA), 3D-conformal with 8 coplanar fields (3D-CRT 8 fields), 8 fields intensity modulated radiotherapy (IMRT), and volumetric modulated arc therapy using 2 full arcs (VMAT) were planned on the CT images of 32 COVID-19 patients. Organ average and maximum doses, and PTV dose distribution indexes were calculated and compared between different techniques. The radiation induced cancer and mortality risks were estimated and compared for the assessed techniques.Results: In IMRT and VMAT techniques, heart (mean, and max), breast (mean, and max), and stomach (mean) doses and also maximum dose in the body were significantly lower compared to 3D-CRT techniques. The calculated conformity indexes were similar in all the techniques. However, the homogeneity indexes were lower (i.e. better) in intensity modulated techniques (P<0.03) with no significant differences between IMRT and VMAT plans. Lifetime lung cancer incident risks for all the delivery techniques were statistically similar (P>0.4). Cancer risks for organs located closer to lung like breast, and stomach were significantly higher in 3D-CRT techniques compared to IMRT or VMAT techniques (for a 30 years old man: 2.041±0.237% Vs 1.560±0.210%; and woman: 6.624±0.548% Vs 4.963±0.462%) (P<0.03). However, 8 fields 3D-conformal had significantly lower breast cancer risk compared to the 3D-CRT AP-PA technique (P<0.01).Conclusion: Although all the radiotherapy techniques had low cancer risks, the overall risks induced by IMRT and VMAT radiotherapy techniques were lower than the 3D-CRT techniques and can be used clinically in younger patients or patients having higher concerns about future cancers. Higher cancer risks except the lungs are related to breast, and stomach which must be considered for lung LDRT.

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“…In particular, the Schneider's model [22][23][24][25] was chosen. A detailed description of the use of this model can be found in Sánchez-Nieto et al 2017 [26]. The parameters of the model were taken from Schneider et al 2011 [24].…”

Section: Cancer Risk Calculationsmentioning

confidence: 99%

Low dose radiation therapy for COVID-19: Effective dose and estimation of cancer risk

Garcia-Hernandez

Romero-Expósito

Sánchez‐Nieto

2020

Radiotherapy and Oncology

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Background and purpose The objective of this work is to evaluate the risk of carcinogenesis of low dose ionizing radiation therapy (LDRT), for treatment of immune-related pneumonia following COVID-19 infection, through the estimation of effective dose and the lifetime attributable risk of cancer (LAR). Material and methods LDRT treatment was planned in male and female computational phantoms. Equivalent doses in organs were estimated using both treatment planning system calculations and a peripheral dose model (based on ionization chamber measurements). Skin dose was estimated using radiochromic films. Later, effective dose and LAR were calculated following radiation protection procedures. Results Equivalent doses to organs per unit of prescription dose range from 10 mSv/cGy to 0.0051 mSv/cGy. Effective doses range from 204 mSv to 426 mSv, for prescription doses ranging from 50cGy to 100cGy. Total LAR for a prescription dose of 50 cGy ranges from 1.7 to 0.29 % for male and from 4.9 to 0.54 % for female, for ages ranging from 20 to 80 years old. Conclusions The organs that mainly contribute to risk are lung and breast. Risk for out-of-field organs is low, less than 0.06 cases per 10000. Female LAR is on average 2.2 times that of a male of the same age. Effective doses are of the same order of magnitude than higher dose interventional radiology techniques. For a 60 year-old male, LAR is 8 times that from a cardiac CT, when prescription dose is 50 cGy.

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Uncomplicated and Cancer-Free Control Probability (UCFCP): A new integral approach to treatment plan optimization in photon radiation therapy

Cited by 14 publications

References 36 publications

Study of out‐of‐field dose in photon radiotherapy: A commercial treatment planning system versus measurements and Monte Carlo simulations

Study of out‐of‐field dose in photon radiotherapy: A commercial treatment planning system versus measurements and Monte Carlo simulations

Estimating Cancer Risks Due to Whole Lungs Low Dose Radiotherapy With Different Techniques for Treating COVID-19 Pneumonia

Low dose radiation therapy for COVID-19: Effective dose and estimation of cancer risk

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