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The Impact of IMRT and Proton Radiotherapy on Secondary Cancer Incidence = Entstehung von Zweittumoren nach Radiotherapie: der Einfluss von IMRT und Protonentherapie

Schneider, Uwe ; Lomax, Antony ; Pemler, Peter ; Besserer, Jürgen ; Ross, Dieter ; Lombriser, Norbert ; Kaser-Hotz, Barbara

In: Strahlentherapie und Onkologie, 2006, vol. 182, no. 11, p. 647-652

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    Titel
    • The Impact of IMRT and Proton Radiotherapy on Secondary Cancer Incidence
    Titel Übersetzung ()
    • Entstehung von Zweittumoren nach Radiotherapie: der Einfluss von IMRT und Protonentherapie
    Autor
    • Schneider, Uwe. Division of Medical Physics, Department of Radiation Oncology and Nuclear Medicine, Triemli Hospital, Zürich, Switzerland
    • Lomax, Antony. Department of Radiation Medicine, Paul Scherrer Institute, Villigen, Switzerland
    • Pemler, Peter. Division of Medical Physics, Department of Radiation Oncology and Nuclear Medicine, Triemli Hospital, Zürich, Switzerland
    • Besserer, Jürgen. Division of Medical Physics, Department of Radiation Oncology and Nuclear Medicine, Triemli Hospital, Zürich, Switzerland
    • Ross, Dieter. Division of Medical Physics, Department of Radiation Oncology and Nuclear Medicine, Triemli Hospital, Zürich, Switzerland
    • Lombriser, Norbert. Division of Medical Physics, Department of Radiation Oncology and Nuclear Medicine, Triemli Hospital, Zürich, Switzerland
    • Kaser-Hotz, Barbara. Division of Diagnostic Imaging and Radio-Oncology, Vetsuisse Faculty, University of Zürich, Zürich, Switzerland
    Dokumententyp
    • Postprint
    Sprache
    • Englisch
    Veröffentlicht in
    • Strahlentherapie und Onkologie, 2006, vol. 182, no. 11, p. 647-652. Urban & Vogel
    Andere elektronische Ausgabe
    OAI-PMH-ID
    • oai:doc.rero.ch:317256
    Summary
    Background and Purpose:: There is concern about the increase of radiation-induced malignancies with the application of modern radiation treatment techniques such as intensity-modulated radiotherapy (IMRT) and proton radiotherapy. Therefore, X-ray scatter and neutron radiation as well as the impact of the primary dose distribution on secondary cancer incidence are analyzed. Material and Methods:: The organ equivalent dose (OED) concept with a linear-exponential and a plateau dose-response curve was applied to dose distributions of 30 patients who received radiation therapy of prostate cancer. Three-dimensional conformal radiotherapy was used in eleven patients, another eleven patients received IMRT with 6-MV photons, and eight patients were treated with spot-scanned protons. The treatment plans were recalculated with 15-MV and 18-MV photons. Secondary cancer risk was estimated based on the OED for the different treatment techniques. Results:: A modest increase of 15% radiation-induced cancer results from IMRT using low energies (6 MV), compared to conventional four-field planning with 15-MV photons (plateau dose-response: 1%). The probability to develop a secondary cancer increases with IMRT of higher energies by 20% and 60% for 15 MV and 18 MV, respectively (plateau dose-response: 2% and 30%). The use of spot-scanned protons can reduce secondary cancer incidence as much as 50% (independent of dose-response). Conclusion:: By including the primary dose distribution into the analysis of radiation-induced cancer incidence, the resulting increase in risk for secondary cancer using modern treatment techniques such as IMRT is not as dramatic as expected from earlier studies. By using 6-MV photons, only a moderate risk increase is expected. Spot-scanned protons are the treatment of choice in regard to secondary cancer incidence