A critical evaluation of secondary cancer risk models applied to Monte Carlo dose distributions of 2-dimensional, 3-dimensional conformal and hybrid intensity-modulated radiation therapy for breast cancer
The comparison of radiotherapy techniques regarding secondary cancer risk has yielded contradictory results possibly stemming from the many different approaches used to estimate risk. The purpose of this study was to make a comprehensive evaluation of different available risk models applied to detai...
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Published in: | Physics in medicine & biology 2014-08, Vol.59 (16), p.4697-4722 |
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description | The comparison of radiotherapy techniques regarding secondary cancer risk has yielded contradictory results possibly stemming from the many different approaches used to estimate risk. The purpose of this study was to make a comprehensive evaluation of different available risk models applied to detailed whole-body dose distributions computed by Monte Carlo for various breast radiotherapy techniques including conventional open tangents, 3D conformal wedged tangents and hybrid intensity modulated radiation therapy (IMRT). First, organ-specific linear risk models developed by the International Commission on Radiological Protection (ICRP) and the Biological Effects of Ionizing Radiation (BEIR) VII committee were applied to mean doses for remote organs only and all solid organs. Then, different general non-linear risk models were applied to the whole body dose distribution. Finally, organ-specific non-linear risk models for the lung and breast were used to assess the secondary cancer risk for these two specific organs. A total of 32 different calculated absolute risks resulted in a broad range of values (between 0.1% and 48.5%) underlying the large uncertainties in absolute risk calculation. The ratio of risk between two techniques has often been proposed as a more robust assessment of risk than the absolute risk. We found that the ratio of risk between two techniques could also vary substantially considering the different approaches to risk estimation. Sometimes the ratio of risk between two techniques would range between values smaller and larger than one, which then translates into inconsistent results on the potential higher risk of one technique compared to another. We found however that the hybrid IMRT technique resulted in a systematic reduction of risk compared to the other techniques investigated even though the magnitude of this reduction varied substantially with the different approaches investigated. Based on the epidemiological data available, a reasonable approach to risk estimation would be to use organ-specific non-linear risk models applied to the dose distributions of organs within or near the treatment fields (lungs and contralateral breast in the case of breast radiotherapy) as the majority of radiation-induced secondary cancers are found in the beam-bordering regions. |
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The purpose of this study was to make a comprehensive evaluation of different available risk models applied to detailed whole-body dose distributions computed by Monte Carlo for various breast radiotherapy techniques including conventional open tangents, 3D conformal wedged tangents and hybrid intensity modulated radiation therapy (IMRT). First, organ-specific linear risk models developed by the International Commission on Radiological Protection (ICRP) and the Biological Effects of Ionizing Radiation (BEIR) VII committee were applied to mean doses for remote organs only and all solid organs. Then, different general non-linear risk models were applied to the whole body dose distribution. Finally, organ-specific non-linear risk models for the lung and breast were used to assess the secondary cancer risk for these two specific organs. A total of 32 different calculated absolute risks resulted in a broad range of values (between 0.1% and 48.5%) underlying the large uncertainties in absolute risk calculation. The ratio of risk between two techniques has often been proposed as a more robust assessment of risk than the absolute risk. We found that the ratio of risk between two techniques could also vary substantially considering the different approaches to risk estimation. Sometimes the ratio of risk between two techniques would range between values smaller and larger than one, which then translates into inconsistent results on the potential higher risk of one technique compared to another. We found however that the hybrid IMRT technique resulted in a systematic reduction of risk compared to the other techniques investigated even though the magnitude of this reduction varied substantially with the different approaches investigated. Based on the epidemiological data available, a reasonable approach to risk estimation would be to use organ-specific non-linear risk models applied to the dose distributions of organs within or near the treatment fields (lungs and contralateral breast in the case of breast radiotherapy) as the majority of radiation-induced secondary cancers are found in the beam-bordering regions.</description><identifier>ISSN: 0031-9155</identifier><identifier>EISSN: 1361-6560</identifier><identifier>DOI: 10.1088/0031-9155/59/16/4697</identifier><identifier>PMID: 25082795</identifier><identifier>CODEN: PHMBA7</identifier><language>eng</language><publisher>England: IOP Publishing</publisher><subject>Breast Neoplasms - diagnostic imaging ; Breast Neoplasms - radiotherapy ; Humans ; Linear Models ; Models, Statistical ; monte carlo ; Monte Carlo Method ; Neoplasms, Radiation-Induced - etiology ; Neoplasms, Second Primary - etiology ; Nonlinear Dynamics ; Phantoms, Imaging ; Radiation Dosage ; Radiation Protection ; Radiotherapy Dosage ; Radiotherapy, Intensity-Modulated - adverse effects ; Risk Assessment ; risk models ; secondary cancer ; Tomography, X-Ray Computed ; Whole Body Imaging</subject><ispartof>Physics in medicine & biology, 2014-08, Vol.59 (16), p.4697-4722</ispartof><rights>2014 Institute of Physics and Engineering in Medicine</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c447t-88d6648e5920484cc0eac0ac7be440bb6e3e1f59f904acf2b4225cf9fc9e8b883</citedby><cites>FETCH-LOGICAL-c447t-88d6648e5920484cc0eac0ac7be440bb6e3e1f59f904acf2b4225cf9fc9e8b883</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25082795$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Joosten, A</creatorcontrib><creatorcontrib>Bochud, F</creatorcontrib><creatorcontrib>Moeckli, R</creatorcontrib><title>A critical evaluation of secondary cancer risk models applied to Monte Carlo dose distributions of 2-dimensional, 3-dimensional conformal and hybrid intensity-modulated radiation therapy for breast cancer</title><title>Physics in medicine & biology</title><addtitle>PMB</addtitle><addtitle>Phys. Med. Biol</addtitle><description>The comparison of radiotherapy techniques regarding secondary cancer risk has yielded contradictory results possibly stemming from the many different approaches used to estimate risk. The purpose of this study was to make a comprehensive evaluation of different available risk models applied to detailed whole-body dose distributions computed by Monte Carlo for various breast radiotherapy techniques including conventional open tangents, 3D conformal wedged tangents and hybrid intensity modulated radiation therapy (IMRT). First, organ-specific linear risk models developed by the International Commission on Radiological Protection (ICRP) and the Biological Effects of Ionizing Radiation (BEIR) VII committee were applied to mean doses for remote organs only and all solid organs. Then, different general non-linear risk models were applied to the whole body dose distribution. Finally, organ-specific non-linear risk models for the lung and breast were used to assess the secondary cancer risk for these two specific organs. A total of 32 different calculated absolute risks resulted in a broad range of values (between 0.1% and 48.5%) underlying the large uncertainties in absolute risk calculation. The ratio of risk between two techniques has often been proposed as a more robust assessment of risk than the absolute risk. We found that the ratio of risk between two techniques could also vary substantially considering the different approaches to risk estimation. Sometimes the ratio of risk between two techniques would range between values smaller and larger than one, which then translates into inconsistent results on the potential higher risk of one technique compared to another. We found however that the hybrid IMRT technique resulted in a systematic reduction of risk compared to the other techniques investigated even though the magnitude of this reduction varied substantially with the different approaches investigated. Based on the epidemiological data available, a reasonable approach to risk estimation would be to use organ-specific non-linear risk models applied to the dose distributions of organs within or near the treatment fields (lungs and contralateral breast in the case of breast radiotherapy) as the majority of radiation-induced secondary cancers are found in the beam-bordering regions.</description><subject>Breast Neoplasms - diagnostic imaging</subject><subject>Breast Neoplasms - radiotherapy</subject><subject>Humans</subject><subject>Linear Models</subject><subject>Models, Statistical</subject><subject>monte carlo</subject><subject>Monte Carlo Method</subject><subject>Neoplasms, Radiation-Induced - etiology</subject><subject>Neoplasms, Second Primary - etiology</subject><subject>Nonlinear Dynamics</subject><subject>Phantoms, Imaging</subject><subject>Radiation Dosage</subject><subject>Radiation Protection</subject><subject>Radiotherapy Dosage</subject><subject>Radiotherapy, Intensity-Modulated - adverse effects</subject><subject>Risk Assessment</subject><subject>risk models</subject><subject>secondary cancer</subject><subject>Tomography, X-Ray Computed</subject><subject>Whole Body Imaging</subject><issn>0031-9155</issn><issn>1361-6560</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><recordid>eNqFkc1u1DAUhS1ERYeWN0DISxaEsRPbsZfViD-piE27thz7RnVx4mA7SPOOPBSOZqhYwcq-0nfOuboHodeUvKdEyj0hHW0U5XzP1Z6KPROqf4Z2tBO0EVyQ52j3hFyilzk_EkKpbNkLdNlyItte8R36dYNt8sVbEzD8NGE1xccZxxFnsHF2Jh2xNbOFhJPP3_EUHYSMzbIEDw6XiL_GuQA-mBQidjEDdj6X5Id1M8qbU9s4P8Gc62zCO9z9PeIaMsY01Z-ZHX44Dsk77KtlBcqxqXlrMKVGJeP8abnyAMksR1x1eEhgcjmveI0uRhMyvDq_V-j-44e7w-fm9tunL4eb28Yy1pdGSicEk8BVS5hk1hIwlhjbD8AYGQYBHdCRq1ERZuzYDqxtuR3VaBXIQcruCr09-S4p_lghFz35bCEEM0Ncs65X7qUigvb_RzmnXa2sayvKTqhNMecEo16Sn2oBmhK9Va63PvXWp-ZKU6G3yqvszTlhHSZwT6I_HVeAnAAfF_0Y11TPnv_t-RtGMLqJ</recordid><startdate>20140821</startdate><enddate>20140821</enddate><creator>Joosten, A</creator><creator>Bochud, F</creator><creator>Moeckli, R</creator><general>IOP Publishing</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>P64</scope></search><sort><creationdate>20140821</creationdate><title>A critical evaluation of secondary cancer risk models applied to Monte Carlo dose distributions of 2-dimensional, 3-dimensional conformal and hybrid intensity-modulated radiation therapy for breast cancer</title><author>Joosten, A ; Bochud, F ; Moeckli, R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c447t-88d6648e5920484cc0eac0ac7be440bb6e3e1f59f904acf2b4225cf9fc9e8b883</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Breast Neoplasms - diagnostic imaging</topic><topic>Breast Neoplasms - radiotherapy</topic><topic>Humans</topic><topic>Linear Models</topic><topic>Models, Statistical</topic><topic>monte carlo</topic><topic>Monte Carlo Method</topic><topic>Neoplasms, Radiation-Induced - etiology</topic><topic>Neoplasms, Second Primary - etiology</topic><topic>Nonlinear Dynamics</topic><topic>Phantoms, Imaging</topic><topic>Radiation Dosage</topic><topic>Radiation Protection</topic><topic>Radiotherapy Dosage</topic><topic>Radiotherapy, Intensity-Modulated - adverse effects</topic><topic>Risk Assessment</topic><topic>risk models</topic><topic>secondary cancer</topic><topic>Tomography, X-Ray Computed</topic><topic>Whole Body Imaging</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Joosten, A</creatorcontrib><creatorcontrib>Bochud, F</creatorcontrib><creatorcontrib>Moeckli, R</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><jtitle>Physics in medicine & biology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Joosten, A</au><au>Bochud, F</au><au>Moeckli, R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A critical evaluation of secondary cancer risk models applied to Monte Carlo dose distributions of 2-dimensional, 3-dimensional conformal and hybrid intensity-modulated radiation therapy for breast cancer</atitle><jtitle>Physics in medicine & biology</jtitle><stitle>PMB</stitle><addtitle>Phys. Med. Biol</addtitle><date>2014-08-21</date><risdate>2014</risdate><volume>59</volume><issue>16</issue><spage>4697</spage><epage>4722</epage><pages>4697-4722</pages><issn>0031-9155</issn><eissn>1361-6560</eissn><coden>PHMBA7</coden><abstract>The comparison of radiotherapy techniques regarding secondary cancer risk has yielded contradictory results possibly stemming from the many different approaches used to estimate risk. The purpose of this study was to make a comprehensive evaluation of different available risk models applied to detailed whole-body dose distributions computed by Monte Carlo for various breast radiotherapy techniques including conventional open tangents, 3D conformal wedged tangents and hybrid intensity modulated radiation therapy (IMRT). First, organ-specific linear risk models developed by the International Commission on Radiological Protection (ICRP) and the Biological Effects of Ionizing Radiation (BEIR) VII committee were applied to mean doses for remote organs only and all solid organs. Then, different general non-linear risk models were applied to the whole body dose distribution. Finally, organ-specific non-linear risk models for the lung and breast were used to assess the secondary cancer risk for these two specific organs. A total of 32 different calculated absolute risks resulted in a broad range of values (between 0.1% and 48.5%) underlying the large uncertainties in absolute risk calculation. The ratio of risk between two techniques has often been proposed as a more robust assessment of risk than the absolute risk. We found that the ratio of risk between two techniques could also vary substantially considering the different approaches to risk estimation. Sometimes the ratio of risk between two techniques would range between values smaller and larger than one, which then translates into inconsistent results on the potential higher risk of one technique compared to another. We found however that the hybrid IMRT technique resulted in a systematic reduction of risk compared to the other techniques investigated even though the magnitude of this reduction varied substantially with the different approaches investigated. Based on the epidemiological data available, a reasonable approach to risk estimation would be to use organ-specific non-linear risk models applied to the dose distributions of organs within or near the treatment fields (lungs and contralateral breast in the case of breast radiotherapy) as the majority of radiation-induced secondary cancers are found in the beam-bordering regions.</abstract><cop>England</cop><pub>IOP Publishing</pub><pmid>25082795</pmid><doi>10.1088/0031-9155/59/16/4697</doi><tpages>26</tpages></addata></record> |
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subjects | Breast Neoplasms - diagnostic imaging Breast Neoplasms - radiotherapy Humans Linear Models Models, Statistical monte carlo Monte Carlo Method Neoplasms, Radiation-Induced - etiology Neoplasms, Second Primary - etiology Nonlinear Dynamics Phantoms, Imaging Radiation Dosage Radiation Protection Radiotherapy Dosage Radiotherapy, Intensity-Modulated - adverse effects Risk Assessment risk models secondary cancer Tomography, X-Ray Computed Whole Body Imaging |
title | A critical evaluation of secondary cancer risk models applied to Monte Carlo dose distributions of 2-dimensional, 3-dimensional conformal and hybrid intensity-modulated radiation therapy for breast cancer |
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