Does electron and proton therapy reduce the risk of radiation induced cancer after spinal irradiation for childhood medulloblastoma? A comparative treatment planning study.

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Does electron and proton therapy reduce the risk of radiation induced cancer after spinal irradiation for childhood medulloblastoma? A comparative treatment planning study.

Mu, Xiangkui (author): Umeå universitet,Onkologi

Björk-Eriksson, Thomas, 1960 (author): Gothenburg University,Göteborgs universitet,Institutionen för särskilda specialiteter, Avdelningen för onkologi,Institute of Selected Clinical Sciences, Department of Oncology

Nill, Simeon (author)

Oelfke, Uwe (author)

Johansson, Karl-Axel (author): Gothenburg University,Göteborgs universitet,Institutionen för särskilda specialiteter, Avdelningen för radiofysik,Institute of Selected Clinical Sciences, Department of Radiation Physics

Gagliardi, Giovanna (author): Karolinska Institutet

Johansson, Lennart (author): Umeå universitet,Radiofysik

Karlsson, Mikael (author): Umeå universitet,Radiofysik

Zackrisson, Björn (author): Umeå universitet,Onkologi

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(creator_code:org_t)

2009-07-08
2005
English.
In: Acta oncologica (Stockholm, Sweden). - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 44:6, s. 554-62

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Journal article (peer-reviewed)

Abstract Subject headings

The aim of this treatment planning comparison study was to explore different spinal irradiation techniques with respect to the risk of late side-effects, particularly radiation-induced cancer. The radiotherapy techniques compared were conventional photon therapy, intensity modulated x-ray therapy (IMXT), conventional electron therapy, intensity/energy modulated electron therapy (IMET) and proton therapy (IMPT).CT images for radiotherapy use from five children, median age 8 and diagnosed with medulloblastoma, were selected for this study. Target volumes and organs at risk were defined in 3-D. Treatment plans using conventional photon therapy, IMXT, conventional electron therapy, IMET and IMPT were set up. The probability of normal tissue complication (NTCP) and the risk of cancer induction were calculated using models with parameters-sets taken from published data for the general population; dose data were taken from dose volume histograms (DVH).Similar dose distributions in the targets were achieved with all techniques but the absorbed doses in the organs-at-risk varied significantly between the different techniques. The NTCP models based on available data predicted very low probabilities for side-effects in all cases. However, the effective mean doses outside the target volumes, and thus the predicted risk of cancer induction, varied significantly between the techniques. The highest lifetime risk of secondary cancers was estimated for IMXT (30%). The lowest risk was found with IMPT (4%). The risks associated with conventional photon therapy, electron therapy and IMET were 20%, 21% and 15%, respectively.This model study shows that spinal irradiation of young children with photon and electron techniques results in a substantial risk of radiation-induced secondary cancers. Multiple beam IMXT seems to be associated with a particularly high risk of secondary cancer induction. To minimise this risk, IMPT should be the treatment of choice. If proton therapy is not available, advanced electron therapy may provide a better alternative.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Cancer och onkologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cancer and Oncology (hsv//eng)

Keyword

Child
Dose-Response Relationship
Radiation
Electrons
adverse effects
therapeutic use
Female
Humans
Male
Medulloblastoma
radiotherapy
Neoplasms
Radiation-Induced
etiology
prevention & control
Protons
adverse effects
therapeutic use
Radiotherapy
adverse effects
methods
Radiotherapy Dosage
Risk Assessment
Spinal Neoplasms
radiotherapy
Viscera
radiation effects
X-Ray Therapy
adverse effects

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ref (subject category)
art (subject category)

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By the author/editor: Mu, Xiangkui; Björk-Eriksson, ...; Nill, Simeon; Oelfke, Uwe; Johansson, Karl- ...; Gagliardi, Giova ...; show more...; Johansson, Lenna ...; Karlsson, Mikael; Zackrisson, Björ ...; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Cancer and Oncol ...

Articles in the publication: Acta oncologica ...

By the university: University of Gothenburg; Umeå University; Karolinska Institutet

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