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Radiation Oncology
Published in: Radiation Oncology 1/2014

Open Access 01-12-2014 | Research

Risk of secondary cancers from scattered radiation during intensity-modulated radiotherapies for hepatocellular carcinoma

Authors: Dong Wook Kim, Kwangzoo Chung, Weon Kuu Chung, Sun Hyun Bae, Dong Oh Shin, Seongeon Hong, Sung Ho Park, Sung-Yong Park, Chae-Seon Hong, Young Kyung Lim, Dongho Shin, Se Byeong Lee, Hyun-ho Lee, Jiwon Sung, Myonggeun Yoon

Published in: Radiation Oncology | Issue 1/2014

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Abstract

Purpose

To evaluate and compare the risks of secondary cancers from therapeutic doses received by patients with hepatocellular carcinoma (HCC) during intensity-modulated radiotherapy (IMRT), volumetric arc therapy (VMAT), and tomotherapy (TOMO).

Methods

Treatments for five patients with hepatocellular carcinoma (HCC) were planned using IMRT, VMAT, and TOMO. Based on the Biological Effects of Ionizing Radiation VII method, the excess relative risk (ERR), excess absolute risk (EAR), and lifetime attributable risk (LAR) were evaluated from therapeutic doses, which were measured using radiophotoluminescence glass dosimeters (RPLGDs) for each organ inside a humanoid phantom.

Results

The average organ equivalent doses (OEDs) of 5 patients were measured as 0.23, 1.18, 0.91, 0.95, 0.97, 0.24, and 0.20 Gy for the thyroid, lung, stomach, liver, small intestine, prostate (or ovary), and rectum, respectively. From the OED measurements, LAR incidence were calculated as 83, 46, 22, 30, 2 and 6 per 104 person for the lung, stomach, normal liver, small intestine, prostate (or ovary), and rectum.

Conclusions

We estimated the secondary cancer risks at various organs for patients with HCC who received different treatment modalities. We found that HCC treatment is associated with a high secondary cancer risk in the lung and stomach.
Appendix
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Literature
1.
Okuda K, Ohtsuki T, Obata H, Tomimatsu M, Okazaki N, Hasegawa H, Nakajima Y, Ohnishi K: Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients. Cancer 1985,56(4):918-928. 10.1002/1097-0142(19850815)56:4<918::AID-CNCR2820560437>3.0.CO;2-ECrossRefPubMed
2.
Song TJ, Ip EW, Fong Y: Hepatocellular carcinoma: current surgical management. Gastroenterology 2004,127(5 Suppl 1):S248-S260.CrossRefPubMed
3.
Lau WY, Lai EC: Hepatocellular carcinoma: current management and recent advances. Hepatobiliary Pancreat Dis Int: HBPD INT 2008,7(3):237-257.PubMed
4.
Lencioni RA, Allgaier HP, Cioni D, Olschewski M, Deibert P, Crocetti L, Frings H, Laubenberger J, Zuber I, Blum HE, Bartolozzi C: Small hepatocellular carcinoma in cirrhosis: randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection. Radiology 2003,228(1):235-240. 10.1148/radiol.2281020718CrossRefPubMed
5.
Lin SM, Lin CJ, Lin CC, Hsu CW, Chen YC: Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma < or =4 cm. Gastroenterology 2004,127(6):1714-1723. 10.1053/j.gastro.2004.09.003CrossRefPubMed
6.
Cheng JC, Chuang VP, Cheng SH, Huang AT, Lin YM, Cheng TI, Yang PS, You DL, Jian JJ, Tsai SY, Sung JL, Horng CF: Local radiotherapy with or without transcatheter arterial chemoembolization for patients with unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 2000,47(2):435-442. 10.1016/S0360-3016(00)00462-4CrossRefPubMed
7.
Hawkins MA, Dawson LA: Radiation therapy for hepatocellular carcinoma: from palliation to cure. Cancer 2006,106(8):1653-1663. 10.1002/cncr.21811CrossRefPubMed
8.
Llovet JM, Bruix J: Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival. Hepatology 2003,37(2):429-442. 10.1053/jhep.2003.50047CrossRefPubMed
9.
Emami B, Lyman J, Brown A, Coia L, Goitein M, Munzenrider JE, Shank B, Solin LJ, Wesson M: Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 1991,21(1):109-122. 10.1016/0360-3016(91)90171-YCrossRefPubMed
10.
Hoskin PJ: Advances in IMRT: a clinical perspective. Lancet Oncol 2000, 1: 74. 10.1016/S1470-2045(00)00074-7CrossRefPubMed
11.
Low DA, Mutic S: A commercial IMRT treatment-planning dose-calculation algorithm. Int J Radiat Oncol Biol Phys 1998,41(4):933-937. 10.1016/S0360-3016(98)00129-1CrossRefPubMed
12.
Teh BS, Woo SY, Butler EB: Intensity modulated radiation therapy (IMRT): a new promising technology in radiation oncology. Oncologist 1999,4(6):433-442.PubMed
13.
Vaarkamp J, Krasin M: Reduction of target dose inhomogeneity in IMRT treatment planning using biologic objective functions. Int J Radiat Oncol Biol Phys 2001,49(5):1518-1520. 10.1016/S0360-3016(00)01538-8CrossRefPubMed
14.
Ahamad A, Stevens CW, Smythe WR, Liao Z, Vaporciyan AA, Rice D, Walsh G, Guerrero T, Chang J, Bell B, Komaki R, Forster K: Promising early local control of malignant pleural mesothelioma following postoperative intensity modulated radiotherapy (IMRT) to the chest. Cancer J 2003,9(6):476-484. 10.1097/00130404-200311000-00008CrossRefPubMed
15.
Wieland P, Dobler B, Mai S, Hermann B, Tiefenbacher U, Steil V, Wenz F, Lohr F: IMRT for postoperative treatment of gastric cancer: covering large target volumes in the upper abdomen: a comparison of a step-and-shoot and an arc therapy approach. Int J Radiat Oncol Biol Phys 2004,59(4):1236-1244. 10.1016/j.ijrobp.2004.02.051CrossRefPubMed
16.
Malhotra HK, Raina S, Avadhani JS, de Boer S, Podgorsak MB: Technical and dosimetric considerations in IMRT treatment planning for large target volumes. J Appl Clin Med Phys/American College of Medical Physics 2005,6(4):77-87. 10.1120/jacmp.2026.25360CrossRef
17.
Council NR: Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation, Health Risks from Exposure to Low Levels of Ionizing Radiation (BEIR VII Phase 2). Washington, DC: National Academies Press; 2006.
18.
Petersen JB, Lassen Y, Hansen AT, Muren LP, Grau C, Hoyer M: Normal liver tissue sparing by intensity-modulated proton stereotactic body radiotherapy for solitary liver tumours. Acta Oncol 2011,50(6):823-828. 10.3109/0284186X.2011.590526CrossRefPubMed
19.
Brahme A, Roos JE, Lax I: Solution of an integral equation encountered in rotation therapy. Phys Med Biol 1982,27(10):1221-1229. 10.1088/0031-9155/27/10/002CrossRefPubMed
20.
Otto K: Volumetric modulated arc therapy: IMRT in a single gantry arc. Med Phys 2008,35(1):310-317. 10.1118/1.2818738CrossRefPubMed
21.
Yu CX: Intensity-modulated arc therapy with dynamic multileaf collimation: an alternative to tomotherapy. Phys Med Biol 1995,40(9):1435-1449. 10.1088/0031-9155/40/9/004CrossRefPubMed
22.
Welsh JS, Patel RR, Ritter MA, Harari PM, Mackie TR, Mehta MP: Helical tomotherapy: an innovative technology and approach to radiation therapy. Technol Cancer Res T 2002,1(4):311-316.CrossRef
23.
Mackie TR: History of tomotherapy. Phys Med Biol 2006,51(13):R427-R453. 10.1088/0031-9155/51/13/R24CrossRefPubMed
24.
Cao D, Holmes TW, Afghan MK, Shepard DM: Comparison of plan quality provided by intensity-modulated arc therapy and helical tomotherapy. Int J Radiat Oncol Biol Phys 2007,69(1):240-250. 10.1016/j.ijrobp.2007.04.073CrossRefPubMed
25.
Galinski M, Racine SX, Bossard AE, Fleyfel M, Hamza L, Bouchemal N, Adnet F, Le Moyec L: Detection and follow-up, after partial liver resection, of the urinary paracetamol metabolites by proton NMR spectroscopy. Pharmacology 2014,93(1–2):18-23.CrossRefPubMed
26.
Jeong H, Lee SB, Yoo SH, Lim YK, Kim TH, Park S, Chai GY, Kang KM, Shin D: Compensation method for respiratory motion in proton treatment planning for mobile liver cancer. J Appl Clin Med Phys /American College of Medical Physics 2013,14(2):4055.
27.
Matsuzaki Y, Tanaka N, Chiba T: [Efficacy of proton irradiation for HCC]. Nihon Rinsho Jpn J Clin Med 2001,59(Suppl 6):659-664.
28.
Hall EJ, Wuu CS: Radiation-induced second cancers: the impact of 3D-CRT and IMRT. Int J Radiat Oncol Biol Phys 2003,56(1):83-88. 10.1016/S0360-3016(03)00073-7CrossRefPubMed
29.
Yoon M, Ahn SH, Kim J, Shin DH, Park SY, Lee SB, Shin KH, Cho KH: Radiation-induced cancers from modern radiotherapy techniques: intensity-modulated radiotherapy versus proton therapy. Int J Radiat Oncol Biol Phys 2010,77(5):1477-1485. 10.1016/j.ijrobp.2009.07.011CrossRefPubMed
30.
Kim DW, Chung WK, Shin D, Hong S, Park SH, Park SY, Chung K, Lim YK, Shin D, Lee SB, Lee HH, Yoon M: Risk of second cancer from scattered radiation of intensity-modulated radiotherapies with lung cancer. Radiat Oncol 2013, 8: 47. 10.1186/1748-717X-8-47PubMedCentralCrossRefPubMed
31.
Kim S, Min BJ, Yoon M, Kim J, Shin DH, Lee SB, Park SY, Cho S, Kim DH: Secondary radiation doses of intensity-modulated radiotherapy and proton beam therapy in patients with lung and liver cancer. Radiat Oncol: Journal of the European Society for Therapeutic Radiology and Oncology 2011,98(3):335-339. 10.1016/j.radonc.2011.01.018CrossRef
32.
Howell RM, Hertel NE, Wang Z, Hutchinson J, Fullerton GD: Calculation of effective dose from measurements of secondary neutron spectra and scattered photon dose from dynamic MLC IMRT for 6 MV, 15 MV, and 18 MV beam energies. Med Phys 2006,33(2):360-368. 10.1118/1.2140119CrossRefPubMed
33.
34.
Schneider U, Kaser-Hotz B: A simple dose–response relationship for modeling secondary cancer incidence after radiotherapy. Zeitschrift fur Medizinische Physik 2005,15(1):31-37.CrossRefPubMed
35.
Chiyoda Technol Corporation: Personal monitoring system by glass badge. Tokyo: Chiyoda Technol; 2003.
36.
Corporation ATG: RPL Glass Dosimeter/Small Element System Dose Ace. Tokyo: Asahi Glass Co., LTD; 2000.
37.
Peisch E, Burgkhardt B, Vilgis M: Photoluminescence dosimetry: progress and present state of art. Radiat Prot Dosim 1990, 33: 215-225.
38.
Arakia F, Moribe N, Shimonobou T, Yamashita Y: Dosimetric properties of radiophotoluminescent glass rod detector in high-energy photon beams from a linear accelerator and cyber-knife. Med Phys 2004,31(7):1980-1986. 10.1118/1.1758351CrossRefPubMed
39.
Hsu SM, Yeh SH, Lin MS, Chen WL: Comparison on characteristics of radiophotoluminescent glass dosemeters and thermoluminescent dosemeters. Radiat Prot Dosim 2006,119(1–4):327-331.CrossRef
40.
KIM DW, Chung W: Characteristic study of radiophotoluminescence glass rod detector for clinical usages: skin and inner body in-vivo verification. J of Korean Phys Soc 2013,62(3):670-676.
41.
Fogliata A, Nicolini G, Vanetti E, Clivio A, Cozzi L: Dosimetric validation of the anisotropic analytical algorithm for photon dose calculation: fundamental characterization in water. Phys Med Biol 2006,51(6):1421-1438. 10.1088/0031-9155/51/6/004CrossRefPubMed
42.
Van Esch A, Tillikainen L, Pyykkonen J, Tenhunen M, Helminen H, Siljamaki S, Alakuijala J, Paiusco M, Lori M, Huyskens DP: Testing of the analytical anisotropic algorithm for photon dose calculation. Med Phys 2006,33(11):4130-4148. 10.1118/1.2358333CrossRefPubMed
43.
Sterpin E, Salvat F, Olivera G, Vynckier S: Monte Carlo evaluation of the convolution/superposition algorithm of Hi-Art tomotherapy in heterogeneous phantoms and clinical cases. Med Phys 2009,36(5):1566-1575. 10.1118/1.3112364CrossRefPubMed
44.
Gibbons JP, Smith K, Cheek D, Rosen I: Independent calculation of dose from a helical TomoTherapy unit. J Appl Clin Med Phys /American College of Medical Physics 2009,10(1):2772.
45.
Ramsey C, Seibert R, Mahan SL, Desai D, Chase D: Out-of-field dosimetry measurements for a helical tomotherapy system. J Appl Clin Med Phys/American College of Medical Physics 2006,7(3):1-11.
46.
Howell RM, Scarboro SB, Taddei PJ, Krishnan S, Kry SF, Newhauser WD: Methodology for determining doses to in-field, out-of-field and partially in-field organs for late effects studies in photon radiotherapy. Phys Med Biol 2010,55(23):7009-7023. 10.1088/0031-9155/55/23/S04PubMedCentralCrossRefPubMed
47.
Howell RM, Scarboro SB, Kry SF, Yaldo DZ: Accuracy of out-of-field dose calculations by a commercial treatment planning system. Phys Med Biol 2010,55(23):6999-7008. 10.1088/0031-9155/55/23/S03PubMedCentralCrossRefPubMed
48.
Davidson MT, Blake SJ, Batchelar DL, Cheung P, Mah K: Assessing the role of volumetric modulated arc therapy (VMAT) relative to IMRT and helical tomotherapy in the management of localized, locally advanced, and post-operative prostate cancer. Int J Radiat Oncol Biol Phys 2011,80(5):1550-1558. 10.1016/j.ijrobp.2010.10.024CrossRefPubMed
49.
Foroudi F, Wilson L, Bressel M, Haworth A, Hornby C, Pham D, Cramb J, Gill S, Tai KH, Kron T: A dosimetric comparison of 3D conformal vs intensity modulated vs volumetric arc radiation therapy for muscle invasive bladder cancer. Radiat Oncol 2012, 7: 111. 10.1186/1748-717X-7-111PubMedCentralCrossRefPubMed
50.
Taddei PJ, Howell RM, Krishnan S, Scarboro SB, Mirkovic D, Newhauser WD: Risk of second malignant neoplasm following proton versus intensity-modulated photon radiotherapies for hepatocellular carcinoma. Phys Med Biol 2010,55(23):7055-7065. 10.1088/0031-9155/55/23/S07PubMedCentralCrossRefPubMed
51.
Brenner DJ, Curtis RE, Hall EJ, Ron E: Second malignancies in prostate carcinoma patients after radiotherapy compared with surgery. Cancer 2000,88(2):398-406. 10.1002/(SICI)1097-0142(20000115)88:2<398::AID-CNCR22>3.0.CO;2-VCrossRefPubMed
Metadata
Title
Risk of secondary cancers from scattered radiation during intensity-modulated radiotherapies for hepatocellular carcinoma
Authors
Dong Wook Kim
Kwangzoo Chung
Weon Kuu Chung
Sun Hyun Bae
Dong Oh Shin
Seongeon Hong
Sung Ho Park
Sung-Yong Park
Chae-Seon Hong
Young Kyung Lim
Dongho Shin
Se Byeong Lee
Hyun-ho Lee
Jiwon Sung
Myonggeun Yoon
Publication date
01-12-2014
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2014
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/1748-717X-9-109

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