Estimating Radiotherapy-Induced Secondary Cancer Risk Arising from Brain Irradiation at High Energy: A Monte Carlo Study
-
Soheil Elmtalab
,
Amir Hossein Karimi
,
Fardin Samadi Khoshe Mehr
,
Hamed Zamani
,
Iraj Abedi
,
Fakhereh Pashaei
Abstract
Background: The present study aims to determine the whole-body out-of-field photon dose equivalents of high-energy conventional radiation therapy treatment. Also, it is tried to estimate the probability of fatal secondary cancer risk for the susceptible organs using a Monte Carlo (MC) code.
Materials and methods: An Monte Carlo N-Particle eXtended (MCNPX)-based model of 18-MV Medical Linear Accelerator (LINAC) was created to calculate the out-of-field photon dose equivalent at the locations of fascinating organs in the mathematical female Medical Internal Radiation Dosimetry (MIRD) phantom. Then, the secondary malignancies risk was estimated based on out-of-field doses and radiation risk coefficients according to the National Council of Radiation Protection and Measurements (NCRP).
Results: The average photon equivalent dose in out-of-field organs was about 3.25 mSv/Gy, ranging from 0.23 to 37.2 mSv/Gy, respectively, for the organs far from the Planning Target Volume (PTV) (Eyes) and those close to the treatment field (rectum). The entire secondary cancer risk for the 60 Gy prescribed dose to isocenter was obtained as 2.9987%. Here, the maximum doses among off-field organs were related to stomach (0.0805%), lung (0.0601%), and thyroid (0.0404%).
Conclusion: Regarding the estimated values for the probability of secondary cancer risk, it is suggested to perform a long-term follow-up of brain cancer patients regarding the prevalence of thyroid, stomach, and lung cancer after completing the treatment course.
1- Juratli TA, Schackert G, Krex D "Current status of local therapy in malignant gliomas—a clinical review of three selected approaches.", Pharmacol Ther, 1;139(3):341-58, (2013).
2- NCCN Clinical Practice Guidelines in Oncology: Anaplastic Gliomas/Glioblastoma, (2018).
3- "Medical Research Council Brain Tumour Working Party Randomized trial of procarbazine, lomustine, and vincristine in the adjuvant treatment of high-grade astrocytoma: a Medical Research Council trial.", J Clin Oncol, 19(2):509-18, (2001).
4- Kry SF, Salehpour M, Followill DS, et al. "Out-of-field photon and neutron dose equivalents from step-and-shoot intensity-modulated radiation therapy." Int J Radiat Oncol* Biol* Phys, 62(4):1204-16, (2005).
5- Greene D, Chu GL, Thomas DW "Dose levels outside radiotherapy beams.", The Br J Radiol, 56(668):543-50, (1983).
6- Kase KR, Svensson GK, Wolbarst AB, et al. "Measurements of dose from secondary radiation outside a treatment field.", Int J Radiat Oncol* Biol* Phys, 9(8):1177-83, (1983).
7- Harrison RM "Introduction to dosimetry and risk estimation of second cancer induction following radiotherapy.", Radiat Meas, 57:1-8, (2013).
8- Newhauser WD and Durante M "Assessing the risk of second malignancies after modern radiotherapy.", Nat Rev Cancer, 11(6):438-48, (2011).
9- Hall EJ and Wuu CS "Radiation-induced second cancers: the impact of 3D-CRT and IMRT." Int J Radiat Oncol* Biol* Phys, 56(1):83-8, (2003).
10- Wang B and Xu XG, "Measurements of non-target organ doses using MOSFET dosemeters for selected IMRT and 3D CRT radiation treatment procedures.", Radiat prot dosimetry,128(3):336-42, (2008).
11- Howell RM, Scarboro SB, Kry SF, et al. "Accuracy of out-of-field dose calculations by a commercial treatment planning system." Phys Med Biol, 55(23):6999, (2010).
12- Kavousi N, Nedaie HA, Gholami S, Esfahani M, Geraily G. "Evaluation of dose calculation algorithms accuracy for eclipse, PCRT3D, and monaco treatment planning systems using IAEA TPS commissioning tests in a Heterogeneous Phantom.", Iran J Med Phys, 1;16(4):285-93, (2019).
13- Meinhold CB, Abrahamson S, Adelstein SJ, et al. "Limitation of exposure to ionizing radiation." NCRP REP, (116):1-86, (1993).
14- Majer M, Stolarczyk L, De Saint-Hubert M, et al. "Out-of-field dose measurements for 3D conformal and intensity- modulated radiotherapy of a paediatric brain tumour." Radiat Prot dosimetry, 176(3):331-40, (2017).
15- Foo ML, McCullough EC, Foote RL, et al. "Doses to radiation- sensitive organs and structures located outside the radiotherapeutic target volume for four treatment situations.", Int J Radiat Oncol* Biol* Phys, 27(2):403-17, (1993).
16- Taylor ML, Kron T, Franich RD "Assessment of out-of-field doses in radiotherapy of brain lesions in children.", Inter J Radiat Oncol* Biol* Phys, 79(3):927-33, (2011).
17- Di Betta E, Fariselli L, Bergantin A, Locatelli F, Del Vecchio A, Broggi S, Fumagalli ML. "Evaluation of the peripheral dose in stereotactic radiotherapy and radiosurgery treatments." Med Phys;37(7Part1):3587-94, (2010).
18- Miljanić S, Hršak H, Knežević Ž, Majer M, Heinrich Z. "Peripheral doses in children undergoing Gamma Knife radiosurgery and second cancer risk.", Radiat Meas, 1;55:38-42, (2013).
19- Hendricks, John S., et al. "MCNPX 2.6. 0 Extensions." Los Alamos National Laboratory, (2008).
20- Alem-Bezoubiri A, Bezoubiri F, Badreddine A, et al. "Monte Carlo estimation of photoneutrons spectra and dose equivalent around an 18 MV medical linear accelerator.", Radiat Phys Chem, 97:381-92, (2014).
21- Chegeni N, Karimi AH, Jabbari I, et al. "Photoneutron Dose Estimation in GRID Therapy Using an Anthropomorphic Phantom: A Monte Carlo Study." JMSS, 9(1):75, (2019).
22- Karimi AH, Brkić H, Shahbazi-Gahrouei D, et al. "Essential considerations for accurate evaluation of photoneutron contamination in radiotherapy.", Appl Radiat Isot, 145:24-31, (2019).
23- Karimi AH and Vega-Carrillo HR "Grid therapy vs. conventional radiotherapy–18 MV treatments: Photoneutron contamination along the maze of a linac bunker.", Appl Radiat Isot, 158:109064, (2020).
24- Han EY, Bolch WE, Eckerman KF "Revisions to the ORNL series of adult and pediatric computational phantoms for use with the MIRD schema." Health Phys, 90(4):337-356, (2006).
25- Ruben JD, Smith R, Lancaster CM, Haynes M, et al. "Constituent components of out-of-field scatter dose for 18-MV intensity-modulated radiation therapy versus 3-dimensional conformal radiation therapy: a comparison with 6-MV and implications for carcinogenesis.", Int J Radiat Oncol* Biol* Phys, 90(3):645-53, (2014).
26- Kry SF, Salehpour M, Titt U, et al. "Monte Carlo study shows no significant difference in second cancer risk between 6-and 18-MV intensity-modulated radiation therapy.", Radiother Oncol, 91(1):132-7, (2009).
27- Elmtalab S, Abedi I. "Investigating the out-of-field doses and estimating the risk of secondary thyroid cancer in high-grade gliomas radiation therapy with modulated intensity and 3D-conformal: a phantom study." Int J Radiat Res;19(3):569-74, (2021).
28- Ahmadi M, Tavakoli MB, Amouheidari A, et al. "Investigation of the absorbed dose and estimation of the risk of secondary thyroid cancer in whole-brain radiotherapy." J Isfahan Med Sch, 34(413):1590-1594, (2017).
29- Elmtalab S, Abedi I, Choopan-Dastjerdi M, et al. "Evaluation of the risk of secondary thyroid cancer caused by neutron dose equivalent from brain tumor 3D-conformal radiation therapy (3D-CRT)." J Isfahan Med Sch, 38(586):569-574, (2020).
30- Gold DG, Neglia JP, Potish RA, et al. "Second neoplasms following megavoltage radiation for pediatric tumors.", Cancer, 100(1):212-3, (2004).
31- Diallo I, Haddy N, Adjadj E, et al. "Frequency distribution of second solid cancer locations in relation to the irradiated volume among 115 patients treated for childhood cancer.", Int J Radiat Oncol* Biol* Phys, 74(3):876-83, (2009).
32- Shore RE "Issues and epidemiological evidence regarding radiation-induced thyroid cancer.", Radiat Res, 131(1):98-111, (1992).
2- NCCN Clinical Practice Guidelines in Oncology: Anaplastic Gliomas/Glioblastoma, (2018).
3- "Medical Research Council Brain Tumour Working Party Randomized trial of procarbazine, lomustine, and vincristine in the adjuvant treatment of high-grade astrocytoma: a Medical Research Council trial.", J Clin Oncol, 19(2):509-18, (2001).
4- Kry SF, Salehpour M, Followill DS, et al. "Out-of-field photon and neutron dose equivalents from step-and-shoot intensity-modulated radiation therapy." Int J Radiat Oncol* Biol* Phys, 62(4):1204-16, (2005).
5- Greene D, Chu GL, Thomas DW "Dose levels outside radiotherapy beams.", The Br J Radiol, 56(668):543-50, (1983).
6- Kase KR, Svensson GK, Wolbarst AB, et al. "Measurements of dose from secondary radiation outside a treatment field.", Int J Radiat Oncol* Biol* Phys, 9(8):1177-83, (1983).
7- Harrison RM "Introduction to dosimetry and risk estimation of second cancer induction following radiotherapy.", Radiat Meas, 57:1-8, (2013).
8- Newhauser WD and Durante M "Assessing the risk of second malignancies after modern radiotherapy.", Nat Rev Cancer, 11(6):438-48, (2011).
9- Hall EJ and Wuu CS "Radiation-induced second cancers: the impact of 3D-CRT and IMRT." Int J Radiat Oncol* Biol* Phys, 56(1):83-8, (2003).
10- Wang B and Xu XG, "Measurements of non-target organ doses using MOSFET dosemeters for selected IMRT and 3D CRT radiation treatment procedures.", Radiat prot dosimetry,128(3):336-42, (2008).
11- Howell RM, Scarboro SB, Kry SF, et al. "Accuracy of out-of-field dose calculations by a commercial treatment planning system." Phys Med Biol, 55(23):6999, (2010).
12- Kavousi N, Nedaie HA, Gholami S, Esfahani M, Geraily G. "Evaluation of dose calculation algorithms accuracy for eclipse, PCRT3D, and monaco treatment planning systems using IAEA TPS commissioning tests in a Heterogeneous Phantom.", Iran J Med Phys, 1;16(4):285-93, (2019).
13- Meinhold CB, Abrahamson S, Adelstein SJ, et al. "Limitation of exposure to ionizing radiation." NCRP REP, (116):1-86, (1993).
14- Majer M, Stolarczyk L, De Saint-Hubert M, et al. "Out-of-field dose measurements for 3D conformal and intensity- modulated radiotherapy of a paediatric brain tumour." Radiat Prot dosimetry, 176(3):331-40, (2017).
15- Foo ML, McCullough EC, Foote RL, et al. "Doses to radiation- sensitive organs and structures located outside the radiotherapeutic target volume for four treatment situations.", Int J Radiat Oncol* Biol* Phys, 27(2):403-17, (1993).
16- Taylor ML, Kron T, Franich RD "Assessment of out-of-field doses in radiotherapy of brain lesions in children.", Inter J Radiat Oncol* Biol* Phys, 79(3):927-33, (2011).
17- Di Betta E, Fariselli L, Bergantin A, Locatelli F, Del Vecchio A, Broggi S, Fumagalli ML. "Evaluation of the peripheral dose in stereotactic radiotherapy and radiosurgery treatments." Med Phys;37(7Part1):3587-94, (2010).
18- Miljanić S, Hršak H, Knežević Ž, Majer M, Heinrich Z. "Peripheral doses in children undergoing Gamma Knife radiosurgery and second cancer risk.", Radiat Meas, 1;55:38-42, (2013).
19- Hendricks, John S., et al. "MCNPX 2.6. 0 Extensions." Los Alamos National Laboratory, (2008).
20- Alem-Bezoubiri A, Bezoubiri F, Badreddine A, et al. "Monte Carlo estimation of photoneutrons spectra and dose equivalent around an 18 MV medical linear accelerator.", Radiat Phys Chem, 97:381-92, (2014).
21- Chegeni N, Karimi AH, Jabbari I, et al. "Photoneutron Dose Estimation in GRID Therapy Using an Anthropomorphic Phantom: A Monte Carlo Study." JMSS, 9(1):75, (2019).
22- Karimi AH, Brkić H, Shahbazi-Gahrouei D, et al. "Essential considerations for accurate evaluation of photoneutron contamination in radiotherapy.", Appl Radiat Isot, 145:24-31, (2019).
23- Karimi AH and Vega-Carrillo HR "Grid therapy vs. conventional radiotherapy–18 MV treatments: Photoneutron contamination along the maze of a linac bunker.", Appl Radiat Isot, 158:109064, (2020).
24- Han EY, Bolch WE, Eckerman KF "Revisions to the ORNL series of adult and pediatric computational phantoms for use with the MIRD schema." Health Phys, 90(4):337-356, (2006).
25- Ruben JD, Smith R, Lancaster CM, Haynes M, et al. "Constituent components of out-of-field scatter dose for 18-MV intensity-modulated radiation therapy versus 3-dimensional conformal radiation therapy: a comparison with 6-MV and implications for carcinogenesis.", Int J Radiat Oncol* Biol* Phys, 90(3):645-53, (2014).
26- Kry SF, Salehpour M, Titt U, et al. "Monte Carlo study shows no significant difference in second cancer risk between 6-and 18-MV intensity-modulated radiation therapy.", Radiother Oncol, 91(1):132-7, (2009).
27- Elmtalab S, Abedi I. "Investigating the out-of-field doses and estimating the risk of secondary thyroid cancer in high-grade gliomas radiation therapy with modulated intensity and 3D-conformal: a phantom study." Int J Radiat Res;19(3):569-74, (2021).
28- Ahmadi M, Tavakoli MB, Amouheidari A, et al. "Investigation of the absorbed dose and estimation of the risk of secondary thyroid cancer in whole-brain radiotherapy." J Isfahan Med Sch, 34(413):1590-1594, (2017).
29- Elmtalab S, Abedi I, Choopan-Dastjerdi M, et al. "Evaluation of the risk of secondary thyroid cancer caused by neutron dose equivalent from brain tumor 3D-conformal radiation therapy (3D-CRT)." J Isfahan Med Sch, 38(586):569-574, (2020).
30- Gold DG, Neglia JP, Potish RA, et al. "Second neoplasms following megavoltage radiation for pediatric tumors.", Cancer, 100(1):212-3, (2004).
31- Diallo I, Haddy N, Adjadj E, et al. "Frequency distribution of second solid cancer locations in relation to the irradiated volume among 115 patients treated for childhood cancer.", Int J Radiat Oncol* Biol* Phys, 74(3):876-83, (2009).
32- Shore RE "Issues and epidemiological evidence regarding radiation-induced thyroid cancer.", Radiat Res, 131(1):98-111, (1992).
| Files | ||
| Issue | Vol 9 No 1 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/fbt.v9i1.8145 | |
| Keywords | ||
| Brain Cancer Radiotherapy Peripheral Doses Secondary Neoplasms Monte Carlo | ||
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How to Cite
1.
Elmtalab S, Karimi AH, Samadi Khoshe Mehr F, Zamani H, Abedi I, Pashaei F. Estimating Radiotherapy-Induced Secondary Cancer Risk Arising from Brain Irradiation at High Energy: A Monte Carlo Study. Frontiers Biomed Technol. 2021;9(1):53-58.
