Secondary Cancer Risk of Radiotherapy and Imaging Examination for Two Different Malignancies in One Patient

Mohammad Hosein Zare; Hamidreaza Masjedi; Fateme Tabatabaee; Shiva Rahbar Yazdi; Masoud Shabani; Mohammad Ali Broomand

doi:10.18502/fbt.v10i4.13732

Secondary Cancer Risk of Radiotherapy and Imaging Examination for Two Different Malignancies in One Patient

Mohammad Ali Broomand

Abstract

Purpose: Radiotherapy (RT), which is considered one of the critical treatments for cancer patients is also known as adjuvant therapy and palliative care, and can be attempted alone or concurrent with chemotherapy. Although RT reduces the risk of recurrence, the scattered dose may enhance the risk of secondary cancer induction; this is raising some challenges in clinical practice. To the best of our knowledge, few studies to date have assessed such effects of brain cancer adjuvant radiotherapy.

Materials and Methods: We estimated the RT-induced risk of secondary cancer for a 45-year-old patient who had undergone radiotherapy of the head and pelvis with a 6 MV photon beam in 15 and 10 sessions, respectively. The absorbed dose by the thyroid, breast, eye lenses, region overlying ovaries, and parotids was measured using Thermoluminescent Dosimeters (TLD). Since the patient was scanned before radiotherapy, it was decided to calculate their risk as well. To evaluate the cancer risk, radiobiological models for Excess Absolute Risk (EAR), as well as Excess Relative Risk (ERR) published by the Committee on the Biological Effects of Ionizing Radiation (BEIR) in report VII, were implemented. This study thus aimed to estimate the Risk of Exposure-Induced Death (REID) and assess the radiation dose delivered to patients from Computed Tomography (CT) scans and common diagnostic nuclear medicine examinations.

Results: The mean risk of secondary cancer for sensitive organs was calculated 3 years after radiotherapy. The highest estimated ERR was related to the region overlying right and left ovaries for pelvic radiotherapy (47.82) and (51.17), and the next highest EAR followed by right and left eye lenses for brain radiotherapy (18.09) and (15.43), respectively. In addition, other cancers arising from CT scans had the highest REID values for solid cancer (0.0015) and bone scans revealed the highest REID values for other cancers (0.00121).

Conclusion: Calculating the corresponding risks of RT is of great significance for the patients in procedural change. Choosing proper field sizes and adapted techniques to avoid excessive doses to healthy organs can thus be a great assistance in this regard.

1- Jay S Cooper et al., "Second malignancies in patients who have head and neck cancer: incidence, effect on survival and implications based on the RTOG experience." International Journal of Radiation Oncology* Biology* Physics, Vol. 17 (No. 3), pp. 449-56, (1989).
2- Eleftherios Tzanis, Michael Mazonakis, and John Damilakis, "A software tool for organ-specific second cancer risk assessment from exposure to therapeutic doses." Reports of Practical Oncology and Radiotherapy, (2022).
3- Hess CB, Thompson HM, Benedict SH, Seibert JA, Wong K, Vaughan AT, Chen AM. "Exposure risks among children undergoing radiation therapy: considerations in the era of image guided radiation therapy." International Journal of Radiation Oncology* Biology* Physics;94(5):978-92, (2016).
4- JM Cosset, M Hetnal, and C Chargari, "Second cancers after radiotherapy: update and recommandations." Radioprotection, Vol. 53 (No. 2), pp. 101-05, (2018).
5- National Research Council, "Health risks from exposure to low levels of ionizing radiation: BEIR VII phase 2." (2006).
6- Mark P Little et al., "Review of the risk of cancer following low and moderate doses of sparsely ionising radiation received in early life in groups with individually estimated doses." Environment international, Vol. 159p. 106983, (2022).
7- HR Baghani, SMR Aghamiri, H Gharaati, M Mohammadi, and SM Daghigh, "Treatment planning verification in craniospinal radiotherapy." in World Congress on Medical Physics and Biomedical Engineering May 26-31, 2012, Beijing, China, (2013): Springer, pp. 1723-26.
8- Viktor Iakovenko, Brian Keller, Arjun Sahgal, and Arman Sarfehnia, "Experimental measurement of ionization chamber angular response and associated magnetic field correction factors in MR‐linac." Medical Physics, Vol. 47 (No. 4), pp. 1940-48, (2020).
9- S Mattsson et al., "Radiation dose to patients from radiopharmaceuticals: a compendium of current information related to frequently used substances." ed, (2015).
10- Sören Mattsson, "Need for individual cancer risk estimates in X-ray and nuclear medicine imaging." Radiation protection dosimetry, Vol. 169 (No. 1-4), pp. 11-16, (2016).
11- PJ Mountford and DH Temperton, "Recommendations of the international commission on radiological protection (ICRP) 1990." ed: Springer, (1992).
12- Maede Mahmoodi and Ali Chaparian, "Organ doses, effective dose, and cancer risk from coronary CT angiography examinations." American Journal of Roentgenology, Vol. 214 (No. 5), pp. 1131-36, (2020).
13- Tainara Lage do Amaral, "Uso do software PC Program For X-Ray Monte Carlo para estimativa de doses na radiologia." (2021).
14- Kalliopi M Kourinou, Michalis Mazonakis, Efrosini Lyraraki, John Stratakis, and John Damilakis, "Scattered dose to radiosensitive organs and associated risk for cancer development from head and neck radiotherapy in pediatric patients." Physica Medica, Vol. 29 (No. 6), pp. 650-55, (2013).
15- Mohammad Maarouf, Harald Treuer, Martin Kocher, Jürgen Voges, Andreas Gierich, and Volker Sturm, "Radiation exposure of extracranial organs at risk during stereotactic linac radiosurgery." Strahlentherapie und Onkologie, Vol. 181 (No. 7), pp. 463-67, (2005).
16- Steven L Hancock, I Ross McDougall, and Louis S Constine, "Thyroid abnormalities after therapeutic external radiation." International Journal of Radiation Oncology* Biology* Physics, Vol. 31 (No. 5), pp. 1165-70, (1995).
17- Roy E Shore, "Issues and epidemiological evidence regarding radiation-induced thyroid cancer." Radiation research, Vol. 131 (No. 1), pp. 98-111, (1992).
18- Gudrun Svahn-Tapper et al., "Radiation dose and relapse are predictors for development of second malignant solid tumors after cancer in childhood and adolescence: a population-based case-control study in the five Nordic countries." Acta Oncologica, Vol. 45 (No. 4), pp. 438-48, (2006).
19- Douglas G Gold, Joseph P Neglia, Roger A Potish, and Kathryn E Dusenbery, "Second neoplasms following megavoltage radiation for pediatric tumors." Cancer: Interdisciplinary International Journal of the American Cancer Society, Vol. 100 (No. 1), pp. 212-13, (2004).
20- Ibrahima Diallo et al., "Frequency distribution of second solid cancer locations in relation to the irradiated volume among 115 patients treated for childhood cancer." International Journal of Radiation Oncology* Biology* Physics, Vol. 74 (No. 3), pp. 876-83, (2009).
21- Sivapar V Mathan, Mohit Rajput, and Rana P Singh, "Chemotherapy and radiation therapy for cancer." in Understanding Cancer: Elsevier, (2022), pp. 217-36.
22- FK Miah, MF Ahmed, Z Begum, B Alam, and Q Chowdhury, "Dose distribution over different parts of cancer patients during radiotherapy treatment in Bangladesh." Radiation protection dosimetry, Vol. 77 (No. 3), pp. 199-203, (1998).

Files	XML PDF (826KB)
Issue	Vol 10 No 4 (2023)
Section	Case Report(s)
DOI	https://doi.org/10.18502/fbt.v10i4.13732
Keywords
Radiotherapy Cancer Risk Thermoluminescent Dosimeters Organ Dose

Rights and permissions
	This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

How to Cite

Zare MH, Masjedi H, Tabatabaee F, Rahbar Yazdi S, Shabani M, Broomand MA. Secondary Cancer Risk of Radiotherapy and Imaging Examination for Two Different Malignancies in One Patient. Frontiers Biomed Technol. 2023;10(4):496-502.

Vancouver

Download Citation