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Radiation-induced second cancer risk from stereotactic ablative radiotherapy (SABR) for lung cancer: a review of planning studies

Published online by Cambridge University Press:  11 October 2017

Vasanthan Sakthivel ,
Ganesh Kadirampatti Mani ,
Sunil Mani  and
Raghavendiran Boopathy
Vasanthan Sakthivel*
Affiliation:
Research and Development Centre, Bharathiar University, Coimbatore, Tamil Nadu, India Advanced Medical Physics, Houston, TX, USA
Ganesh Kadirampatti Mani
Affiliation:
Research and Development Centre, Bharathiar University, Coimbatore, Tamil Nadu, India Department of Radiation Physics, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
Sunil Mani
Affiliation:
Advanced Medical Physics, Houston, TX, USA
Raghavendiran Boopathy
Affiliation:
Advanced Medical Physics, Houston, TX, USA
*
Correspondence to: Vasanthan Sakthivel, Bharathiar University, Coimbatore, Tamil Nadu 641046, India. Tel: +1 281 813 7776. E-mail:vasanthan.sakthivel@gmail.com
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Abstract

Purpose

The aim of the current study was to (i) to calculate organ equivalent dose (OED) and (ii) to estimate excess absolute risks (EARs), lifetime attributable risks (LARs) and relative risks (RRs) from stereotactic ablative radiotherapy (SABR) for lung cancer to in-field, close to field, and out of field structures.

Methods

A total of five patients with T1, T2 (≤4 cm), N0, M0 medically inoperable non-small cell lung cancer were selected for treatment planning. Patient selection criteria were based on RTOG 0236. Five treatment deliveries were investigated: (i) three-dimensional conformal radiotherapy (3DCRT), (ii) intensity-modulated radiotherapy (IMRT), (iii) intensity-modulated radiotherapy with flattening filter free beam (IMRTF), (iv) volumetric modulated arc therapy (VMAT) and (v) volumetric modulated arc therapy with flattening filter free arcs (VMATF). Delineated normal structures included chest wall, left and right lung, trachea, small and large airways, spinal cord, oesophagus and involved ribs. All plans were prescribed to 60 Gy in five fractions to primary planning target volume (PTV) volume so that ≥98% of the PTV received ≥98% of the prescription dose and internal tumour volume received 100% of the prescription dose. The OED for all delineated normal structures was calculated using differential dose volume histograms. Using risk models, the age-dependent LAR’s and RR were calculated. Additionally, the secondary cancer risk for organs inside primary radiation was analysed using sarcoma and carcinoma risk models.

Results

For all patients, the mean V20 volumes from the SABR plans were 4·1% (3DRT), 11·8% (IMRT), and 12·7% (VMAT), respectively. The EAR (combining all organs EAR) for all the organs studied, ranged from 8·5 to 10·6/10,000 persons/year for VMATF and 3DCRT, respectively. The EAR (combining all organs EAR) for all the organs studied, ranged from 8·5 to 10·6/10,000 persons/year for VMATF and 3DCRT, respectively. The absolute EAR difference between IMRT and IMRTF was low ranging from 0·2 to 0·4/10,000 persons-year, whereas delivery difference (IMRT and VMAT) had a significant impact on EAR with absolute difference ranging from 0·5 to 1·0/10,000 persons-year for IMRT and VMAT and 1·1–1·5/10,000 persons-year for IMRTF, VMATF, respectively. The LAR data showed a strong dependence on age at exposure and the LAR decreased as a function of age at exposure. The absolute attributable risk of bone sarcoma was lower with the VMAT plan and was significantly higher with the 3DCRT plan.

Conclusion

From a clinical perspective, it should be concluded that all five solutions investigated in the study can offer high quality of patient treatments and only estimates of radiation-induced malignancies can truly differentiate among them. The results suggested it would be reasonable to use the cumulative LAR difference when needed to select between treatment techniques. In conclusion, the LAR of radiation-induced secondary cancer was significantly lower when using VMATF than when using IMRT for SABR lung patients. VMATF would be the right choice for the treatment of SABR lung patients in terms of LAR. However, more work is required for the specific estimation and long-term validation and updating of the models behind LAR estimation.

Keywords

lifetime attributable risklung cancersecond cancer riskstereotactic ablative radiotherapyvolumetric modulated arc therapy
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 17 , Issue 2 , June 2018 , pp. 194 - 204
Copyright
© Cambridge University Press 2017 

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References

1.Global surveillance of cancer survival 1995–2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62038-9/abstract. Accessed on 14th August 2017.Google Scholar
2.Appropriate use of advanced technologies for radiation therapy and surgery in oncology. https://www.nap.edu/read/21859/chapter/1. Accessed on 14th August 2017.Google Scholar
3. Billy, W L. Stereotactic ablative radiotherapy (SABR) for lung cancer: What does the future hold? J Thorac Dis 2011; 3 (3): 150–152.Google Scholar
4. Chaturvedi, A K, Ahamad, A A, Iyer, R B et al. Feasibility of dose escalation using intensity modulated radiotherapy in posthysterectomy cervical carcinoma. J Natl Cancer Inst 2007; 99: 1634–1643.Google Scholar
5. Travis, L B, Hill, D A, Dores, G M, Gospaodarowicz, M et al. Breast cancer following radiotherapy and chemotherapy among young women with Hodgkin disease. J Am Med Assoc 2003; 290 (4): 465–475.Google Scholar
6. Hall, E J, Wuu, C S. Radiation-induced second cancers: the impact of 3DCRT and IMRT. Int J Radiat Oncol Biol Phys 2003; 56: 83–88.Google Scholar
7. Brenner, D J, Curtis, R E, Hall, E J et al. Second malignancies in prostate carcinoma patients after radiotherapy compared with surgery. Cancer 2000; 88: 398–406.Google Scholar
8. Movas, B, Hanlon, A L, Pinover, W et al. Is there an increased risk of second primaries following prostate irradiation? Int J Radiat Oncol Biol Phys 1998; 41: 251–255.Google Scholar
9.RTOG 0236 – A Phase II Trial of stereotactic body radiation therapy (SBRT) in the treatment of patients with medically inoperable stage I/II non-small cell lung cancer. https://www.rtog.org/ClinicalTrials/ProtocolTable/StudyDetails.aspx?study=0236. Accessed on 14th August 2017.Google Scholar
10.ICRU 50. http://www.icru.org/home/reports/prescribing-recording-and-reporting-photonbeam-therapy-report-50. Accessed on 14th August 2017.Google Scholar
11. Weiss, E, Siebers, J V, Keall, P J et al. An analysis of 6-MV versus 18-MV photon energy plans for intensitymodulated radiation therapy (IMRT) of lung cancer. Radiother Oncol. 2007; 82 (1): 55–62.Google Scholar
12. Marco, D, Stefano, G, Vitaliania, S et al. Integral dose and radiation induced secondary malignancies: comparison between stereotactic body radiation therapy and three-dimensional conformal therapy. Int J Environ Res Public Health 2012; 9 (11): 4223–4240.Google Scholar
13. Schneider, U, Walsh, L. Cancer risk estimates from the combined Japanese A-bomb and Hodgkins cohorts for doses relevant to radiotherapy. Radiat Environ Biophys 2008; 47: 253–263.Google Scholar
14. Schneider, U. Modeling the risk of secondary malignancies after radiotherapy. Genes 2011; 2: 1033–1049.Google Scholar
15. Maryam, M, Torunn, I, Harlad, P et al. The risk of radiation-induced second cancers in the high to medium dose region: a comparison between passive and scanned proton therapy, IMRT and VMAT for pediatric patients with brain tumors. Phys Med Bio 2014; 59 (12): 2883–2899.Google Scholar
16.National Cancer Institute. http://www.seer.cancer.gov/statfacts/html/breast.html/. Accessed on 14th August 2017.Google Scholar
17. Yu, J, Wilson, D, Keith, B et al. Glioblastoma induction after radiosurgery for meningioma. Lancet 2000; 356: 1576–1577.Google Scholar
18. Kim, D W, Chung, W K, Dongoh, S et al. Risk of second cancer from scattered radiation of intensity modulated radiotherapies with lung cancer. Biomed Central 2013; 8: 47–55.Google Scholar
19. Dasu, A, Toma-Dasu, I, Olofsson, J, Karlsson, M. The use of risk estimation models for the induction of secondary cancers following radiotherapy. Acta Oncol. 2005; 44: 339–347.Google Scholar
20. Murray, L J, Thompson, C M, Lilley, J et al. Radiation-induced second primary cancer risks from modern external beam radiotherapy for early prostate cancer: impact of stereotactic ablative radiotherapy (SABR), volumetric modulated arc therapy (VMAT) and flattening filter free (FFF) radiotherapy. Phys Med Bio 2015; 60: 1237–1257.Google Scholar
21. Rehman, J, Tailor, R, Isa, M et al. Evaluations of secondary cancer risk in spine radiotherapy using 3DCRT, IMRT, and VMAT: a phantom study. Med Dosim. 2015; 40 (1): 70–75.Google Scholar
22. Mok, H, Carane, C H, Palmer, M B et al. Intensity-modulated radiation therapy (IMRT): differences in target volumes and improvement in clinically relevant doses to small bowel in rectal carcinoma. Radiat Oncol. 2011; 6: 63.Google Scholar