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Title: The Impact of Dose Escalation on Secondary Cancer Risk After Radiotherapy of Prostate Cancer

Abstract

Purpose: To estimate secondary cancer risk due to dose escalation in patients treated for prostatic carcinoma with three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated RT (IMRT), and spot-scanned proton RT. Methods and Materials: The organ equivalent dose (OED) concept with a linear-exponential, a plateau, and a linear dose-response curve was applied to dose distributions of 23 patients who received RT of prostate cancer. Conformal RT was used in 7 patients, 8 patients received IMRT with 6- and 15-MV photons, and 8 patients were treated with spot-scanned protons. We applied target doses ranging from 70 Gy to 100 Gy. Cancer risk was estimated as a function of target dose and tumor control probability. Results: At a 100-Gy target dose the secondary cancer risk relative to the 3D treatment plan at 70 Gy was +18.4% (15.0% for a plateau model, 22.3% for a linear model) for the 6-MV IMRT plan, +25.3% (17.0%, 14.1%) for the 15-MV IMRT plan, and -40.7% (-41.3%, -40.0%) for the spot-scanned protons. The increasing risk of developing a radiation-associated malignancy after RT with increasing dose was balanced by the enhanced cure rates at a larger dose. Conclusions: Cancer risk after dose escalation for prostate RT is expected to be equalmore » to or lower than for conventional 3D treatment at 70 Gy, independent of treatment modality or dose-response model. Spot-scanned protons are the treatment of choice for dose escalation because this therapy can halve the risk of secondary cancers.« less

Authors:
 [1];  [2];  [1];  [1];  [1]
  1. Division of Medical Physics, Department of Radiation Oncology and Nuclear Medicine, Triemli Hospital, Zurich (Switzerland)
  2. Department of Radiation Medicine, Paul Scherrer Institute, Villigen (Switzerland)
Publication Date:
OSTI Identifier:
20951720
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 68; Journal Issue: 3; Other Information: DOI: 10.1016/j.ijrobp.2007.02.029; PII: S0360-3016(07)00468-3; Copyright (c) 2007 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; DOSE EQUIVALENTS; HEALTH HAZARDS; PATIENTS; PHOTON BEAMS; PROSTATE; PROTON BEAMS; RADIATION DOSE DISTRIBUTIONS; RADIATION DOSES; RADIOTHERAPY

Citation Formats

Schneider, Uwe, Lomax, Antony, Besserer, Juergen, Pemler, Peter, Lombriser, Norbert, and Kaser-Hotz, Barbara D.V.M. The Impact of Dose Escalation on Secondary Cancer Risk After Radiotherapy of Prostate Cancer. United States: N. p., 2007. Web. doi:10.1016/j.ijrobp.2007.02.029.
Schneider, Uwe, Lomax, Antony, Besserer, Juergen, Pemler, Peter, Lombriser, Norbert, & Kaser-Hotz, Barbara D.V.M. The Impact of Dose Escalation on Secondary Cancer Risk After Radiotherapy of Prostate Cancer. United States. https://doi.org/10.1016/j.ijrobp.2007.02.029
Schneider, Uwe, Lomax, Antony, Besserer, Juergen, Pemler, Peter, Lombriser, Norbert, and Kaser-Hotz, Barbara D.V.M. 2007. "The Impact of Dose Escalation on Secondary Cancer Risk After Radiotherapy of Prostate Cancer". United States. https://doi.org/10.1016/j.ijrobp.2007.02.029.
@article{osti_20951720,
title = {The Impact of Dose Escalation on Secondary Cancer Risk After Radiotherapy of Prostate Cancer},
author = {Schneider, Uwe and Lomax, Antony and Besserer, Juergen and Pemler, Peter and Lombriser, Norbert and Kaser-Hotz, Barbara D.V.M.},
abstractNote = {Purpose: To estimate secondary cancer risk due to dose escalation in patients treated for prostatic carcinoma with three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated RT (IMRT), and spot-scanned proton RT. Methods and Materials: The organ equivalent dose (OED) concept with a linear-exponential, a plateau, and a linear dose-response curve was applied to dose distributions of 23 patients who received RT of prostate cancer. Conformal RT was used in 7 patients, 8 patients received IMRT with 6- and 15-MV photons, and 8 patients were treated with spot-scanned protons. We applied target doses ranging from 70 Gy to 100 Gy. Cancer risk was estimated as a function of target dose and tumor control probability. Results: At a 100-Gy target dose the secondary cancer risk relative to the 3D treatment plan at 70 Gy was +18.4% (15.0% for a plateau model, 22.3% for a linear model) for the 6-MV IMRT plan, +25.3% (17.0%, 14.1%) for the 15-MV IMRT plan, and -40.7% (-41.3%, -40.0%) for the spot-scanned protons. The increasing risk of developing a radiation-associated malignancy after RT with increasing dose was balanced by the enhanced cure rates at a larger dose. Conclusions: Cancer risk after dose escalation for prostate RT is expected to be equal to or lower than for conventional 3D treatment at 70 Gy, independent of treatment modality or dose-response model. Spot-scanned protons are the treatment of choice for dose escalation because this therapy can halve the risk of secondary cancers.},
doi = {10.1016/j.ijrobp.2007.02.029},
url = {https://www.osti.gov/biblio/20951720}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 3,
volume = 68,
place = {United States},
year = {Sun Jul 01 00:00:00 EDT 2007},
month = {Sun Jul 01 00:00:00 EDT 2007}
}