Effect of Intensity-Modulated Pelvic Radiotherapy on Second Cancer Risk in the Postoperative Treatment of Endometrial and Cervical Cancer

Journal Article · Mon Jun 01 00:00:00 EDT 2009 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2009.01.051· OSTI ID:21276835

Zwahlen, Daniel R ^[1]; Ruben, Jeremy D; Jones, Phillip; Gagliardi, Frank; Millar, Jeremy L ^[1]; Schneider, Uwe ^[2]

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1. Radiation Oncology, Alfred Hospital and Monash University, Melbourne (Australia)
2. Division of Medical Physics, Department of Radiation Oncology and Nuclear Medicine, Triemli Hospital, Zurich and Vetsuisse Faculty, University of Zurich, Zurich (Switzerland)

Purpose: To estimate and compare intensity-modulated radiotherapy (IMRT) with three-dimensional conformal radiotherapy (3DCRT) in terms of second cancer risk (SCR) for postoperative treatment of endometrial and cervical cancer. Methods and Materials: To estimate SCR, the organ equivalent dose concept with a linear-exponential, a plateau, and a linear dose-response model was applied to dose distributions, calculated in a planning computed tomography scan of a 68-year-old woman. Three plans were computed: four-field 18-MV 3DCRT and nine-field IMRT with 6- and 18-MV photons. SCR was estimated as a function of target dose (50.4 Gy/28 fractions) in organs of interest according to the International Commission on Radiological Protection Results: Cumulative SCR relative to 3DCRT was +6% (3% for a plateau model, -4% for a linear model) for 6-MV IMRT and +26% (25%, 4%) for the 18-MV IMRT plan. For an organ within the primary beam, SCR was +12% (0%, -12%) for 6-MV and +5% (-2%, -7%) for 18-MV IMRT. 18-MV IMRT increased SCR 6-7 times for organs away from the primary beam relative to 3DCRT and 6-MV IMRT. Skin SCR increased by 22-37% for 6-MV and 50-69% for 18-MV IMRT inasmuch as a larger volume of skin was exposed. Conclusion: Cancer risk after IMRT for cervical and endometrial cancer is dependent on treatment energy. 6-MV pelvic IMRT represents a safe alternative with respect to SCR relative to 3DCRT, independently of the dose-response model. 18-MV IMRT produces second neutrons that modestly increase the SCR.

• OSTI ID: 21276835
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 74, Issue 2; Other Information: DOI: 10.1016/j.ijrobp.2009.01.051; PII: S0360-3016(09)00231-4; Copyright (c) 2009 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
COMPUTERIZED TOMOGRAPHY
DOSE EQUIVALENTS
HAZARDS
NEOPLASMS
PHOTONS
PLANNING
RADIATION DOSE DISTRIBUTIONS
RADIATION DOSES
RADIOTHERAPY
SKIN
WOMEN