From: Second primary cancers after radiation for prostate cancer: a review of data from planning studies
Study | Region assessed§ | Method of obtaining dose data | Method of risk calculation | Energy | % Risk of second fatal malignancy | |
---|---|---|---|---|---|---|
Conventional/ 3D-CRT | IMRT | |||||
Followill 1997 [47]¥ | Out of field | Measured in phantom- previously published data | Whole body dose equivalent for neutrons and photons | 6MV | 0.6%§ | 1% |
18MV | 2.5% | 4.5% | ||||
NCRP risk coefficients | 25MV | 4.5% | 8.4% | |||
Hall 2003 [2] | In field and out of field | Scanned volume: calculated from DVHs (TPS not stated) | LP | 6MV | 1% | 1.75% |
LE (with 2 gradients of dose fall off) | ||||||
Scatter: measured in phantom- previously published | ||||||
Kry 2005 [40] | Out of field | Measured in phantom- previously published data | Organ specific dose equivalents for photons and neutrons | 6MV | NR | 2.9% |
10MV | NR | 2.1% | ||||
15MV | NR | 3.4% | ||||
NRCP risk co-efficients | 18MV | 1.7% | 5.1% | |||
Based on maximum MU to generate “conservative maximum risk estimate” | ||||||
Schneider 2006 [41] | In field and out of field | Scanned volume: calculated from TPS (Eclipse 7.3.10) | Organ equivalent dose | Risk shown is increased risk relative to 15MV 3D-CRT | ||
LE | 6MV | 15%(LE) 1%(LP) | ||||
Photon scatter and neutrons: measured in phantoms- previously published data | LP | 15MV | 20% (LE) 2% (LP) | |||
18MV | 60% (LE) 30% (LP) | |||||
Kry 2007 [50] | Out of field | Measured in phantom- previously published data | Organ specific dose equivalents for photons and neutrons | (Risk ratio relative to 18MV 3D-CRT and 90% CI in parentheses) | ||
EPA risk co-efficients | 6MV | with 1.9% (RR:1.4;1.1-1.8) | ||||
Based on average MU | 10MV | 1.5% (RR: 1.1; 0.9-1.3) | ||||
15MV | 2.2% (RR: 1.6; 1.3-2.0) | |||||
18MV | 3.6% (RR: 2.7; 2.1-3.2) | |||||
Schneider 2007 [49] | In field and out of field | Scanned volume: calculated from TPS (Eclipse 7.3.10) | Organ equivalent dose | Increased risk for 100Gy IMRT relative to 70Gy 15MV 3D-CRT | ||
LNT | 6MV | 18.4% (LE), 15.0% (LP), 22.3% (LNT) | ||||
LE | 15MV | 25.3% (LE), 17.0% (LP), 14.1% (LNT) | ||||
Photon scatter and neutrons: measured in phantoms- previously published data | LP | |||||
Stathakis 2007 [45] | Primary and out of field photons | Calculated using Monte Carlo simulations (EGS4/MCSIM) using whole body CT scans | Whole body dose equivalent | 6MV | 2.40% (LNT)** | 3.55% (LNT) |
NCRP risk coefficients | 1.13%(LP) | 2.65%(LP) | ||||
0.93%* | 2.46%* | |||||
Neutron contribution not included-likely to increase risk by 4-10% | LNT | 10MV | 3.43% (LNT) | 4.19%(LNT) | ||
LP | 1.72%(LP) | 3.19% (LP) | ||||
Out-of-field component only | 1.54%* | 3.02%* | ||||
18MV | 3.54% (LNT) | 4.05% (LNT) | ||||
1.73%(LP) | 3.07% (LP) | |||||
1.56%* | 2.90% * | |||||
Ruben 2008 [42] | In field and out of field | Scanned volume: calculated from TPS Plato RTS v1.8 and Plato-ITP v2.5) | DVH analysis | 18MV (3D-CRT) | 1% (2.1%) (LP) | |
Data in parentheses shown for no correction for PCa patients with long term survival (i.e. no reduced weighting) | 0.8% (1.5%)(LE) | |||||
Rest of body: measured in phantom Neutrons: measured in phantoms- previously published data | ||||||
LP | 6MV (IMRT) | 0.8% (1.7%) (LP) | ||||
LE | ||||||
0.6% (1.1%) (LE) | ||||||
Stathakis 2009 [46] | In field and out of field | Calculated using Monte Carlo simulations (EGS4/MCSIM) using whole body CT scan | Whole body effective dose equivalent. | 6MV | 2.61%** | 3.39% |
10MV | 2.48% | 3.09% | ||||
Neutron contribution not included | NRCP risk co-efficients | 18MV | 2.24% | 2.84% | ||
LNT | ||||||
Bednarz 2010 [33] | Out of field | Calculated using Monte Carlo simulations (MCNPX) using computational phantom | BEIR VII co-efficients | 18MV (3D-CRT: 4 field box + 6 field boost, anterior-posterior 4 field of box delivered using 6MV, rest of fields 18MV) | Risk of second tumour in: | |
Stomach: 0.03% | ||||||
Colon: 0.3% | ||||||
Oesophagus: 0.07% | ||||||
Thyroid: 3.1X10-4% | ||||||
6MV IMRT | Risk of second tumour in: | |||||
Stomach: 0.04% | ||||||
Colon: 0.4% | ||||||
Oesophagus: 0.07% | ||||||
Thyroid: 1.92X10-4% | ||||||
Patil 2010 [62] | In field | Scanned volume: calculated from TPS (Eclipse 7.3.10) | Organ equivalent dose | 6MV | No comparator | Modal estimate per 10000 person years: |
LP | ||||||
Bladder: 0.1 | ||||||
Rectum: 3.42 | ||||||
Small intestine: 7.789 | ||||||
(Whole body: 129.95***) |