Radiobiological risk estimates of adverse events and secondary cancer for proton and photon radiation therapy of pediatric medulloblastoma

Nils P. Brodin, Per Munck Af Rosenschöld, Marianne C. Aznar, Anne Kiil-Berthelsen, Ivan R. Vogelius, Per Nilsson, Birgitta Lannering, Thomas Björk-Eriksson

Research output: Contribution to journalArticle

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Abstract

Introduction. The aim of this model study was to estimate and compare the risk of radiation-induced adverse late effects in pediatric patients with medulloblastoma (MB) treated with either three-dimensional conformal radiotherapy (3D CRT), inversely-optimized arc therapy (RapidArc ® (RA)) or spot-scanned intensity-modulated proton therapy (IMPT). The aim was also to find dose-volume toxicity parameters relevant to children undergoing RT to be used in the inverse planning of RA and IMPT, and to use in the risk estimations. Material and methods. Treatment plans were created for all three techniques on 10 pediatric patients that have been treated with craniospinal irradiation (CSI) at our institution in 20072009. Plans were generated for two prescription CSI doses, 23.4 Gy and 36 Gy. Risk estimates were based on childhood cancer survivor data when available and secondary cancer (SC) risks were estimated as a function of age at exposure and attained age according to the organ-equivalent dose (OED) concept. Results. Estimates of SC risk was higher for the RA plans and differentiable from the estimates for 3D CRT at attained ages above 40 years. The risk of developing heart failure, hearing loss, hypothyroidism and xerostomia was highest for the 3D CRT plans. The risks of all adverse effects were estimated as lowest for the IMPT plans, even when including secondary neutron (SN) irradiation with high values of the neutron radiation weighting factors (WRneutron). Conclusions. When comparing RA and 3D CRT treatment for pediatric MB it is a matter of comparing higher SC risk against higher risks of non-cancer adverse events. Considering time until onset of the different complications is necessary to fully assess patient benefit in such a comparison. The IMPT plans, including SN dose contribution, compared favorably to the photon techniques in terms of all radiobiological risk estimates.

Original languageEnglish (US)
Pages (from-to)806-816
Number of pages11
JournalActa Oncologica
Volume50
Issue number6
DOIs
StatePublished - Aug 2011
Externally publishedYes

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Medulloblastoma
Photons
Protons
Radiotherapy
Pediatrics
Proton Therapy
Neoplasms
Neutrons
Craniospinal Irradiation
Radiation
Conformal Radiotherapy
Xerostomia
Hypothyroidism
Hearing Loss
Prescriptions
Survivors
Therapeutics
Heart Failure

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Hematology

Cite this

Brodin, N. P., Rosenschöld, P. M. A., Aznar, M. C., Kiil-Berthelsen, A., Vogelius, I. R., Nilsson, P., ... Björk-Eriksson, T. (2011). Radiobiological risk estimates of adverse events and secondary cancer for proton and photon radiation therapy of pediatric medulloblastoma. Acta Oncologica, 50(6), 806-816. https://doi.org/10.3109/0284186X.2011.582514

Radiobiological risk estimates of adverse events and secondary cancer for proton and photon radiation therapy of pediatric medulloblastoma. / Brodin, Nils P.; Rosenschöld, Per Munck Af; Aznar, Marianne C.; Kiil-Berthelsen, Anne; Vogelius, Ivan R.; Nilsson, Per; Lannering, Birgitta; Björk-Eriksson, Thomas.

In: Acta Oncologica, Vol. 50, No. 6, 08.2011, p. 806-816.

Research output: Contribution to journalArticle

Brodin, NP, Rosenschöld, PMA, Aznar, MC, Kiil-Berthelsen, A, Vogelius, IR, Nilsson, P, Lannering, B & Björk-Eriksson, T 2011, 'Radiobiological risk estimates of adverse events and secondary cancer for proton and photon radiation therapy of pediatric medulloblastoma', Acta Oncologica, vol. 50, no. 6, pp. 806-816. https://doi.org/10.3109/0284186X.2011.582514
Brodin, Nils P. ; Rosenschöld, Per Munck Af ; Aznar, Marianne C. ; Kiil-Berthelsen, Anne ; Vogelius, Ivan R. ; Nilsson, Per ; Lannering, Birgitta ; Björk-Eriksson, Thomas. / Radiobiological risk estimates of adverse events and secondary cancer for proton and photon radiation therapy of pediatric medulloblastoma. In: Acta Oncologica. 2011 ; Vol. 50, No. 6. pp. 806-816.
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AU - Brodin, Nils P.

AU - Rosenschöld, Per Munck Af

AU - Aznar, Marianne C.

AU - Kiil-Berthelsen, Anne

AU - Vogelius, Ivan R.

AU - Nilsson, Per

AU - Lannering, Birgitta

AU - Björk-Eriksson, Thomas

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N2 - Introduction. The aim of this model study was to estimate and compare the risk of radiation-induced adverse late effects in pediatric patients with medulloblastoma (MB) treated with either three-dimensional conformal radiotherapy (3D CRT), inversely-optimized arc therapy (RapidArc ® (RA)) or spot-scanned intensity-modulated proton therapy (IMPT). The aim was also to find dose-volume toxicity parameters relevant to children undergoing RT to be used in the inverse planning of RA and IMPT, and to use in the risk estimations. Material and methods. Treatment plans were created for all three techniques on 10 pediatric patients that have been treated with craniospinal irradiation (CSI) at our institution in 20072009. Plans were generated for two prescription CSI doses, 23.4 Gy and 36 Gy. Risk estimates were based on childhood cancer survivor data when available and secondary cancer (SC) risks were estimated as a function of age at exposure and attained age according to the organ-equivalent dose (OED) concept. Results. Estimates of SC risk was higher for the RA plans and differentiable from the estimates for 3D CRT at attained ages above 40 years. The risk of developing heart failure, hearing loss, hypothyroidism and xerostomia was highest for the 3D CRT plans. The risks of all adverse effects were estimated as lowest for the IMPT plans, even when including secondary neutron (SN) irradiation with high values of the neutron radiation weighting factors (WRneutron). Conclusions. When comparing RA and 3D CRT treatment for pediatric MB it is a matter of comparing higher SC risk against higher risks of non-cancer adverse events. Considering time until onset of the different complications is necessary to fully assess patient benefit in such a comparison. The IMPT plans, including SN dose contribution, compared favorably to the photon techniques in terms of all radiobiological risk estimates.

AB - Introduction. The aim of this model study was to estimate and compare the risk of radiation-induced adverse late effects in pediatric patients with medulloblastoma (MB) treated with either three-dimensional conformal radiotherapy (3D CRT), inversely-optimized arc therapy (RapidArc ® (RA)) or spot-scanned intensity-modulated proton therapy (IMPT). The aim was also to find dose-volume toxicity parameters relevant to children undergoing RT to be used in the inverse planning of RA and IMPT, and to use in the risk estimations. Material and methods. Treatment plans were created for all three techniques on 10 pediatric patients that have been treated with craniospinal irradiation (CSI) at our institution in 20072009. Plans were generated for two prescription CSI doses, 23.4 Gy and 36 Gy. Risk estimates were based on childhood cancer survivor data when available and secondary cancer (SC) risks were estimated as a function of age at exposure and attained age according to the organ-equivalent dose (OED) concept. Results. Estimates of SC risk was higher for the RA plans and differentiable from the estimates for 3D CRT at attained ages above 40 years. The risk of developing heart failure, hearing loss, hypothyroidism and xerostomia was highest for the 3D CRT plans. The risks of all adverse effects were estimated as lowest for the IMPT plans, even when including secondary neutron (SN) irradiation with high values of the neutron radiation weighting factors (WRneutron). Conclusions. When comparing RA and 3D CRT treatment for pediatric MB it is a matter of comparing higher SC risk against higher risks of non-cancer adverse events. Considering time until onset of the different complications is necessary to fully assess patient benefit in such a comparison. The IMPT plans, including SN dose contribution, compared favorably to the photon techniques in terms of all radiobiological risk estimates.

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