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Comparing second cancer risk for multiple radiotherapy modalities in survivors of hodgkin lymphoma


Timlin, Claire; Loken, James; Kruse, Jon; Miller, Robert; Schneider, Uwe (2020). Comparing second cancer risk for multiple radiotherapy modalities in survivors of hodgkin lymphoma. British Journal of Radiology:Epub ahead of print.

Abstract

Objectives:

To assess if Excess Absolute Risk (EAR) of radiation-induced solid cancer can be used to rank radiotherapy plans for treatment of Hodgkin Lymphoma (HL) in a statistically significant way.

Methods:

EAR models, calibrated with data from the Life Span Study and HL survivors, have been incorporated into a voxelised risk-calculation software, which is used to compare four treatment modalities planned for five virtual HL patients. Organ-specific parameters are generated repeatedly in a Monte Carlo fashion to model their uncertainties. This in turn enables a quantitative estimation of the EAR uncertainties.

Results:

Parameter driven uncertainties on total EAR are around 13%, decreasing to around 2–5% for relative EAR comparisons. Total EAR estimations indicate that Intensity Modulated Proton Therapy decreases the average risk by 40% compared to the Intensity Modulated Radiation Therapy plan, 28% compared to the Volumetric Modulated Arc Therapy plan whereas the 3D Conformal Radiation Therapy plan is equivalent within the uncertainty.

Conclusions:

Relative EAR is a useful metric for distinguishing between radiotherapy plans in terms of second cancer risk.

Advances in knowledge:

Relative EAR is not dominated by model or parameter uncertainties and can be used to guide the choice of radiotherapy for HL patients.

Abstract

Objectives:

To assess if Excess Absolute Risk (EAR) of radiation-induced solid cancer can be used to rank radiotherapy plans for treatment of Hodgkin Lymphoma (HL) in a statistically significant way.

Methods:

EAR models, calibrated with data from the Life Span Study and HL survivors, have been incorporated into a voxelised risk-calculation software, which is used to compare four treatment modalities planned for five virtual HL patients. Organ-specific parameters are generated repeatedly in a Monte Carlo fashion to model their uncertainties. This in turn enables a quantitative estimation of the EAR uncertainties.

Results:

Parameter driven uncertainties on total EAR are around 13%, decreasing to around 2–5% for relative EAR comparisons. Total EAR estimations indicate that Intensity Modulated Proton Therapy decreases the average risk by 40% compared to the Intensity Modulated Radiation Therapy plan, 28% compared to the Volumetric Modulated Arc Therapy plan whereas the 3D Conformal Radiation Therapy plan is equivalent within the uncertainty.

Conclusions:

Relative EAR is a useful metric for distinguishing between radiotherapy plans in terms of second cancer risk.

Advances in knowledge:

Relative EAR is not dominated by model or parameter uncertainties and can be used to guide the choice of radiotherapy for HL patients.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:07 Faculty of Science > Physics Institute
Dewey Decimal Classification:530 Physics
Uncontrolled Keywords:Radiology Nuclear Medicine and imaging, General Medicine
Language:English
Date:25 November 2020
Deposited On:15 Jan 2021 08:13
Last Modified:15 Jan 2021 08:13
Publisher:British Institute of Radiology
ISSN:0007-1285
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1259/bjr.20200354
PubMed ID:33237825

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