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Complete patient exposure during paediatric brain cancer treatment for photon and proton therapy techniques including imaging procedures

De Saint-Hubert, Marijke; Boissonnat, Guillaume; Schneider, Uwe; Bäumer, Christian; Verbeek, Nico; Esser, Johannes; Wulff, Jörg; Stuckmann, Florian; Suesselbeck, Finja; Nabha, Racell; Dabin, Jérémie; Vasi, Fabiano; Radonic, Stephan; Rodriguez, Miguel; Simon, Anne Catherine; Journy, Neige; Timmermann, Beate; Thierry-Chef, Isabelle; Brualla, Lorenzo (2023). Complete patient exposure during paediatric brain cancer treatment for photon and proton therapy techniques including imaging procedures. Frontiers in Oncology, 13:1222800.

Abstract

BackgroundIn radiotherapy, especially when treating children, minimising exposure of healthy tissue can prevent the development of adverse outcomes, including second cancers. In this study we propose a validated Monte Carlo framework to evaluate the complete patient exposure during paediatric brain cancer treatment.Materials and methodsOrgan doses were calculated for treatment of a diffuse midline glioma (50.4 Gy with 1.8 Gy per fraction) on a 5-year-old anthropomorphic phantom with 3D-conformal radiotherapy, intensity modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT) and intensity modulated pencil beam scanning (PBS) proton therapy. Doses from computed tomography (CT) for planning and on-board imaging for positioning (kV-cone beam CT and X-ray imaging) accounted for the estimate of the exposure of the patient including imaging therapeutic dose. For dose calculations we used validated Monte Carlo-based tools (PRIMO, TOPAS, PENELOPE), while lifetime attributable risk (LAR) was estimated from dose-response relationships for cancer induction, proposed by Schneider et al.ResultsOut-of-field organ dose equivalent data of proton therapy are lower, with doses between 0.6 mSv (testes) and 120 mSv (thyroid), when compared to photon therapy revealing the highest out-of-field doses for IMRT ranging between 43 mSv (testes) and 575 mSv (thyroid). Dose delivered by CT ranged between 0.01 mSv (testes) and 72 mSv (scapula) while a single imaging positioning ranged between 2 $_{μ}$Sv (testes) and 1.3 mSv (thyroid) for CBCT and 0.03 $_{μ}$Sv (testes) and 48 $_{μ}$Sv (scapula) for X-ray. Adding imaging dose from CT and daily CBCT to the therapeutic demonstrated an important contribution of imaging to the overall radiation burden in the course of treatment, which is subsequently used to predict the LAR, for selected organs.ConclusionThe complete patient exposure during paediatric brain cancer treatment was estimated by combining the results from different Monte Carlo-based dosimetry tools, showing that proton therapy allows significant reduction of the out-of-field doses and secondary cancer risk in selected organs.

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:07 Faculty of Science > Physics Institute
Dewey Decimal Classification:530 Physics
Scopus Subject Areas:Health Sciences > Oncology
Life Sciences > Cancer Research
Uncontrolled Keywords:Cancer Research, Oncology
Language:English
Date:19 September 2023
Deposited On:15 Dec 2023 12:02
Last Modified:30 Oct 2024 02:38
Publisher:Frontiers Research Foundation
ISSN:2234-943X
OA Status:Gold
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.3389/fonc.2023.1222800
Project Information:
  • Funder: H2020 Euratom
  • Grant ID:
  • Project Title:
  • Funder: Ministerio de Ciencia e Innovación
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  • Licence: Creative Commons: Attribution 4.0 International (CC BY 4.0)

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