The British journal of radiology · 2021
Comparing second cancer risk for multiple radiotherapy modalities in survivors of hodgkin lymphoma.
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Timlin Claire, Loken James, Kruse Jon, Miller Robert, Schneider Uwe
Аннотация
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 three-dimensional conformal radiation therapy plan is equivalent within the uncertainty.
CONCLUSION: 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.
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 three-dimensional conformal radiation therapy plan is equivalent within the uncertainty.
CONCLUSION: 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.