TY - JOUR
T1 - Advances in radiotherapy and its impact on second primary cancer risk
T2 - A multi-center cohort study in prostate cancer patients
AU - Jahreiß, Marie Christina
AU - Hoogeman, Mischa
AU - Aben, Katja KH
AU - Dirkx, Maarten
AU - Snieders, Renier
AU - Pos, Floris J.
AU - Janssen, Tomas
AU - Dekker, Andre
AU - Vanneste, Ben
AU - Minken, Andre
AU - Hoekstra, Carel
AU - Smeenk, Robert J.
AU - Incrocci, Luca
AU - Heemsbergen, Wilma D.
N1 - Funding Information:
This study was funded by a grant (12009) from The Dutch Cancer Society (KWF).
Publisher Copyright:
© 2023 The Author(s)
PY - 2023/6
Y1 - 2023/6
N2 - Background: Modelling studies suggest that advanced intensity-modulated radiotherapy may increase second primary cancer (SPC) risks, due to increased radiation exposure of tissues located outside the treatment fields. In the current study we investigated the association between SPC risks and characteristics of applied external beam radiotherapy (EBRT) protocols for localized prostate cancer (PCa). Methods: We collected EBRT protocol characteristics (2000–2016) from five Dutch RT institutes for the 3D-CRT and advanced EBRT era (N = 7908). From the Netherlands Cancer Registry we obtained patient/tumour characteristics, SPC data, and survival information. Standardized incidence ratios (SIR) were calculated for pelvis and non-pelvis SPC. Nationwide SIRs were calculated as a reference, using calendar period as a proxy to label 3D-CRT/advanced EBRT. Results: From 2000-2006, 3D-CRT with 68–78 Gy in 2 Gy fractions, delivered with 10–23 MV and weekly portal imaging was the most dominant protocol. By the year 2010 all institutes routinely used advanced EBRT (IMRT, VMAT, tomotherapy), mainly delivering 78 Gy in 2 Gy fractions, using various kV/MV imaging protocols. Sixteen percent (N = 1268) developed ≥ 1 SPC. SIRs for pelvis and non-pelvis SPC (all institutes, advanced EBRT vs 3D-CRT) were 1.17 (1.00–1.36) vs 1.39 (1.21–1.59), and 1.01 (0.89–1.07) vs 1.03 (0.94–1.13), respectively. Nationwide non-pelvis SIR was 1.07 (1.01–1.13) vs 1.02 (0.98–1.07). Other RT protocol characteristics did not correlate with SPC endpoints. Conclusion: None of the studied RT characteristics of advanced EBRT was associated with increased out-of-field SPC risks. With constantly evolving EBRT protocols, evaluation of associated SPC risks remains important.
AB - Background: Modelling studies suggest that advanced intensity-modulated radiotherapy may increase second primary cancer (SPC) risks, due to increased radiation exposure of tissues located outside the treatment fields. In the current study we investigated the association between SPC risks and characteristics of applied external beam radiotherapy (EBRT) protocols for localized prostate cancer (PCa). Methods: We collected EBRT protocol characteristics (2000–2016) from five Dutch RT institutes for the 3D-CRT and advanced EBRT era (N = 7908). From the Netherlands Cancer Registry we obtained patient/tumour characteristics, SPC data, and survival information. Standardized incidence ratios (SIR) were calculated for pelvis and non-pelvis SPC. Nationwide SIRs were calculated as a reference, using calendar period as a proxy to label 3D-CRT/advanced EBRT. Results: From 2000-2006, 3D-CRT with 68–78 Gy in 2 Gy fractions, delivered with 10–23 MV and weekly portal imaging was the most dominant protocol. By the year 2010 all institutes routinely used advanced EBRT (IMRT, VMAT, tomotherapy), mainly delivering 78 Gy in 2 Gy fractions, using various kV/MV imaging protocols. Sixteen percent (N = 1268) developed ≥ 1 SPC. SIRs for pelvis and non-pelvis SPC (all institutes, advanced EBRT vs 3D-CRT) were 1.17 (1.00–1.36) vs 1.39 (1.21–1.59), and 1.01 (0.89–1.07) vs 1.03 (0.94–1.13), respectively. Nationwide non-pelvis SIR was 1.07 (1.01–1.13) vs 1.02 (0.98–1.07). Other RT protocol characteristics did not correlate with SPC endpoints. Conclusion: None of the studied RT characteristics of advanced EBRT was associated with increased out-of-field SPC risks. With constantly evolving EBRT protocols, evaluation of associated SPC risks remains important.
UR - http://www.scopus.com/inward/record.url?scp=85151661821&partnerID=8YFLogxK
U2 - 10.1016/j.radonc.2023.109659
DO - 10.1016/j.radonc.2023.109659
M3 - Article
C2 - 37003369
AN - SCOPUS:85151661821
SN - 0167-8140
VL - 183
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
M1 - 109659
ER -
