This study was designed to estimate radiation-induced secondary cancer risks from high-dose-rate (HDR) brachytherapy and external radiotherapy for patients with cervical cancer based on measurements of doses absorbed by various organs. Organ doses from HDR brachytherapy and external radiotherapy were measured using glass rod dosimeters. Doses to out-of-field organs were measured at various locations inside an anthropomorphic phantom. Brachytherapy-associated organ doses were measured using a specialized phantom that enabled applicator insertion, with the pelvis portion of the existing anthropomorphic phantom replaced by this new phantom. Measured organ doses were used to calculate secondary cancer risk based on Biological Effects of Ionizing Radiation (BEIR) VII models. In both treatment modalities, organ doses per prescribed dose (PD) mostly depended on the distance between organs. The locations showing the highest and lowest doses were the right kidney (external radiotherapy: 215.2 mGy; brachytherapy: 655.17 mGy) and the brain (external radiotherapy: 15.82 mGy; brachytherapy: 2.49 mGy), respectively. Organ doses to nearby regions were higher for brachytherapy than for external beam therapy, whereas organ doses to distant regions were higher for external beam therapy. Organ doses to distant treatment regions in external radiotherapy were due primarily to out-of-field radiation resulting from scattering and leakage in the gantry head. For brachytherapy, the highest estimated lifetime attributable risk per 100,000 population was to the stomach (88.6), whereas the lowest risks were to the brain (0.4) and eye (0.4); for external radiotherapy, the highest and lowest risks were to the thyroid (305.1) and brain (2.4). These results may help provide a database on the impact of radiotherapy-induced secondary cancer incidence during cervical cancer treatment, as well as suggest further research on strategies to counteract the risks of radiotherapy-associated secondary malignancies.
Boram Lee,1,2 Sung Hwan Ahn,2 Hyeyoung Kim,2 Jaeman Son,1
Jiwon Sung,1 Youngyih Han,3 Seung Jae Huh,3 Jin Sung Kim,4
Dong Wook Kim,5 and Myonggeun Yoon1a
Department of Bio-convergence Engineering,1 Korea University, Seoul; Department of Radiation Oncology,2 Samsung Medical Center, Seoul; Department of Radiation Oncology,3 Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; Department of Radiation Oncology,4 College of Medicine, Yonsei Cancer Center, Seoul; Department of Radiation Oncology,5 Kyung Hee University Hospital at Gangdong, Seoul, Korea
Journal of Applied Clinical Medical Physics 17.5 (2016).