A review of dosimetry studies on external-beam radiation treatment with respect to second cancer ind.pdf

IOP PUBLISHING PHYSICS IN MEDICINE AND BIOLOGY Phys. Med. Biol. 53 (2008) R193–R241 doi:10.1088/0031-9155/53/13/R01 TOPICAL REVIEW A review of dosimetry studies on external-beam radiation treatment with respect to second cancer induction X George Xu1, Bryan Bednarz1 and Harald Paganetti2 1 Nuclear Engineering and Engineering Physics, Rensselaer Polytechnic Institute, Troy, NY 12180, USA 2 Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, USA Received 12 March 2007, in final form 26 April 2008 Published 9 June 2008 Online at /PMB/53/R193 Abstract It has been long known that patients treated with ionizing radiation carry a risk of developing a second cancer in their lifetimes. Factors contributing to the recently renewed concern about the second cancer include improved cancer survival rate, younger patient population as well as emerging treatment modalities such as intensity-modulated radiation treatment (IMRT) and proton therapy that can potentially elevate secondary exposures to healthy tissues distant from the target volume. In the past 30 years, external-beam treatment technologies have evolved significantly, and a large amount of data exist but appear to be difficult to comprehend and compare. This review article aims to provide readers with an understanding of the principles and methods related to scattered doses in radiation therapy by summarizing a large collection of dosimetry and clinical studies. Basic concepts and terminology are introduced at the beginning. That is followed by a comprehensive review of dosimetry studies for external-beam treatment modalities including classical radiation therapy, 3D-conformal x-ray therapy, intensity-modulated x-ray therapy (IMRT and tomotherapy) and proton therapy. Selected clinical data on second cancer induction among radiotherapy patients are also covered. Problems in past studies and controversial issues are discussed. The needs for future studies are presented at the end. Contents 1