Radiobiological Pitfalls of New Techniques in Radiotherapy

Česká verzia

Authors: J. Kubeš; B. Ondrová; P. Vítek; S. Vinakurau
Authors place of work: Oddělení protonové terapie, Proton Therapy Center Czech, Praha
Published in the journal: Klin Onkol 2013; 26(6): 394-398
Category: Review

Summary

Radiotherapy techniques in the last decade evolved to the stage where the potential dose distribution significantly differs from earlier practices. Rotational IMRT, robotic radiotherapy or proton radiotherapy enables extremely precise dose delivery totarget volumes, on the other hand, these techniques can yield a number of problems. As for photon radiotherapy, this concerns primarily the effect of large volume irradiation with doses of 0.1−0.5 Gy. In this range, the hypersensitivity to low doses and the bystander effect may play an important role. Proton therapy is upredictable in its radiobiological effect at the end of the Bragg curve and there is also uncertainty about the peak‘s exact location. These effects should be taken into account when choosing among the irradiation techniques or when applying tolerance doses to critical organs in clinical practice, especially in younger patients with long survival expectation.

Key words:
radiobiology – proton beam therapy – by-stander effect – low dose hypersensitivity

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Submitted:
30. 7. 2013

Accepted:
3. 8. 2013

Zdroje

1. Goodhead DT. Initial events in the cellular effects of ionizing radiation: clustered damage to DNA. Int J Radiat Biol 1994, 65(1): 7–17.

2. Kolesnick R, Fuks Z. Radiation and ceramide-induced apoptosis. Oncogene 2003; 22(37): 5897–5906.

3. Rothkamm K, Lobrich M. Evidence for lack of DNA double-strand break repair in human cells exposed to very low x-ray doses. Proc Natl Acad Sci USA 2003; 100(9): 5057–5062.

4. Joiner MC, Marples B, Lambin P et al. Low-dose hypersensitivity: current status and possible mechanisms. Int J Radiat Oncol Biol Phys 2001; 49(2): 379–389.

5. Emami B, Lyman J, Brown A et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 1991; 21(1): 109–122.

6. Marks LB, Yorke ED, Jackson A et al. Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys 2010; 76 (Suppl 3): S10–S19.

7. Tucker SL, Liu HH, Liao Z et al. Analysis of radiation pneumonitis risk using a generalized Lyman model. Int J Radiat Oncol Biol Phys 2008; 72(2): 568–574.

8. Gondi V, Hermann BP, Mehta MP et al. Hippocampal dosimetry predicts neurocognitive function impairment after fractionated stereotactic radiotherapy for benign or low-grade adult brain tumors. Int J Radiat Oncol Biol Phys 2013; 85(2): 348–354.

9. Marsh JC, Godbole R, Diaz AZ et al. Sparing of the hippocampus, limbic circuit and neural stem cell compartment during partial brain radiotherapy for glioma: a dosimetric feasibility study. J Med Imaging Radiat Oncol 2011; 55(4): 442–449.

10. Honoré HB, Bentzen SM. A modelling study of the potential influence of low dose hypersensitivity on radiation treatment planning. Radiother Oncol 2006; 79(1): 115–121.

11. Yang H, Asaad N, Held KD. Medium-mediated intercellular communication is involved in bystander responses of X-ray irradiated normal human fibroblasts. Oncogene 2005; 24(12): 2096–2103.

12. Mothersill C, Seymour CB. Cell-cell contact during gamma irradiation is not required to induce a bystander effect in normal human keratinocytes: evidence for release during irradiation of a signal controllin survival into the medium. Radiat Res 1998; 149(3): 256–262.

13. Iyer R, Lehnert BE. Factors underlying the cell growth-related bystander responses to alpha particles. Cancer Res 2000; 60: 1290–98.

14. Lorimore SA, Chrystal JA, Robinson JI et al. Chromosomal instability in unirradiated hemaopoietic cells induced by macrophages exposed in vivo to ionizing radiation. Cancer Res 2008; 68(19): 8122–8126.

15. Sowa MB, Goetz W, Baulch JE et al. Lack of evidence for low-LET radiation induced bystander response in normal human fibroblasts and colon carcinoma cells. Int J Radiat Biol 2010; 86(2): 102–113.

16. Baskar R, Balajee AS, Geard CR. Effects of low and high LET radiations on bystander human lung fibroblast cell survival. Int J Radiat Biol 2007; 83(8): 551–559.

17. Morgan GW, Breit SN. Radiation and the lung: a reevaluation of the mechanisms mediating pulmonary injury. Int J Radiat Oncol Biol Phys 1995; 31: 361–369.

18. Hall EJ, Wuu CS. Radiation-induced second cancers: the impact of 3D-CRT and IMRT. Int J Radiat Oncol Biol Phys 2003; 56(1): 83–88.

19. Frese MC, Wilkens JJ, Huber PE et al. Application of constant vs variable relative biological effectiveness in treatment planning of intensity-modulated proton therapy. Int J Radiation Oncology Biol Phys 2011; 79(1): 80–88.

20. Hall EJ. Intensity-modulated radiation therapy, protons, and the risk of second cancers. Int J Radiat Oncol Biol Phys 2006; 65(1): 1–7.

21. Athar BS, Bednarz B, Seco J et al. Comparison of out-of-field photon doses in 6 MV IMRT and neutron doses in proton therapy for adult and pediatric patients. Phys Med Biol 2010; 55(10): 2879–2891.

22. Kry SF, Salehpour M, Followill DS et al. Out-of-field photon and neutron dose equivalents from step-and-shoot intensity-modulated radiation therapy. Int J Radiation Oncology Biol Phys 2005; 62(4): 1204–1216.

23. Kry SF, Salehpour M, Followill DS et al. The calculated risk of fatal secondary malignancies from intensity-modulated radiation therapy. Int J Radiation Oncology Biol Phys 2005; 62(4): 1195–1203.

24. Sterzing F, Stoiber EM, Nill S et al. Intensity modulated radiotherapy (IMRT) in the treatment of children and adolescents – a single institution‘s experience and a review of the literature. Radiat Oncol 2009; 4: 37.

25. Hall P, Adami HO, Trichopoulos D et al. Effect of low doses of ionising radiation in infancy on cognitive function in adulthood: Swedish population based cohort study. BMJ 2004; 328(7430): 19.

26. Gulliford SL, Miah AB, Brennan S et al. Dosimetric explanations of fatigue in head and neck radiotherapy: an analysis from the PARSPORT Phase III trial. Radiother Oncol 2012; 104(2): 205–212.

27. Shen WB, Zhu SC, Gao HM et al. Low dose volume histogram analysis of the lungs in prediction of acute radiation pneumonitis in patients with esophageal cancer treated with three-dimensional conformal radiotherapy. Zhonghua Zhong Liu Za Zhi 2013; 35(1): 45–49.

28. Allen AM, Czerminska M, Jänne PA et al. Fatal pneumonitis associated with intensity-modulated radiation therapy for mesothelioma. Int J Radiat Oncol Biol Phys 2006; 65(3): 640–645.

29. Yorke ED, Jackson A, Rosenzweig KE et al. Correlation of dosimetric factors and radiation pneumonitis for non–small cell lung cancer patients in a recently completed dose escalation study. Int J Radiat Oncol Biol Phys 2005; 63(3): 672–682.

30. Shore RE, Neriishi K, Nakashima E. Epidemiological studies of cataract risk at low to moderate radiation doses: (not) seeing is believing. Radiat Res 2010; 174(6): 889–894.

31. Behrens R, Dietze G. Monitoring the eye lens: which dose quantity is adequate? Phys Med Biol 2010; 55(14): 4047–4062.

32. Kleinerman RA. Cancer risks following diagnosis and therapeutic radiation exposure in children. Pediatr Radiol 2006; 36 (Suppl 14): 121–125.