A software tool for organ-specific second cancer risk assessment from exposure to therapeutic doses
Abstract
The aim of this study was the development of a software tool (SCRcalc) for the automatic estimation of the patient- and organ-specific cancer risk due to radiotherapy. SCRcalc was developed using the Python 3.8.7 programming language. It incorporates equations and parameters of mechanistic models for the calculation of the organ equivalent dose (OED), the excess absolute risk (EAR) and the lifetime attributable risk (LAR) of carcinogenesis for various organs due to radiotherapy. Data from differential dose-volume histograms, as defined by a treatment planning system, could be automatically inserted into the program. Eighteen different cancer risk estimates for various organs were performed of patients subjected to radiation therapy with conventional and modulated techniques. These software estimates were compared with manual calculations. SCRcalc was developed as a standalone executable program without any dependencies. It enables direct estimations of the OED and LAR for various organs at risk. An important aspect of the software is that it does not require pre-processing of the DVH data. No differences were found between the SCRcalc results and those derived from manual calculations. The newly developed software offers the possibility to medical physicists and radiation oncologists to directly estimate the probability of radiotherapy-induced secondary malignancies for various organs at risk.
Keywords: radiotherapyradiation risk assessmentsecondary malignanciesPythonsoftware development
References
- Siegel RL, Miller KD, Goding Sauer A, et al. Cancer statistics, 2020. CA Cancer J Clin. 2020; 70(1): 7–30.
- Kamran SC, Berrington de Gonzalez A, Ng A, et al. Therapeutic radiation and the potential risk of second malignancies. Cancer. 2016; 122(12): 1809–1821.
- Hall EJ. Intensity-modulated radiation therapy, protons, and the risk of second cancers. Int J Radiat Oncol Biol Phys. 2006; 65(1): 1–7.
- Grantzau T, Overgaard J. Risk of second non-breast cancer among patients treated with and without postoperative radiotherapy for primary breast cancer: A systematic review and meta-analysis of population-based studies including 522,739 patients. Radiother Oncol. 2016; 121(3): 402–413.
- Chaturvedi AK, Engels EA, Gilbert ES, et al. Second cancers among 104,760 survivors of cervical cancer: evaluation of long-term risk. J Natl Cancer Inst. 2007; 99(21): 1634–1643.
- Hall EJ, Giaccia AJ. Radiobiology for the radiologist 7th edn. Lippincott Wiliams and Wilkins, Philadelphia 2012.
- ICRP. The 2007 Recommendations of the International Commission on Radiological Protection. CRP publication 103. Ann ICRP. 2007; 37: 9–34.
- National Research Council. Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2 . National Academies Press, Washington 2006.
- Harrison R. Out-of-field doses in radiotherapy: Input to epidemiological studies and dose-risk models. Phys Med. 2017; 42: 239–246.
- Dasu A, Toma-Dasu I. Dose-effect model for risk-relationship to cell survival parameters . Acta Oncol. 2005; 44(8): 829–35.
- Shuryak I, Hahnfeldt P, Hlatky L, et al. A new view of radiation-induced cancer: integrating short- and long-term processes. Part II: second cancer risk estimation. Radiat Environ Biophys. 2009; 48(3): 275–286.
- UNSCEAR. Sources Effects of Ionising Radiation. 2000 Report to the General Assembly, with scientific annexes. United Nations, New York 2000.
- Sachs RK, Brenner DJ. Solid tumor risks after high doses of ionizing radiation. Proc Natl Acad Sci U S A. 2005; 102(37): 13040–13045.
- Dasu A, Toma-Dasu I. Models for the risk of secondary cancers from radiation therapy. Phys Med. 2017; 42: 232–238.
- Schneider U. Modeling the risk of secondary malignancies after radiotherapy. Genes (Basel). 2011; 2(4): 1033–1049.
- Schneider U, Sumila M, Robotka J. Site-specific dose-response relationships for cancer induction from the combined Japanese A-bomb and Hodgkin cohorts for doses relevant to radiotherapy. Theor Biol Med Model. 2011; 8: 27.
- Murray L, Sethugavalar B, Robertshaw H, et al. Involved Node, Site, Field and Residual Volume Radiotherapy for Lymphoma: A Comparison of Organ at Risk Dosimetry and Second Malignancy Risks. Clin Oncol (R Coll Radiol). 2015; 27(7): 401–410.
- Dörr W, Herrmann T. Second primary tumors after radiotherapy for malignancies. Treatment-related parameters. Strahlenther Onkol. 2002; 178(7): 357–362.
- Murray L, Sethugavalar B, Robertshaw H, et al. Involved Node, Site, Field and Residual Volume Radiotherapy for Lymphoma: A Comparison of Organ at Risk Dosimetry and Second Malignancy Risks. Clin Oncol (R Coll Radiol). 2015; 27(7): 401–410.
- Arias E. United States Life Tables, 2017. Natl Vital Stat Rep. 2019; 68(7): 1–66.
- Diallo I, Haddy N, Adjadj E, et al. Frequency distribution of second solid cancer locations in relation to the irradiated volume among 115 patients treated for childhood cancer. Int J Radiat Oncol Biol Phys. 2009; 74(3): 876–883.
- Welte B, Suhr P, Bottke D, et al. Second malignancies in high‑dose areas of previous tumor radiotherapy. Strahlenther Onkol. 2010; 186(3): 174–179.
- Gonzalez Ade, Curtis R, Kry S, et al. Proportion of second cancers attributable to radiotherapy treatment in adults: a cohort study in the US SEER cancer registries. Lancet Oncol. 2011; 12(4): 353–360.
- Mazonakis M, Kourinou K, Lyraraki E, et al. Thyroid exposure to scattered radiation and associated second cancer risk from paediatric radiotherapyfor extracranial tumours. Radiat Prot Dosimetry. 2012; 152(4): 317–322.
- Mazonakis M, Berris T, Varveris C, et al. Out-of-field organ doses and associated radiogenic risks from para-aortic radiotherapy for testicular seminoma. Med Phys. 2014; 41(5): 051702.