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Lifetime radiation-induced sarcoma risk in patients subjected to IMRT or VMAT for uterine cervix carcinoma

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Abstract

This study was conducted to estimate the lifetime radiation-induced bone and soft tissue sarcoma risks from intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) for uterine cervix carcinoma. 13 cervical cancer patients were included. The bone and soft tissue structures were defined on patients’ treatment planning computed tomography (CT) scans. Both CT-based IMRT and VMAT plans with 6 MV photons delivering 45 Gy to the target site were designed for each patient. The organ equivalent dose (OED) and the lifetime attributable risk (LAR) for developing bone or soft tissue sarcoma were estimated using treatment planning data and a non-linear mechanistic model. The estimation method did not consider the survival rates following radiotherapy and the use of brachytherapy treatments. The patient-specific OEDs of the bone structure from IMRT and VMAT were 2.33–2.83 and 2.34–2.82 Gy, respectively. The corresponding values for the soft tissue structure were 1.27–1.70 and 1.32–1.73 Gy. An insignificant difference was found between the patient-specific OEDs and the directly proportional sarcoma risks (bone: P = 0.07; soft tissue: P = 0.38). The LAR for the development of a bone sarcoma varied from 0.05 to 0.16% by the patient’s age during irradiation and the applied treatment delivery technique. The corresponding LAR range for radiation-induced soft-tissue sarcoma was 0.08–0.27%. The above LARs resulted in a relative risk of more than 1.20 indicating that IMRT or VMAT may lead to a considerable risk increase of developing bone or soft tissue sarcoma exceeding 20% in respect to the current incidence of these malignancies in unexposed population.

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Data availability

The complete datasets can be obtained by the corresponding author on reasonable request.

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Acknowledgements

The present research study was supported with a grant from the Research Committee of the University of Crete (Code: 10599).

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Authors and Affiliations

  1. Department of Medical Physics, Faculty of Medicine, University of Crete, P.O. Box 2208, 71003, Iraklion, Crete, Greece

    M. Mazonakis & J. Damilakis

  2. Department of Radiotherapy and Oncology, University Hospital of Iraklion, 71110, Iraklion, Crete, Greece

    E. Lyraraki

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  1. M. Mazonakis
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Correspondence to M. Mazonakis.

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The authors declare that they have no competing interests.

Ethical approval

The study was performed in accordance with the principles of the Declaration of Helsinki. Approval was granted by the ethics committee of the University Hospital of Heraklion, Crete, Greece (Reference: 425/04-09-2019) and the ethics committee of the University of Crete (Reference: 71/26-03-2020).

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Informed consent was obtained from all individual participants included in this study.

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Mazonakis, M., Lyraraki, E. & Damilakis, J. Lifetime radiation-induced sarcoma risk in patients subjected to IMRT or VMAT for uterine cervix carcinoma. Phys Eng Sci Med 44, 573–579 (2021). https://doi.org/10.1007/s13246-021-01002-5

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