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DEGRO practical guidelines for radiotherapy of non-malignant disorders

Part I: physical principles, radiobiological mechanisms, and radiogenic risk

DEGRO-S2e-Leitlinie für die Strahlentherapie von gutartigen Erkrankungen

Teil I: Physikalische Grundlagen, radiobiologische Mechanismen und radiogene Risiken

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Abstract

Purpose

Synopsis of the introductory paragraph of the DEGRO consensus S2e-guideline recommendations for the radiotherapy of benign disorders, including physical principles, radiobiological mechanisms, and radiogenic risk.

Materials and methods

This work is based on the S2e-guideline recommendations published November 14, 2013. The basic principles of radiation physics and treatment delivery, evaluation of putative underlying radiobiological mechanisms, and the assessment of genetic and cancer risk following low-dose irradiation will be presented.

Results

Radiation therapy of benign diseases is performed according to similar physical principles as those governing treatment of malignant diseases in radiation oncology, using the same techniques and workflows. These methods comprise usage of orthovoltage X-ray units, gamma irradiation facilities, linear accelerators (LINACs), and brachytherapy. Experimental in vitro and in vivo models recently confirmed the clinically observed anti-inflammatory effect of low-dose X-irradiation, and implicated a multitude of radiobiological mechanisms. These include modulation of different immunological pathways, as well as the activities of endothelial cells, mono- and polymorphonuclear leukocytes, and macrophages. The use of effective dose for radiogenic risk assessment and the corresponding tumor incidence rate of 5.5 %/Sv are currently controversially discussed. Some authors argue that the risk of radiation-induced cancers should be estimated on the basis of epidemiological data. However, such data are rarely available at present and associated with high variability.

Conclusion

Current radiobiological studies clearly demonstrate a therapeutic effectiveness of radiation therapy used to treat benign diseases and implicate various molecular mechanisms. Radiogenic risks should be taken into account when applying radiation treatment for benign diseases.

Zusammenfassung

Hintergrund

Zusammenfassung des einführenden Kapitels der DEGRO-S2e-Leitlinie zur Strahlentherapie gutartiger Erkrankungen einschließlich der physikalischen Grundlagen, strahlenbiologischer Mechanismen und des radiogenen Risikos.

Material und Methoden

Basis für diesen Beitrag ist die am 14. November 2013 neu aufgelegte S2e-Leitlinie zur Strahlentherapie gutartiger Erkrankungen. Dabei werden die allgemeinen Grundlagen der Strahlenphysik und Bestrahlungstechnik, zugrundeliegende radiobiologische Mechanismen und die Erfassung des genetischen und Tumorrisikos nach niedrigdosierter Bestrahlung dargestellt.

Ergebnisse

Die Strahlentherapie gutartiger Erkrankungen erfolgt gemäß den gleichen physikalischen Prinzipien und Abläufen wie die Behandlung von Tumorerkrankungen in der Radioonkologie und umfasst den Einsatz von Hochvolt-Röntgentherapieanlagen, Gammabestrahlungsgeräten, Linearbeschleunigern und der Brachytherapie. Experimentelle In-vitro- und In-vivo-Modelle konnten kürzlich die klinisch beobachtete entzündungshemmende Wirkung der niedrigdosierten Strahlentherapie bestätigen und eine Vielzahl zugrundeliegender strahlenbiologischer Mechanismen aufzeigen. Diese umfassen die Modulation unterschiedlicher immunologischer Reaktionskaskaden und die Aktivität von Endothelzellen, mono- und polymorphonukleären Leukozyten und Makrophagen. Die Anwendung der effektiven Dosis zur Risikoabschätzung und entsprechende Angaben einer Tumorinzidenz von 5,5 %/Sv werden derzeit kontrovers diskutiert. Einige Autoren plädieren dafür, die Abschätzung des Risikos strahleninduzierter Krebserkrankungen auf der Basis epidemiologischer Daten vorzunehmen. Diese Daten hingegen sind derzeit noch selten und mit einer hohen Variabilität assoziiert.

Schlussfolgerung

Aktuelle strahlenbiologische Studien belegen eine therapeutische Wirksamkeit und zeigen zugrundeliegende molekulare Mechanismen auf. Bei Indikationsstellung zur Therapie gutartiger Erkrankungen sollte ein mögliches radiogenes Risiko berücksichtigt werden.

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Authors and Affiliations

  1. Department of Radiotherapy and Radiation Oncology, Hospital Weiden, Söllnerstrasse 16, 92637, Weiden, Germany

    Berthold Reichl Dipl.-Phys.

  2. Institute for Medical Radiation Physics and Radiation Protection, Hospital Dortmund, Dortmund, Germany

    Andreas Block PhD

  3. Dept. of Radiotherapy, Lippe Hospital, Lemgo, Germany

    Ulrich Schäfer MD

  4. Dept. of Radiation Oncology, University Hospitals Erlangen, Erlangen, Germany

    Christoph Bert PhD & Reinhold Müller PhD

  5. Dept. of Radiotherapy and Radiation Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany

    Horst Jung PhD

  6. Dept. of Radiotherapy and Oncology, University Hospital Goethe-University, Frankfurt am Main, Germany

    Franz Rödel PhD

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  1. Berthold Reichl Dipl.-Phys.
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  2. Andreas Block PhD
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  3. Ulrich Schäfer MD
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the German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD)

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Correspondence to Berthold Reichl Dipl.-Phys..

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Conflict of interest

B. Reichl, A. Block, U. Schäfer, C. Bert, R. Müller, H. Jung, and F. Rödel state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

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Reichl, B., Block, A., Schäfer, U. et al. DEGRO practical guidelines for radiotherapy of non-malignant disorders. Strahlenther Onkol 191, 701–709 (2015). https://doi.org/10.1007/s00066-015-0865-8

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