Estimating Radiotherapy-Induced Secondary Cancer Risk Arising from Brain Irradiation at High Energy: A Monte Carlo Study
Background: The present study aims to determine the whole-body out-of-field photon dose equivalents of high-energy conventional radiation therapy treatment. Also, it is tried to estimate the probability of fatal secondary cancer risk for the susceptible organs using a Monte Carlo (MC) code.
Materials and methods: An Monte Carlo N-Particle eXtended (MCNPX)-based model of 18-MV Medical Linear Accelerator (LINAC) was created to calculate the out-of-field photon dose equivalent at the locations of fascinating organs in the mathematical female Medical Internal Radiation Dosimetry (MIRD) phantom. Then, the secondary malignancies risk was estimated based on out-of-field doses and radiation risk coefficients according to the National Council of Radiation Protection and Measurements (NCRP).
Results: The average photon equivalent dose in out-of-field organs was about 3.25 mSv/Gy, ranging from 0.23 to 37.2 mSv/Gy, respectively, for the organs far from the Planning Target Volume (PTV) (Eyes) and those close to the treatment field (rectum). The entire secondary cancer risk for the 60 Gy prescribed dose to isocenter was obtained as 2.9987%. Here, the maximum doses among off-field organs were related to stomach (0.0805%), lung (0.0601%), and thyroid (0.0404%).
Conclusion: Regarding the estimated values for the probability of secondary cancer risk, it is suggested to perform a long-term follow-up of brain cancer patients regarding the prevalence of thyroid, stomach, and lung cancer after completing the treatment course.