Risks of secondary malignancies with heterotopic bone radiation therapy for patients younger than 40 years

Catherine L. Cadieux, Colleen DesRosiers, Kevin McMullen

Research output: Contribution to journalArticle

Abstract

Heterotopic ossification (HO) of the bone is defined as a benign condition in which abnormal bone formation occurs in soft tissue. One of the most common prophylactic treatments for HO is radiation therapy (RT). This study retrospectively reviewed 20 patients younger than the age of 40 who received radiation to prevent HO in a single fraction of 7 Gray. The purpose of this study is to assess the risk of a second malignancy in these patients by recreating their treatment fields and contouring organs at risk to estimate the radiation dose absorbed by normal tissues outside the radiation treatment field. Diagnostic computed tomography (CT) scans for each patient were used to recreate treatment fields and to calculate dose to structures of interest. The distance from the field edge to each structure and its depth was recorded. Dose measurements in a water phantom were performed for the range of depths, distances, and field sizes used in the actual treatment plans. Computer-generated doses were compared to estimates based on measurement. The structure dose recorded was the higher dose generated between the 2 methods. Scatter dose was recorded to the rectum, bladder, sigmoid colon, small bowel, ovaries and utero-cervix in female patients, and prostate and gonads in male patients. In some patients, there is considerable dose received by certain organs from scatter because of their proximity to the radiation field. The average dose to the ovarian region was 4.125. Gy with a range of 1.085 to 6.228. Gy. The risk estimate for these patients ranged from 0.16% to 0.93%. The average total lifetime risk estimate for the bladder in all patients is 0.22% and the average total lifetime risk estimate for the remainder organs in all patients is 1.25%. In conclusions, proper shielding created from multileaf collimators (MLCs), blocks, and shields should always be used when possible.

Original languageEnglish (US)
JournalMedical Dosimetry
DOIs
StateAccepted/In press - May 1 2015

Fingerprint

Radiotherapy
Bone and Bones
Heterotopic Ossification
Neoplasms
Radiation
Urinary Bladder
Organs at Risk
Therapeutics
Second Primary Neoplasms
Gonads
Sigmoid Colon
Rectum
Osteogenesis
Cervix Uteri
Prostate
Ovary
Tomography
Water

Keywords

  • Heterotopic bone ossification
  • Radiation therapy treatment
  • Secondary malignancies
  • Side effect

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

Risks of secondary malignancies with heterotopic bone radiation therapy for patients younger than 40 years. / Cadieux, Catherine L.; DesRosiers, Colleen; McMullen, Kevin.

In: Medical Dosimetry, 01.05.2015.

Research output: Contribution to journalArticle

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abstract = "Heterotopic ossification (HO) of the bone is defined as a benign condition in which abnormal bone formation occurs in soft tissue. One of the most common prophylactic treatments for HO is radiation therapy (RT). This study retrospectively reviewed 20 patients younger than the age of 40 who received radiation to prevent HO in a single fraction of 7 Gray. The purpose of this study is to assess the risk of a second malignancy in these patients by recreating their treatment fields and contouring organs at risk to estimate the radiation dose absorbed by normal tissues outside the radiation treatment field. Diagnostic computed tomography (CT) scans for each patient were used to recreate treatment fields and to calculate dose to structures of interest. The distance from the field edge to each structure and its depth was recorded. Dose measurements in a water phantom were performed for the range of depths, distances, and field sizes used in the actual treatment plans. Computer-generated doses were compared to estimates based on measurement. The structure dose recorded was the higher dose generated between the 2 methods. Scatter dose was recorded to the rectum, bladder, sigmoid colon, small bowel, ovaries and utero-cervix in female patients, and prostate and gonads in male patients. In some patients, there is considerable dose received by certain organs from scatter because of their proximity to the radiation field. The average dose to the ovarian region was 4.125. Gy with a range of 1.085 to 6.228. Gy. The risk estimate for these patients ranged from 0.16{\%} to 0.93{\%}. The average total lifetime risk estimate for the bladder in all patients is 0.22{\%} and the average total lifetime risk estimate for the remainder organs in all patients is 1.25{\%}. In conclusions, proper shielding created from multileaf collimators (MLCs), blocks, and shields should always be used when possible.",
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