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      Evaluation of Breast Cancer Radiation Therapy Techniques in Outfield Organs of Rando Phantom with Thermoluminescence Dosimeter

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          Abstract

          Background:

          Given the importance of scattered and low doses in secondary cancer caused by radiation treatment, the point dose of critical organs, which were not subjected to radiation treatment in breast cancer radiotherapy, was measured.

          Objective:

          The purpose of this study is to evaluate the peripheral dose in two techniques of breast cancer radiotherapy with two energies.

          Material and Methods:

          Eight different plans in two techniques (conventional and conformal) and two photon energies (6 and 15 MeV) were applied to Rando Alderson Phantom’s DICOM images. Nine organs were contoured in the treatment planning system and specified on the phantom. To measure the photon dose, forty-eight thermoluminescence dosimeters (MTS700) were positioned in special places on the above nine organs and plans were applied to Rando phantom with Elekta presice linac. To obtain approximately the same dose distribution in the clinical organ volume, a wedge was used on planes with an energy of 6 MeV photon.

          Results:

          Point doses in critical organs with 8 different plans demonstrated that scattering in low-energy photon is greater than high-energy photon. In contrast, neutron contamination in high-energy photon is not negligible. Using the wedge and shield impose greater scattering and neutron contamination on patients with low-and high-energy photon, respectively.

          Conclusion:

          Deciding on techniques and energies required for preparing an acceptable treatment plan in terms of scattering and neutron contamination is a key issue that may affect the probability of secondary cancer in a patient.

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          Most cited references23

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          Incidence and Mortality and Epidemiology of Breast Cancer in the World.

          Breast cancer is the most common malignancy in women around the world. Information on the incidence and mortality of breast cancer is essential for planning health measures. This study aimed to investigate the incidence and mortality of breast cancer in the world using age-specific incidence and mortality rates for the year 2012 acquired from the global cancer project (GLOBOCAN 2012) as well as data about incidence and mortality of the cancer based on national reports. It was estimated that 1,671,149 new cases of breast cancer were identified and 521,907 cases of deaths due to breast cancer occurred in the world in 2012. According to GLOBOCAN, it is the most common cancer in women, accounting for 25.1% of all cancers. Breast cancer incidence in developed countries is higher, while relative mortality is greatest in less developed countries. Education of women is suggested in all countries for early detection and treatment. Plans for the control and prevention of this cancer must be a high priority for health policy makers; also, it is necessary to increase awareness of risk factors and early detection in less developed countries.
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            EUROCARE-4. Survival of cancer patients diagnosed in 1995-1999. Results and commentary.

            EUROCARE-4 analysed about three million adult cancer cases from 82 cancer registries in 23 European countries, diagnosed in 1995-1999 and followed to December 2003. For each cancer site, the mean European area-weighted observed and relative survival at 1-, 3-, and 5-years by age and sex are presented. Country-specific 1- and 5-year relative survival is also shown, together with 5-year relative survival conditional to surviving 1-year. Within-country variation in survival is analysed for selected cancers. Survival for most solid cancers, whose prognosis depends largely on stage at diagnosis (breast, colorectum, stomach, skin melanoma), was highest in Finland, Sweden, Norway and Iceland, lower in the UK and Denmark, and lowest in the Czech Republic, Poland and Slovenia. France, Switzerland and Italy generally had high survival, slightly below that in the northern countries. There were between-region differences in the survival for haematologic malignancies, possibly due to differences in the availability of effective treatments. Survival of elderly patients was low probably due to advanced stage at diagnosis, comorbidities, difficult access or lack of availability of appropriate care. For all cancers, 5-year survival conditional to surviving 1-year was higher and varied less with region, than the overall relative survival.
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              Site-specific dose-response relationships for cancer induction from the combined Japanese A-bomb and Hodgkin cohorts for doses relevant to radiotherapy

              Background and Purpose Most information on the dose-response of radiation-induced cancer is derived from data on the A-bomb survivors. Since, for radiation protection purposes, the dose span of main interest is between zero and one Gy, the analysis of the A-bomb survivors is usually focused on this range. However, estimates of cancer risk for doses larger than one Gy are becoming more important for radiotherapy patients. Therefore in this work, emphasis is placed on doses relevant for radiotherapy with respect to radiation induced solid cancer. Materials and methods For various organs and tissues the analysis of cancer induction was extended by an attempted combination of the linear-no-threshold model from the A-bomb survivors in the low dose range and the cancer risk data of patients receiving radiotherapy for Hodgkin's disease in the high dose range. The data were fitted using organ equivalent dose (OED) calculated for a group of different dose-response models including a linear model, a model including fractionation, a bell-shaped model and a plateau-dose-response relationship. Results The quality of the applied fits shows that the linear model fits best colon, cervix and skin. All other organs are best fitted by the model including fractionation indicating that the repopulation/repair ability of tissue is neither 0 nor 100% but somewhere in between. Bone and soft tissue sarcoma were fitted well by all the models. In the low dose range beyond 1 Gy sarcoma risk is negligible. For increasing dose, sarcoma risk increases rapidly and reaches a plateau at around 30 Gy. Conclusions In this work OED for various organs was calculated for a linear, a bell-shaped, a plateau and a mixture between a bell-shaped and plateau dose-response relationship for typical treatment plans of Hodgkin's disease patients. The model parameters (α and R) were obtained by a fit of the dose-response relationships to these OED data and to the A-bomb survivors. For any three-dimensional inhomogenous dose distribution, cancer risk can be compared by computing OED using the coefficients obtained in this work.
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                Author and article information

                Journal
                J Biomed Phys Eng
                J Biomed Phys Eng
                Journal of Biomedical Physics & Engineering
                Journal of Biomedical Physics and Engineering (Iran )
                2251-7200
                April 2019
                01 April 2019
                : 9
                : 2
                : 179-188
                Affiliations
                [1 ] Department of Medical Physics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
                [2 ]Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
                [3 ]Royal Adelaide Hospital, Department of Medical Physics, Adelaide, Australia.
                [4 ]Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
                Author notes
                *Corresponding author:M. T. Bahreyni Toossi, Mashhad University of Medical Sciences, Medical Physics Research Center, Mashhad, Iran.
                Article
                JBPE-9-2
                10.31661/JBPE.V0I0.1067
                6538909
                31214523
                5a377348-f290-4909-8e56-ead894782a57
                Copyright: © Journal of Biomedical Physics and Engineering

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 22 December 2018
                : 6 December 2018
                Categories
                Original Article

                photon dose measurement , radiation therapy , breast cancer , thermoluminescence dosimeter , rando phantom

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