Estimation of radiation-induced secondary cancer risks for early-stage non-small cell lung cancer patients after stereotactic body radiation therapy

Purpose: In this study, we evaluated radiation-induced secondary lung cancer risks for the lung and the breast from stereotactic body radiation therapy treatment of early-stage non-small cell lung cancer with different radiation therapy treatment modalities. Methods and materials: Ten patients (5 men and 5 women) with early-stage non-small cell lung cancer who received definitive stereotactic body radiation therapy treatments were retrospectively selected. For each patient, two 3-dimensional conformal radiation therapy (3D-CRT) plans using 6- and 10-MV photons, respectively; a helical tomotherapy (HT) plan; and 2 volumetric modulated arc therapy (VMAT) plans using 1 and 2 arcs, respectively, were generated. The excess absolute risk (EAR) for secondary cancer occurrence was calculated using 3 organ equivalent dose models: the linear-exponential model, the plateau model, and the linear model for prescription dose range of 30 to 70 Gy. Results: The 3D-CRT plans showed significantly lower monitor units compared with the rotational intensity modulate radiation therapy plans. Based on each of the 3 organ equivalent dose models, HT and VMAT plans showed comparable average EARs to both the lung and the breast compared with the 3D-CRT plans in the prescription dose range of 30 to 70 Gy. At a prescription dose of 50 Gy and using the linear-exponential model, the average lung EAR estimation ranged from 15.7 +/- 5.3 to 16.0 +/- 6.5 per 10,000 patients per year with the 5 delivery techniques, and the average EAR estimation for the breast ranged from 18.0 +/- 14.0 to 21.0 +/- 15.0 per 10,000 patients per year. The secondary cancer risk increased approximately linearly with mean organ dose. The 3D-CRT plans showed significantly higher secondary cancer risk for the ipsilateral lung and lower risk for the contralateral lung compared with the HT and VMAT plans. Conclusions: Rotational intensity modulate radiation therapy techniques including helical tomotherapy and VMAT do not increase secondary cancer risks for the lung or the breast compared with 3D-CRT techniques, despite higher monitor units used. (C) 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.