Search

Partial body exposure and inhomogeneous dose delivery are features of the majority of medical and occupational exposure situations. However, mounting evidence indicates that the effects of partial body exposure are not limited to the irradiated area but also have systemic effects that are propagated outside the irradiated field. It was the aim of the “Partial body exposure” session within the MELODI workshop 2020 to discuss recent developments and insights into this field by covering clinical, epidemiological, dosimetric as well as mechanistic aspects. Especially the impact of out-of-field effects on dysfunctions of immune cells, cardiovascular diseases and effects on the brain were debated. The presentations at the workshop acknowledged the relevance of out-of-field effects as components of the cellular and organismal radiation response. Furthermore, their importance for the understanding of radiation-induced pathologies, for the discovery of early disease biomarkers and for the identification of high-risk organs after inhomogeneous exposure was emphasized. With the rapid advancement of clinical treatment modalities, including new dose rates and distributions a better understanding of individual health risk is urgently needed. To achieve this, a deeper mechanistic understanding of out-of-field effects in close connection to improved modelling was suggested as priorities for future research. This will support the amelioration of risk models and the personalization of risk assessments for cancer and non-cancer effects after partial body irradiation.

A 67-year-old man was admitted to our hospital for massive pleural effusion. He had a history of mandibular gingival carcinoma treated with radiation therapy (RT). Based on the cytology findings of pleural effusion and a thoracoscopic pleural biopsy, we finally diagnosed him with radiation-associated angiosarcoma. Retrospective cell-block immunocytochemistry with pleural effusion also showed potential utility for the diagnosis. This case highlights the importance of considering the possibility of radiation-associated secondary cancer in patients with pleural effusion who have a history of RT.

The aim of this study was to evaluate secondary cancer incidence (Excess Relative Risk (ERR)) and mortality incidence (Excess Absolute Risk (EAR)) during conformal radiotherapy treatment of breast cancer. Twenty-four patients with breast cancer treated with a mono-isocentric, three-dimensional conformal radiotherapy technique were studied. The ERR and EAR were calculated using the International Commission on Radiological Protection (ICRP) risk models. The results obtained are significantly higher than those estimated by previous studies; this confirms thus the need to improve the training of health professionals involved in the management of patients.

Purpose: This study aims at evaluating the excess absoluterisk(EAR)of cancer in thirty patients with high and intermediate risks of prostate cancer based on the Amico’s classification, who received a three-dimensional conformal radiotherapy(3DCRT) or a modulated volumetric arc therapy (VMAT) with 6 MV photons energy. Materials and Methods: VMAT plans were performed in simultaneous integrated boost, with 76 Gy to prostateand 56 Gy to pelvic lymph node and seminal vesicle.3DCRT planning was realized in two stages with prostate, seminal vesicles, and pelvic lymph node receiving46 Gy, in the first stage, and in the second stage, prostateprescribed at 28 Gy. The EAR was assessed using the Schneider concept based on the equivalent dose for a given organ (OED). Thus, the EAR of the rectum, bladder,pelvicbone and healthy pelvic tissues were calculated and compared on the basis of the Mechanistic, Exponential Linear, Plateau and Sarcoma specific Mechanistic models. Results: The EAR in the rectum were found to be higher in 3DCRT than in VMAT. The EAR values ranged from 3.98-5.37 for the rectum, and from 1.05-3.76 for the bladder depending on the model used. Conclusion: The overall EARs analysis for both radiation modalities indicated that the risk of induction of carcinoma in the rectum was higher with 3DCRT, compared with VMAT.However, it would be necessary for validation of predicted models, to conduct prospective clinal trials with a larger patient cohort

The aim of this study was to examine the risk of HPV-associated oral cavity, oropharyngeal or anal cancer in men with penile cancer to test the hypothesis of an increased risk to develop a second HPV-associated cancer later in life.We conducted a population-based register study including all men in Sweden diagnosed with penile cancer between 2000 and 2012. For each patient, six men without penile cancer were matched based on age and county of residence. Data were retrieved from Swedish cancer and population registers, to assess the risk of oral cavity, oropharyngeal or anal cancer in patients with penile cancer. Cox proportional hazard models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Risks in men with penile cancer were also compared with the background Swedish male population by use of standardized incidence ratios.In total, 1634 men with and 9804 without penile cancer were included in the study. Among men with penile cancer, four men were subsequently diagnosed with oral cavity cancer, one with oropharyngeal cancer and one with anal cancer. Corresponding numbers among the penile cancer-free men were ten, two and three, respectively. There was evidence of an increased risks of all three cancers under study with an HR of 2.84 (95% CI 0.89-9.06) for oral cavity cancer, 3.66 (95% CI 0.33-40.39) for oropharyngeal cancer and 2.34 (95% CI 0.24-22.47) for anal cancer. When comparing the incidence of these malignancies between penile cancer patients and the background population, the patterns of association were similar.Our findings indicate that men with penile cancer are at an increased risk of a second HPV-associated cancer of the oral cavity, oropharynx and anal canal. Considering that our study was based on small numbers reflecting the rarity of these cancers, larger studies are needed to confirm our findings.

Highlights • Proton beam therapy is likely to be safe for liver hemangiomas because, in our experience. • Proton beam therapy achieves good local control for liver hemangiomas without causing severe hepatic damage. • Proton beam therapy expected to minimize the risk of late adverse events., Background Hepatic hemangiomas are benign tumors with a favorable prognosis, but giant hepatic hemangiomas can cause abdominal symptoms and are indicated for treatment. Most cases are treated with surgery, but radiotherapy has also been used. However, to date, there have been no reports of proton beam therapy for a hepatic hemangioma. Case presentation A 46-year-old woman had a tumor of 80 × 80 mm in the left medial lobe of the liver, which was diagnosed as a giant hemangioma based on the contrast pattern. Therapy was required for a giant hepatic hemangioma with symptoms, but the patient refused blood transfusion due to religious reasons, which made surgical resection difficult. Therefore, she was referred to our hospital for proton beam therapy. At her first visit, liver function was Child-Pugh A (5 points) and there was no elevation of tumor markers. Proton beam therapy of 28.6 Gy (RBE) given in 13 fractions was performed without interruption. The only observed acute radiation toxicity was Grade 1 dermatitis. One year after proton beam therapy, the hemangioma had significantly decreased, and a complete response has been maintained for 15 years based on ultrasound and MRI. Conclusion This case is the first reported use of proton beam therapy for a hepatic hemangioma. The outcome suggests that this treatment may be effective for a giant liver hemangioma.

Endocrine therapy is the mainstay treatment for hormone receptor-positive ductal carcinoma in situ. The aim of this study was to examine the long-term secondary malignancy risk of tamoxifen therapy. The data of patients diagnosed with breast cancer between January 2007 and December 2015 were retrieved from the database of the Health Insurance Review and Assessment Service of South Korea. The International Classification of Diseases, 10th revision, was used to track all-site cancers. Age at the time of surgery, chronic disease status, and type of surgery were considered covariates in the propensity score matching analysis. The median follow-up duration was 89 months. Forty-one patients in the tamoxifen group and nine in the control group developed endometrial cancer. The Cox regression hazard ratio model showed that tamoxifen therapy was the only significant predictor of the development of endometrial cancer (hazard ratio, 2.791; 95% confidence interval, 1.355–5.747; p = 0.0054). No other type of cancer was associated with long-term tamoxifen use. In consonance with the established knowledge, the real-world data in this study demonstrated that tamoxifen therapy is related to an increased incidence of endometrial cancer.

We used the method proposed by Schneider et al. Theor Biol Med Model 2011;8:27, to clarify how the radiation-induced secondary cancer incidence rate changes in patients after proton craniospinal irradiation (CSI) without and with vertebral-body-sparing (VBS). Eight patients aged 3–15 years who underwent proton CSI were enrolled in the study. For each case, two types of plan without and with VBS in the target were compared. The prescribed doses were assumed to be 23.4 Gy relative biological effectiveness (RBE) and 36 Gy (RBE). Using the dose–volume histograms of the two plans, the lifetime attributable risk (LAR) was calculated by both methods for each patient based on the dose data calculated using an XiO-M treatment planning system. Eight organs were analyzed as follows: lung, colon, stomach, small intestine, liver, bladder, thyroid and bone. When the prescribed dose used was 23.4 Gy (RBE), the average LAR differences and the average number needed to treat (NNT) between proton CSI without and with VBS were 4.04 and 24.8, respectively, whereas the average LAR difference and the average NNT were larger at 8.65 and 11.6, respectively, when the prescribed dose of 36 Gy (RBE) was used. The LAR for radiation-induced secondary cancer was significantly lower in proton CSI with VBS than without VBS in pediatric patients, especially for the colon, lung, stomach and thyroid. The results of this study could serve as reference data when considering how much of vertebral bodies should be included when performing proton CSI according to age in clinical settings.

Skin lesions have been reported in about 10–12% of hairy cell leukemia (HCL) patients. Most are etiologically related to autoimmune or infectious processes, although secondary cutaneous neoplasms and drug-induced lesions are also reported. However, leukemia cutis with the direct infiltration of the skin by leukemic cells is extremely rare in HCL patients. This paper reviews the epidemiology, pathogenesis, clinical symptoms, diagnosis, and approach to treating skin lesions in HCL. A literature review of the MEDLINE database for articles in English concerning hairy cell leukemia, skin lesions, leukemia cutis, adverse events, infectious, cutaneous, drug reactions, neutrophilic dermatoses, secondary neoplasms, and vasculitis was conducted via PubMed. Publications from January 1980 to September 2020 were scrutinized. Additional relevant publications were obtained by reviewing the references from the chosen articles.

Introduction: The aim of the present study was to estimate the impact of the addition of internal mammary chain (IMC) irradiation in node-positive left-sided breast cancer (BC) patients undergoing regional nodal irradiation (RNI) and comparatively evaluate excess relative and absolute risks of radiation-induced lung cancer/BC and ischaemic heart disease for intensity-modulated radiotherapy (IMRT) versus 3D conformal radiotherapy (3D-CRT). Methods: Four treatment plans were created (3D-CRT and IMRT –/+ IMC) for each of the 10 evaluated patients, and estimates of excess relative risk (ERR) and 10-year excess absolute risk (EAR) were calculated for radiation-induced lung cancer/BC and coronary events using linear, linear-exponential and plateau models. Results: The addition of IMC irradiation to RNI significantly increased the dose exposure of the heart, lung and contralateral breast using both techniques, increasing ERR for secondary lung cancer (58 vs. 44%, p = 0.002), contralateral BC (49 vs. 31%, p = 0.002) and ischaemic heart disease (41 vs. 27%, p = 0.002, IMRT plans). IMRT significantly reduced the mean cardiac dose and mean lung dose as compared to 3D-CRT, decreasing ERR for major coronary events (64% 3D-CRT vs. 41% IMRT, p = 0.002) and ERR for secondary lung cancer (75 vs. 58%, p = 0.004) in IMC irradiation, without a significant impact on secondary contralateral BC risks. Conclusion: Although IMC irradiation has been shown to increase survival rates in node-positive BC patients, it increased dose exposure of organs at risk in left-sided BC, resulting in significantly increased risks for secondary lung cancer/contralateral BC and ischaemic heart disease. In this setting, the adoption of IMRT seems advantageous when compared to 3D-CRT.

Purpose Proton pencil beam scanning (PBS) represents an interesting option for the treatment of breast cancer (BC) patients with nodal involvement. Here we compare tangential 3D-CRT and VMAT to PBS proton therapy (PT) in terms of secondary cancer risk (SCR) for the lungs and for contralateral breast. Methods Five BC patients including supraclavicular (SVC) nodes in the target (Group 1) and five including SVC plus internal-mammary-nodes (IMNs, Group 2) were considered. The Group 1 patients were planned by PT versus tangential 3D-CRT in free-breathing (FB). The Group 2 patients were planned by PT versus VMAT considering both FB and deep-inspiration breath hold (DIBH) irradiation. The prescription dose to the target volume was 50 Gy (2 Gy/fraction). A constant RBE = 1.1 was assumed for PT. The SCR was evaluated with the excess absolute risk (EAR) formalism, considering also the age dependence. A cumulative EAR was finally computed. Results According to the linear, linear-exponential and linear-plateau dose response model, the cumulative EAR for Group 1 patients after PT was equal to 45 ± 10, 17 ± 3 and 15 ± 3, respectively. The corresponding relative increase for tangential 3D-CRT was equal to a factor 2.1 ± 0.5, 2.1 ± 0.4 and 2.3 ± 0.4. Group 2 patients showed a cumulative EAR after PT in FB equal to 65 ± 3, 21 ± 1 and 20 ± 1, according to the different models; the relative risk obtained with VMAT increased by a factor 3.5 ± 0.2, 5.2 ± 0.3 and 5.1 ± 0.3. Similar values emerge from DIBH plans. Contrary to photon radiotherapy, PT appears to be not sensitive to the age dependence due to the very low delivered dose. Conclusions PBS PT is associated to significant SCR reduction in BC patients compared to photon radiotherapy. The benefits are maximized for young patients with both SVC and IMNs involvement. When combined with the improved sparing of the heart, this might contribute to the establishment of effective patient-selection criteria for proton BC treatments.

Our aim was to assess the long-term clinical outcome of boron neutron capture therapy (BNCT) using 10B-para-boronophenylalanine (BPA) as the boron delivery agent for cutaneous melanoma. Eight patients (eight lesions) were treated between October 2003 and April 2014. Their ages ranged from 48 to 86 years at the time of treatment. All of the targets were primary lesions and they were located on the sole or face. No patient had evidence of regional lymph node involvement, distant metastases or an active secondary cancer. The clinical stage was cT1-2N0M0 and performance scores were Grade 2 for the long follow-up period. Our results suggest that BNCT may be a promising treatment modality in the management of early stage cutaneous melanoma when wide local excision is not feasible.

Purpose of review The gastritis constellation includes heterogeneous clinicopathological entities, among which long-standing, non-self-limiting gastritis, mainly due to Helicobacter pylori infection, has been epidemiologically, biologically, and clinically linked to gastric cancer development (i.e. “inflammation-associated cancer”). This review illustrates the updated criteria applied in the taxonomy of gastritis (Kyoto classification), elucidates the biological rationale for endoscopy biopsy sampling (heterogeneity of gastric mucosa), and finally reports the results of long-term follow-up studies supporting the reliability of biopsy-based gastritis staging as predictor of gastritis-associated cancer risk. Recent findings By assuming gastric atrophy as the “cancerization field” where (non-syndromic) gastric cancer mostly develops, recent long-term follow-up studies consistently demonstrate the prognostic impact of the gastritis OLGA staging system. Summary Helicobacter pylori eradication is the leading strategy in the primary prevention of gastric cancer. In a multidisciplinary dimension of secondary cancer prevention, the OLGA staging system reliably ranks the patient-specific cancer risk, thus providing the clinical rationale for a tailored follow-up strategy.

Introduction: One of the most feared side effects of radiotherapy (RT) in the setting of breast cancer (BC) patients is cardiac toxicity. This side effect can jeopardize the quality of life (QoL) of long-term survivors. The impact of modern techniques of RT such as deep inspiration breath hold (DIBH) have dramatically changed this setting. We report and discuss the results of the literature overview of this paper. Materials and methods: Literature references were obtained with a PubMed query, hand searching, and clinicaltrials.gov. Results: We reported and discussed the toxicity of RT and the improvements due to the modern techniques in the setting of BC patients. Conclusions: BC patients often have a long life expectancy, thus the RT should aim at limiting toxicities and at the same time maintaining the same high cure rates. Further studies are needed to evaluate the risk–benefit ratio to identify patients at higher risk and to tailor the treatment choices.

Twenty (10 intensity-modulated proton therapy (IMPT) and 10 intensity-modulated x-ray therapy (IMXT) treatment plans for patients with advanced prostate carcinoma were compared in this study. All chosen patients were indicated for prostate and pelvic lymph nodes irradiation using simultaneous integrated boost technique. These patients represent typical specimen for this diagnose. IMPT irradiates just half of the tissue volume with a low dose (up to 10 cobalt gray equivalent) compared to IMXT without compromise in target volumes coverage and in this way reduces the risk of secondary cancer development or other possible complications.

Objective: To assess perspectives and experiences of healthcare professionals and other relevant stakeholders regarding psychosocial support and palliative care in mesothelioma patients and their relatives, to identify gaps and to explore potential improvements in current healthcare. Methods: Individual, semi-structured interviews were conducted with healthcare professionals and other relevant stakeholders. Interviews were transcribed verbatim and analysed thematically using ATLAS.ti. Results: In total, 16 respondents participated in an interview (69% women; mean age: 51.8 years (SD 12.41; range 28–75)). Four key themes were identified: (1) availability of tailored psychosocial and palliative care, (2) timely integration and organisation of psychosocial support and palliative care, (3) differences in provided support and care between healthcare professionals and hospitals and (4) training of healthcare professionals and stakeholders on psychosocial problems. Conclusion: Our study showed that psychosocial support and palliative care for patients with mesothelioma could be improved. A more fluent transition between primary and secondary cancer care and early integration of psychosocial support and palliative care is advised. Lastly, more attention is needed for psychosocial and palliative care in the basic medical training of healthcare professionals.

BackgroundThis study aims to test the effect of the 10 most common nonurological primary cancers (skin, rectal, colon, lymphoma, leukemia, pancreas, stomach, esophagus, liver, lung) on overall mortality (OM) after secondary prostate cancer (PCa).Material and MethodsWithin the Surveillance, Epidemiology, and End Results (SEER) database, patients with 10 most common primary cancers and concomitant secondary PCa (diagnosed 2004–2016) were identified and were matched in 1:4 fashion (age, year at diagnosis, race/ethnicity, treatment type, TNM stage) with primary PCa controls. OM was compared between secondary and primary PCa patients and was stratified according to primary cancer type, as well as according to time interval between primary cancer vs. secondary PCa diagnoses.ResultsWe identified 24,848 secondary PCa patients (skin, n = 3,871; rectal, n = 798; colon, n = 3,665; lymphoma, n = 2,583; leukemia, n = 1,102; pancreatic, n = 118; stomach, n = 361; esophagus, n = 219; liver, n = 160; lung, n = 1,328) vs. 531,732 primary PCa patients. Secondary PCa characteristics were less favorable than those of primary PCa patients (PSA and grade), and smaller proportions of secondary PCa patients received active treatment. After 1:4 matching, all secondary PCa exhibited worse OM than primary PCa patients. Finally, subgroup analyses showed that the survival disadvantage of secondary PCa patients decreased with longer time interval since primary cancer diagnosis and subsequent secondary PCa.ConclusionPatients with secondary PCa are diagnosed with less favorable PSA and grade. Even after matching for PCa characteristics, secondary PCa patients still exhibit worse survival. However, the survival disadvantage is attenuated, when secondary PCa diagnosis is made after longer time interval, since primary cancer diagnosis.

This study was devoted to determining the unwanted dose due to scattered photons to the out-of-field organs and subsequently estimate the risk of secondary cancers in the patients undergoing pelvic radiotherapy. A typical 18 MV Medical Linear Accelerator (Varian Clinac 2100 C/D) was modeled using MCNPX®code to simulate pelvic radiotherapy with four treatment fields: anterior-posterior, posterior-anterior, right lateral, left lateral. Dose evaluation was performed inside Medical Internal Radiation Dose (MIRD) revised female phantom. The average photon equivalent dose in out-of-field organs is 8.53 mSv Gy−1, ranging from 0.17 to 72.11 mSv Gy−1, respectively, for the organs far from the Planning Treatment Volume (Brain) and those close to the treatment field (Colon). Evidence showed that colon with 4.3049% and thyroid with 0.0020% have the highest and lowest risk of secondary cancer, respectively. Accordingly, this study introduced the colon as an organ with a high risk of secondary cancer which should be paid more attention in the follow-up of patients undergoing pelvic radiotherapy. The authors believe that this simple Monte Carlo (MC) model can be also used in other radiotherapy plans and mathematical phantoms with different ages (from childhood to adults) to estimate the out-of-field dose. The extractable information by this simple MC model can be also employed for providing libraries for user-friendly applications (e.g. ‘.apk’) which in turn increase the public knowledge about fatal cancer risk after radiotherapy and subsequently decrease the concerns in this regard among the public.

PurposeSecondary lung cancer (SLC) can offset the benefit of adjuvant breast radiotherapy (RT), and risks compound sharply after 25 to 30 years. We hypothesized that SLC risk is mainly an issue for early-stage breast cancer, and that lives could be saved using different RT techniques.Patients and MethodsThe SEER database was used to extract breast patient age, stage survival, and radiotherapy utilization over time and per stage and to assess the factors associated with increased SLC risk with a multivariable competing risk Cox model. The number of SLC was calculated using the BEIR model modified with patient survival, age, and use of RT from the SEER database. Stage distribution and number of new breast cancer cases were obtained from the NAACCR. Mean lung dose for various irradiation techniques was obtained from measurement or literature.ResultsOut of the 765,697 non-metastatic breast cancers in the SEER database from 1988 to 2012, 49.8% received RT. RT significantly increased the SLC risk for longer follow-up (HR=1.58), early stage including DCIS, stage I and IIA (HR = 1.11), and younger age (HR=1.061) (all pConclusionsSLC after breast RT remains a clinically significant issue for early-stage breast cancers. This mortality could be significantly reduced using a prone technique or APBI.

Background This study aims to test the effect of the 10 most common nonurological primary cancers (skin, rectal, colon, lymphoma, leukemia, pancreas, stomach, esophagus, liver, lung) on overall mortality (OM) after secondary prostate cancer (PCa). Material and Methods Within the Surveillance, Epidemiology, and End Results (SEER) database, patients with 10 most common primary cancers and concomitant secondary PCa (diagnosed 2004–2016) were identified and were matched in 1:4 fashion (age, year at diagnosis, race/ethnicity, treatment type, TNM stage) with primary PCa controls. OM was compared between secondary and primary PCa patients and was stratified according to primary cancer type, as well as according to time interval between primary cancer vs. secondary PCa diagnoses. Results We identified 24,848 secondary PCa patients (skin, n = 3,871; rectal, n = 798; colon, n = 3,665; lymphoma, n = 2,583; leukemia, n = 1,102; pancreatic, n = 118; stomach, n = 361; esophagus, n = 219; liver, n = 160; lung, n = 1,328) vs. 531,732 primary PCa patients. Secondary PCa characteristics were less favorable than those of primary PCa patients (PSA and grade), and smaller proportions of secondary PCa patients received active treatment. After 1:4 matching, all secondary PCa exhibited worse OM than primary PCa patients. Finally, subgroup analyses showed that the survival disadvantage of secondary PCa patients decreased with longer time interval since primary cancer diagnosis and subsequent secondary PCa. Conclusion Patients with secondary PCa are diagnosed with less favorable PSA and grade. Even after matching for PCa characteristics, secondary PCa patients still exhibit worse survival. However, the survival disadvantage is attenuated, when secondary PCa diagnosis is made after longer time interval, since primary cancer diagnosis.

Radiation-induced second cancer is one of the crucial late side effects of radiotherapy treatment of first cancer. Although the second cancer induction mechanism is not well understood yet, many factors are related to its occurrences, such as age at exposure, dose to the organ and surrounding tissues, treatment modalities, and family history of cancer. This study aims to provide long-term estimates of second cancer incidence amongst colon cancer survivors in Saudi Arabia. The lifetime attributable risk (LAR) after radiation treatment of the colon cancer was determined, between the age at exposure and up to 95 years, in a single-institution cohort of male and female cancer survivors whose age at treatment was in the range 43 to 85 years. Risk estimates varied significantly with age at exposure, gender, and organ dose.

Compared to conventional X-ray therapy, proton beam therapy (PBT) has more clinical and physical advantages such as irradiation dose reduction to normal tissues for pediatric medulloblastoma. However, PBT is expensive. We aimed to compare the cost-effectiveness of PBT for pediatric medulloblastoma with that of conventional X-ray therapy, while focusing on radiation-induced secondary cancers, which are rare, serious and negatively affect a patient’s quality of life (QOL). Based on a systematic review, a decision tree model was used for the cost-effectiveness analysis. This analysis was performed from the perspective of health care payers; the cost was estimated from medical fees. The target population was pediatric patients with medulloblastoma below 14 years old. The time horizon was set at 7.7 years after medulloblastoma treatment. The primary outcome was the incremental cost-effectiveness ratio (ICER), which was defined as the ratio of the difference in cost and lifetime attributable risk (LAR) between conventional X-ray therapy and PBT. The discount rate was set at 2% annually. Sensitivity analyses were performed to model uncertainty. Cost and LAR in conventional X-ray therapy and PBT were Japanese yen (JPY) 1 067 608 and JPY 2436061 and 42% and 7%, respectively. The ICER was JPY 3856398/LAR. In conclusion, PBT is more cost-effective than conventional X-ray therapy in reducing the risk of radiation-induced secondary cancers in pediatric medulloblastoma. Thus, our constructed ICER using LAR is one of the valid indicators for cost-effectiveness analysis in radiation-induced secondary cancer.

This study firstly explored the risks of secondary cancer in healthy organs of Chinese paediatric patients with brain tumours after boron neutron capture therapy (BNCT). Three neutron beam irradiation geometries (i.e. right lateral, top to bottom, posterior to anterior) were adopted in treating patients with brain tumours under the clinical environment of BNCT. The concerned organs in this study were those with high cancer morbidity in China (e.g. lung, liver and stomach). The equivalent doses for these organs were calculated using Monte Carlo and anthropomorphic paediatric phantoms with Chinese physiological features. The risk of secondary cancer, characterised by the lifetime attributable risk (LAR) factor given in the BEIR VII report, was compared among the three irradiation geometries. The results showed that the LAR was lower with the PA irradiation geometry than with the two other irradiation geometries when the 2 cm diameter tumour was at a depth of 6 cm on the right side of the brain. Under the PA irradiation geometry, the LAR in the organs increased with increasing tumour volume and depth because of the long irradiation time. As the patients aged from 10-15 years old, the LAR decreased, which was related to the increased patient height and shortened life expectancy. Female patients had a relatively higher risk of secondary cancer than male patients in this study, which could be due to the thinner body thickness and the weaker protective effect on the internal organs of the female patients. In conclusion, the risks of secondary cancer in organs were related to irradiation geometries, gender, and age, indicating that the risk of secondary cancer is a personalised parameter that needs to be evaluated before administering BNCT, especially in patients with large or deep tumours.

Bu çalışma 2014-2017 yılları arasında Bursa Uludağ Üniversitesinde radyoterapi tedavisi almış, serviks kanseri tanılı 10 hastanın arşiv materyali kullanılarak retrospektif olarak yapılmıştır. Serviks kanseri radyoterapisinde kullanılan enerji seviyelerinin kullanılması amaçlanmıştır. Tedavi planlamasında kullanılan volumetrik ayarlı ark terapi (VMAT) ve yoğunluk ayarlı ark terapi(YART) 7 alan tekniği için 6 MV ve 15 MV enerjili foton enerjisi kullanılarak her hastaya özel 4 farklı planlama yapılmıştır. Planlanan hedef hacme 28 fraksiyondan 50.4 Gy doz verilmiş ve kritik organ olarak rektum, mesane, ince bağırsak, sağ ve sol femur başları konturlanarak dozimetrik karşılaştırma amaçlanmıştır. Ayrıca tedavi planı değerlendirme parametrelerinden Conformite İndeksi ve Homojenite İndeksi verileri de değerlendirilmiştir. Karşılaştırmalar sonucunda en uygun PTV doz homojenitesi, CI değerini VMAT 15 MV, en iyi HI değerini YART 15 MV sağlamıştır. Mesane ve Rectum Dort dozları açısından en iyi VMAT 6 MV tekniği, ince bağırsak Dmax değeri YART 15 MV tekniğinde elde edilmiştir. Tüm tekniklerde doz dağılımları kabul edilebilir sınır içerisinde olduğu gözlemlenmiştir Saçılan doz ve ikincil kanser riski düşünüldüğünde VMAT 6 MV tekniği diğer tekniklere oranla daha üstün bulundu. Bu yüzden yan etkiler ve çift oluşum meydana gelme ihtimali göz önüne alındığında tedavi tekniği olarak VMAT 6 MV tekniğinin uygun olduğunu desteklemekteyiz.

Medical exposure to ionizing irradiation has become a recognised carcinogenic risk. Balancing the concomitant imaging dose and positioning accuracy is critical in image-guided-radiotherapy (IGRT) especially for children, whose higher biological susceptibility and longer expected life make them more vulnerable to develop secondary cancer. This work aims to evaluate and benchmark the imaging dose and positioning accuracy of a new MV cone-beam-CT (CBCT)-guided IGRT system, Varian Halcyon, against conventional kV CBCT. Weighted-CT-dose-index (CTDIw) were measured for Varian TrueBeam kV CBCT, and computed for Halcyon MV CBCT using Eclipse system as validated before. Simulating the IGRT workflow, the positioning accuracy of correcting a known shift was tested on various regions of 1-year, 5-year and adult anthropomorphic phantoms, respectively. Inter-scanner and inter-protocol comparisons of dose and accuracy were performed. kV CTDIw for 'Head', 'Thorax', 'Pelvis' and 'Image Gently' (in CTDIΦ16cm/CTDIΦ32cm phantoms, respectively) protocols were measured as 4.5 mGy, 5.4 mGy, 19.3 mGy, and 1.1 mGy/0.5 mGy, respectively. Using 'High Quality' mode, MV CTDIw in the CTDIΦ16cm and CTDI Φ32cm phantoms were computed as 84.5 mGy and 63.8 mGy (imaging length = 28 cm), 68.8 mGy and 55.5 mGy (imaging length = 16 cm), respectively, which were about twice of 'Low Dose' mode. The maximum positioning deviation observed on Halcyon was 0.51 mm ('Low Dose' adult thorax), which was lower than that of standard (0.58 mm, 'Pelvis' adult pelvis) and 'Image Gently' kV CBCT (1.57 mm, adult pelvis). Accuracy of 'Image Gently' kV CBCT head & neck and thoracic imaging were clinically acceptable for adults (maximum deviation = 0.54 mm, adult thorax). Complying with Image Gently campaign, dose-efficient protocols should be used for pediatric IGRT, achieving comparable positioning accuracy on the new Halcyon MV CBCT system relative to the conventional kV CBCT.

Traditionally, cancer has been viewed as a set of diseases that are driven by the accumulation of genetic mutations, but we now understand that disruptions in epigenetic regulatory mechanisms are prevalent in cancer as well. Unlike genetic mutations, however, epigenetic alterations are reversible, making them desirable therapeutic targets. The potential for diet, and bioactive dietary components, to target epigenetic pathways in cancer is now widely appreciated, but our understanding of how to utilize these compounds for effective chemopreventive strategies in humans is in its infancy. This review provides a brief overview of epigenetic regulation and the clinical applications of epigenetics in cancer. It then describes the capacity for dietary components to contribute to epigenetic regulation, with a focus on the efficacy of dietary epigenetic regulators as secondary cancer prevention strategies in humans. Lastly, it discusses the necessary precautions and challenges that will need to be overcome before the chemopreventive power of dietary-based intervention strategies can be fully harnessed.

Paediatric radiotherapy comes at the expense of increased risk of late effects due to out-of-field dose caused not only by the treatment itself but also by image guidance. This study examined how the out-of-field dose to selected radiosensitive organs was affected by applying a 1 mm lead shielding during delivery of volumetric-modulated arc therapy (VMAT) for paediatric brain cancer. The study also investigated how the out-of-field dose to the same organs was affected by the use of flattening-filter free (FFF) beams. Out-of-field doses to the thyroid, breast and testes were measured using thermoluminescence dosimeters inserted in two anthropomorphic phantoms equivalent to a 1-year and 5-year old child. Coplanar VMAT plans were prepared for 6 MV and 6 MV FFF photon beams and delivered using a Varian TrueBeam linear accelerator, with and without lead shielding applied to the phantoms. The measured out-of-field doses were as large as 200,9 cGy for the whole treatment, with associated secondary cancer risk being as large as 1,1%. Shielding of the phantoms was found to decrease the out-of-field dose by up to 24%. The use of 6 MV FFF beams yielded a decrease in the dose to the testes by 21–42% compared to 6 MV, while in one case increasing the dose to the thyroid by 18%. The observation that only doses to organs distant to the primary irradiated volume were significantly decreased for FFF can be explained by an increase in internal scatter caused by the softer energy spectrum of the Varian FFF beam.

Uterine malignant lymphoma is rare and its association with secondary cancer has not been fully described. Here, we report a rare case of endometrial cancer arising after 1 year of complete remission of uterine diffuse large B-cell lymphoma (DLBCL). An 88-year-old woman was referred to us for abnormal genital bleeding and was diagnosed with uterine DLBCL. She underwent chemotherapy comprising rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisolone followed by radiation therapy; subsequently, she achieved complete remission. One year later, she noticed genital bleeding recurrence, and endometrial biopsy revealed endometrial adenocarcinoma. Total hysterectomy and bilateral salpingo-oophorectomy were performed. Her pathological diagnosis was endometrial endometrioid carcinoma, grade 1 (pT1aN0). Adenocarcinoma was observed over foamy macrophages aggregates, indicating remission of DLBCL. Targeted sequencing of both DLBCL and endometrial cancer revealed 24 gene mutations including the truncation-type mutations of ARID1A and PTEN occurring only in endometrial cancer. These multiple somatic gene mutations accumulating within 1 year imply endometrial carcinogenesis induced by DNA damages caused by treatment for DLBCL. Although the epidemiological risk of secondary malignancies after uterine lymphoma remains unclear, the present case serves as a warning for secondary cancer and highlights the importance of early detection and treatment., Highlights • Endometrial cancer could arise after complete remission of uterine lymphoma. • Gene mutation profile of secondary endometrial cancer was firstly described. • ARID1A and PTEN mutation may contribute to secondary endometrial carcinogenesis.

To explore the feasibility of using Volumetric-Modulated Arc Therapy (VMAT) to protect left anterior descending branch (LAD) after breast-conserving surgery for left breast cancer. 15 left breast cancer patients after breast-conserving surgery were selected. 7F-IMRT and 2A-VMAT treatment plans were designed with Varian Eclipse TPS (13.6version). The prescriptions of PTV and PTV Boost were 43.5Gy and 49.5Gy in 15 fractions. The dosimetric parameters, OARs dose sparing and second cancer risk (SCR) were compared between the two plans using a paired t-test. The VMAT plans obtain better PTV conformity and higher mean dose. VMAT plans show a better dose distribution in high dose areas and better sparing of OARs, including left lung, heart, and LAD. The Dmax and Dmean of LAD decreased significantly in VMAT plans. The SCRs of the contralateral lung and breast significantly increased with a higher mean dose. We recommend that contouring and evaluating the dose of LAD and LAD helping structures in left breast cancer radiotherapy. SCR should be evaluated for younger patients.

Introduction The historically feared radiation-induced secondary cancers and cardiac toxicities observed among mediastinal classical Hodgkin Lymphoma (cHL) patients may still negatively burden the benefit of radiotherapy among long-term survivors. Modern radiotherapy (RT) delivery techniques, including intensity-modulated RT (IMRT) and deep inspiration breath-hold (DIBH) solutions, are drastically changing this scenario. Results of a literature overview are reported and discussed in this paper. Materials and methods Key references were derived from a PubMed query. Hand searching and clinicaltrials.gov were also used. Results This paper contains a narrative report and a critical discussion of organs-at-risk dose-volume metrics linked with radiation-induced toxicities in cHL patients. Conclusions The scenario of early-stage cHL presents long-life expectancies, thus the goal of treatment should aim at maintaining high cure rates and limiting the onset of late complications. Further evaluations of dosimetric measures and clinical outcomes are warranted to identify patients at higher risk to target treatment tailoring.

Radiation therapy for breast cancer inevitably results in scattered dose to contralateral breast. Breast tissues being highly sensitive to ionizing radiations, the chance of the contralateral breast developing second cancer after radiation therapy is high. This study investigated dose to contralateral breast and its reduction by superflab during the course of breast cancer radiation therapy. A thorax breast phantom constructed from tissue-equivalent materials and diodes (type IVD2 1137) were used to measure surface doses to the contralateral breast. The mean doses received by the contralateral breast were 2.2% and 7.1% of the prescribed dose of 200 cGy for 5 × 5 cm2 and 10 × 10 cm2 field sizes, respectively. These dose values were mostly comparable to and slightly higher than the dose values reported in the literature. The average reduction of dose to contralateral breast with superflab was 65.6%, in the range of 49 to 100%. The differences between doses with and without superflab were significant at p < 0.05. The superflab was more effective for larger field sizes than smaller. In view of this enormous advantage in dose reduction, this approach should clinically be tested for routine applications in breast cancer radiation therapy at hospitals in Tanzania. Keywords: Breast cancer; contralateral breast dose; secondary cancer; superflab

Background Secondary malignant neoplasms (SMNs) and cardiovascular diseases induced by chemotherapy and radiotherapy represent the main cause of excess mortality for early-stage Hodgkin lymphoma patients, especially when the mediastinum is involved. Conformal radiotherapy techniques such as Intensity-Modulated Radiation Therapy (IMRT) could allow a reduction of the dose to the organs-at-risk (OARs) and therefore limit long-term toxicity. Methods We performed a systematic review of the current literature regarding comparisons between IMRT and conventional photon beam radiotherapy, or between different IMRT techniques, for the treatment of mediastinal lymphoma. Results and conclusions IMRT allows a substantial reduction of the volumes of OARs exposed to high doses, reducing the risk of long-term toxicity. This benefit is conterbalanced by the increase of volumes receiving low doses, that could potentially increase the risk of SMNs. Treatment planning should be personalized on patient and disease characteristics. Dedicated techniques such as “butterfly” VMAT often provide the best trade-off.

In breast cancer radiotherapy, substantial exposure of organs other than the treated breast cannot be entirely avoided, potentially inducing secondary cancer or cardiovascular disease. However, contemporary treatment planning allows for considerable flexibility in the distribution of dose to organs at risk while maintaining the necessary coverage in the target volume. Here, we present an approach to estimate comprehensively the corresponding long-term health risks to support treatment plan optimization. A central premise of our approach is that cancer induction is a local process. Organ cancer risks are estimated by integrating the organ dose-response relationship over the organ dose distribution. Most organs are exposed to low to moderate doses, such that established and elaborated dose-response models from radiation protection can be applied. However, the highly exposed organs dominate risk. For this reason, we join the low-dose models with specific high-dose models for the lung, contralateral breast, and bone marrow. The high-dose models base upon studies on medical exposure. This approach leads to a combined, in general non-linear dose response, which is supported by data over the whole relevant dose range. For cardiovascular diseases, a linear model is provided, consistent with low- and high-dose studies. The resulting model estimates are widely consistent to rate ratios observed in randomized breast cancer radiotherapy trials. A software tool is supplied to apply the risk models for individual breast cancer patients.

Lymphomas are a heterogeneous group of malignancies of the lymphoid cells with almost a hundred different subtypes. In recent decades, there has been a major improvement in treatment results, and nowadays, only one-third of patients die due to lymphoma. As treatment results have improved, more attention has been paid to the adverse effects of treatment, which may be serious or even lead to death. The aim of this study was to describe treatment methods with a smaller risk of late adverse effects without impairing the treatment results. Follicular lymphoma (FL) is the second most common type of lymphoma in adults. Its prognosis is good, but relapses are common, and treatment must often be repeated, which causes a carcinogenic burden to the patient. Secondary malignancies are a significant late-onset adverse effect of lymphoma treatments. Currently, there are several treatment options available for FL. However, the risks of secondary malignancies associated with different treatment methods are not totally clear. In the present study, a higher risk for secondary haematological malignancies was observed after multiple lines of treatment. For secondary solid tumours, on the other hand, the greater risk was associated with the use of bendamustine. Diffuse large B-cell lymphoma is the most common lymphoma subtype. Patients are elderly and therefore more vulnerable to treatment-related adverse effects. Moreover, cardiac comorbidities are common in elderly patients, which may limit the use of certain treatment options. In this study, treatment results with standard therapy R-CHOP were retrospectively compared to those obtained with R-CEOP and R-CIOP, which are known to be less cardiotoxic. Treatment with R-CEOP was comparable to standard therapy, whereas results with R-CIOP were inferior. Nodular lymphocyte predominant Hodgkin lymphoma is a rare lymphoma subtype. These patients are traditionally treated with the same methods as those with classical Hodgkin lymphoma, although the diseases are very different biologically. Treatments used in Hodgkin’s disease are remarkably toxic. We examined the use of an R-bendamustine regimen among this group of patients. The results of the present study indicate that the late adverse effects of lymphoma treatments should be considered when selecting the most optimal treatment for lymphoma patients. Tiivistelmä Lymfoomat ovat heterogeeninen joukko imukudoksen syöpiä ja lähes sata erilaista alatyyppiä on tunnistettu. Lymfoomien hoitotuloksissa on tapahtunut merkittävää edistystä viime vuosikymmenien aikana ja tällä hetkellä vain noin kolmannes potilaista menehtyy tautiin. Hoitotulosten parantuessa on alettu kiinnittää enemmän huomiota myös hoitojen aiheuttamiin haittoihin, jotka saattavat olla huomattavan hankalia ja johtaa jopa potilaan menehtymiseen. Tutkimuksen tarkoituksena oli kuvata hoitomuotoja, joilla hoidon haittojen riski olisi pienempi ilman, että lymfooman hoitotulokset heikkenevät. Follikulaarinen lymfooma on aikuisten toiseksi yleisin lymfoomatyyppi. Taudin ennuste on hyvä, mutta uusiutuminen on yleistä ja tällöin hoitoja joudutaan toistamaan, mikä aiheuttaa potilaille merkittävän karsinogeenisen altistuksen. Mahdollisia hoitomuotoja on useita eikä eri hoitomuotojen aiheuttamaa sekundaarisen syövän riskiä vielä tarkasti tunneta. Tässä tutkimuksessa selvisi, että sekundaaristen hematologisten syöpien riski kasvoi hoitolinjojen lukumäärän kasvaessa. Bendamustiinin käyttö oli yhteydessä suurempaan kiinteiden kasvainten riskiin. Diffuusi suurisoluinen B-solulymfooma on yleisin lymfooman alatyyppi. Potilaat ovat iäkkäitä, mikä lisää riskiä saada hoitojen haittavaikutuksia. Lisäksi iäkkäillä potilailla sydänsairaudet ovat yleisempiä, mikä voi rajoittaa sydäntoksisten hoitovaihtoehtojen käyttöä. Tässä tutkimuksessa verrattiin sydänturvallisempien R-CEOP ja R-CIOP sytostaattiyhdistelmien tehoa R-CHOP standardihoitoon. R-CEOP.lla saadut hoitotulokset olivat verrattavissa standardihoitoon, mutta R-CIOP.lla saadut hoitotulokset olivat heikompia. Nodulaarinen lymfosyyttivaltainen Hodgkinin lymfooma on harvinainen Hodgkinin lymfooma. Näitä potilaita on perinteisesti hoidettu samoilla hoitomuodoilla kun muita Hodgkinin lymfoomia, vaikka taudit ovat biologialtaan hyvin erilaisia. Hodgkinin lymfooman hoidossa käytettävät hoidot ovat huomattavan toksisia. Tutkimuksessamme selvitimme R-Bendamustiinin käyttökelpoisuutta tällä potilasryhmällä. Tutkimustulokseemme osoittivat, että lymfoomahoitojen aiheuttamat haitat tulee huomioida hoitovalinnoissa ja hoitojen haittavaikutuksia tulee aktiivisesti pyrkiä vähentämään. Eri hoitomuotojen aiheuttamista myöhäishaittavaikutuksista on tärkeää olla tietoinen jo hoitopäätöksiä tehtäessä.

Objectives: To estimate radiation dose and the associated risk of secondary cancer risk related to percutaneous cryoablation (PCA) and follow-up imaging in a cohort of patients treated for small renal masses (SRMs). Methods: A total of 149 patients underwent PCA for a SRM at our institution. Based on CT dose reports, we calculated the mean effective dose for a CT-guided PCA procedure and post-ablative follow-up CT. Applying follow-up recommendations by a multidisciplinary expert panel, we calculated the total radiation dose for the PCA procedure and the CT surveillance program corresponding to a minimal and preferable follow-up regime (5-year vs 10-year). Estimates of the lifetime attributable cancer risk for different age groups were calculated based on the cumulative effective dose based on the latest BEIR VII report. Results: Total dose for the PCA treatment and follow-up CTs amounted to 174 and 294 mSv for a minimal and preferable protocol, respectively. Follow-up CTs accounted for the majority of the total effective dose for the minimal and preferable protocol (89% vs 94%). CT fluoroscopy contributed only to a limited amount of the total radiation dose for the minimal and preferable protocol (1.8% vs 1.1%). A 70-year-old male undergoing PCA treatment has a lifetime attributable cancer risk of 0.8% (1 in 131) when completing the preferable follow-up protocol. The same regimen in a 30-year-old female results in a lifetime attributable risk of cancer of 3.4% (1 in 29). Conclusion: Radiation dose and the associated risk of secondary cancer are high for patients with SRMs undergoing PCA and post-ablative follow-up imaging in particular in younger patients. Radiation exposure in the PCA procedure itself accounts for only a limited amount of the total radiation. Radiologists and clinicians must strive to implement radiation dose saving measures especially with respect to the follow-up regime.

The aim of this study was to estimate the radiation-related secondary cancer risks in organs during the treatment of breast cancer with different radiotherapy techniques, such as three-dimensional conformal radiotherapy (3D-CRT), intensity modulated radiotherapy (IMRT), and volumetric modulated arc therapy (VMAT). The treatment plans for 26 patients with breast cancer who received whole-breast irradiation at a dose of 50 Gy included tangential field 3D-CRT with hard-wedges (W-TF), tangential field IMRT (2F-IMRT), multiple field IMRT (6F-IMRT), and double partial arcs (VMAT). Patients were divided into three groups according to the distance between the contralateral breast (CB) and the body of the sternum. Setup error was simulated by moving the isocenter, and the dose distribution was then recalculated without changing the field fluency distribution. Based on the linear-exponential, the plateau, and the full mechanistic dose-response models, the organ equivalent dose and excess absolute risk were calculated from dose-volume histograms to estimate the secondary cancer risks in organs. Compared with 3D-CRT, IMRT and VMAT showed excellent results regarding tumor conformity and homogeneity; however, the low dose volume to organs was considerably higher in 6F-IMRT and VMAT. Secondary cancer risks for 2F-IMRT were comparable or slightly lower than for W-TF, but considerably lower than for 6F-IMRT or VMAT. After setup error simulation, there was a small increase in secondary cancer risk for 2F-IMRT and an increase of 159% and 318% for 6F-IMRT and VMAT, respectively, compared with W-TF. Although these results were obtained in most patients, they did not necessarily apply to every individual. The secondary cancer risks in the CB decreased significantly in correlation with increased distance for all alternative techniques, although they were higher in VMAT and lower in 2F-IMRT regardless of the distance. After setup error simulation, the increased changes in secondary cancer risks in the CB were comparable between 2F-IMRT, 6F-IMRT, and VMAT, suggesting that the secondary cancer risks in the CB mainly depend on radiotherapy techniques and distance, although the effect of setup error cannot be ignored. In the contralateral lung (CL), the secondary cancer risks were almost independent from distance and depended mainly on radiotherapy techniques; they were rarely affected by setup error. VMAT was associated with a higher secondary cancer risk in the CL. For the ipsilateral lung (IL), the secondary cancer risks were higher than those in other organs because the IL receives high doses to achieve tumor control, and they were relatively lower in VMAT. This warrants special consideration when estimating the secondary cancer risk to the IL. The study results suggested that the optimal radiotherapy method for breast cancer should be determined on an individual basis and according to the balance between secondary cancer risks related to anatomic diversity and setup error, which can prevent blind selection of techniques.

Summary Chronic lymphocytic leukemia is one of the most common types of leukemia affecting adults over 65 years of age [1]. The disease is a part of the so-called indolent lymphomas and has a variable clinical course, defined by many factors. In recent years, knowing better the pathogenetic mechanisms of the disease, significant advances in the treatment have been made [2]. Monoclonal antibodies, immunomodulators, tyrosine kinase inhibitors, anti-apoptotic Bcl-2 protein inhibitors have been approved for clinical practice. Nevertheless, the development of tumor resistance and recurrence of the disease remains a challenge for hematologists, biologists, and pharmacists. We present two clinical cases of patients of both age groups (young adults and adults), in whom treatment was started with a Bruton’s tyrosine kinase (BTK) inhibitor, after inadequate response to immunochemotherapy (CIT).

Tumour dormancy presents challenges for clinical control and opportunities for scientific discovery. Current pictures of the mechanisms of tumour dormancy and reawakening remain incomplete. The Cancer Research UK's third Marshall Symposium explored tumour dormancy and reawakening in all their forms. In this forum article, we highlight the key challenges and opportunities discussed at this symposium.

OBJECTIVE: Two longitudinal studies examined whether effects of subjective norms on secondary cancer prevention behaviors were stronger and more likely to non-deliberative (i.e., partially independent of behavioral intentions) for African Americans (AAs) compared to European Americans (EAs), and whether the effects were moderated by racial identity. DESIGN: Study 1 examined between-race differences in predictors of physician communication following receipt of notifications about breast density. Study 2 examined predictors of prostate cancer screening among AA men who had not been previously screened. MAIN OUTCOME MEASURES: Participants’ injunctive and descriptive normative perceptions; racial identity (Study 2); self-reported physician communication (Study 1) and PSA testing (Study 2) behaviors at follow up. RESULTS: In Study 1, subjective norms were significantly associated with behaviors for AAs, but not for EAs. Moreover, there were significant non-deliberative effects of norms for AAs. In Study 2, there was further evidence of non-deliberative effects of subjective norms for AAs. Non-deliberative effects of descriptive norms were stronger for AAs who more strongly identified with their racial group. CONCLUSION: Subjective norms, effects of which are non-deliberative and heightened by racial identity, may be a uniquely robust predictor of secondary cancer prevention behaviors for AAs. Implications for targeted screening interventions are discussed.

Breast cancer radiotherapy may in the long term lead to radiation-induced secondary cancer or heart disease. These health risks hugely vary among patients, partially due to anatomy-driven differences in doses deposited to the heart, ipsilateral lung and contralateral breast. We identify four anatomic features that largely cover these dosimetric variations to enable personalized risk estimates. For three exemplary, very different risk scenarios, the given parameter set reproduces 63–74% of the individual risk variability for left-sided breast cancer patients. These anatomic features will be used in the PASSOS software to support decision processes in breast-cancer therapy.

In this study, we aimed to evaluate dosimetric approaches in ablation treatment of Differentiated Thyroid Carcinoma (DTC) without interrupting the clinical routine. Prior to therapy, 10.7 MBq 131I in average was orally given to 24 patients suffering from DTC. MIRD formalism was used for dosimetric calculations. For blood and bone marrow dosimetry, blood samples and whole‐body counts were collected at 2, 24, 72, and 120 h after I‐131 administration. For remnant tissue dosimetry, uptake measurements were performed at the same time intervals. To estimate the remnant volume, anterior and lateral planar gamma camera images were acquired with a reference source within the field of view at 24 h after I‐131 administration. Ultrasound imaging was also performed. Treatment activities determined with the fixed activity method were administered to the patients. Secondary cancer risk relative to applied therapy was evaluated for dosimetric approaches. The average dose to blood and bone marrow were determined as 0.15 ± 0.04 and 0.11 ± 0.04 Gy/GBq, respectively. The average remnant tissue dose was 0.58 ± 0.52 Gy/MBq and the corresponding required activity to ablate the remnant was approximately 1.3 GBq of 131I. A strong correlation between 24th‐hour uptake and time‐integrated activity coefficient values was obtained. Compared to fixed activity method, approximately five times higher secondary cancer risk was determined in bone marrow dosimetry, while the risk was about three times lower in lesion‐based dosimetry.

Improved cancer treatments and cancer detection methods are not likely to completely eradicate the burden of cancer. Primary prevention of cancer is a logical strategy to use to control cancer while also seeking novel treatments and earlier detection. Lifestyle modification strategies to improve primary prevention and risk reduction for the development of cancer include choosing a healthy diet with an emphasis on plant sources, maintaining a healthy weight throughout life, being physically active, regularly using sunscreen and wearing protective clothing, limiting sun exposure during the hours of 10 AM to 2 PM, avoiding indoor tanning, and reducing or eliminating alcohol use. In addition to continued use of ongoing education of the public, health care providers, and cancer support communities, other policy and public health efforts should be pursued as well. Examples of supported and successful policy approaches are included in this article, including efforts to limit indoor tanning and improve community-wide interventions to reduce ultraviolet radiation exposure as well as to formally support various alcohol policy strategies including increasing alcohol taxes, reducing alcohol outlet density, improving clinical screening for alcohol use disorders, and limiting youth exposure to alcohol marketing and advertising. These prevention strategies are expected to have the largest impact on the development of melanoma as well as breast, colorectal, head and neck, liver, and esophageal cancers. The impact of these strategies as secondary prevention is less well understood. Areas of additional needed research and implementation are also highlighted. Future areas of needed research are the effects of these modifications after the diagnosis of cancer (as secondary prevention).

Neutrons as a one of the by-products of high-energy photons in radiotherapy increase the patient's risks and could cause secondary cancers. Therefore, a new corrected simplified model for linac head was introduced to calculate equivalent (H) and absorbed (D) doses in different tissues/organs of a phantom model. The photoneutron spectrum calculated with this model was in agreement with the spectrum obtained by using a detailed linac´s head model having all components. Besides, an anthropomorphic phantom was irradiated under different gantry angles of the corrected simplified model aiming to emulate 15, 18, 20, and 25 MV Siemens linacs. The results indicated that tissues which were within the treatment field received more dose than others. Furthermore, tissues which were in the vicinity of each other and the same depth in the phantom nearly received the same doses. Finally, fatal secondary cancer risk was also studied.

Introduction: For early stage breast cancer patients, non-breast cancer mortality including secondary cancers and cardiac events can overshadow the benefit of adjuvant radiotherapy. This study evaluates the excess risk of secondary cancer for various breast radiotherapy techniques including accelerated partial breast irradiation (APBI).Methods: Secondary cancers Lifetime Attributable Risks (LAR) were calculated using a modified BEIR-VII formalism to account for the specific survival of breast cancer patients. Those survivals were extracted from the SEER database. Doses scattered to various organs were measured into a Rando phantom with custom-made breast phantoms. Treatments delivered typical doses of brachytherapy APBI (34 Gy in 10 fractions), external beam APBI (38.5 Gy in 10 fractions) using 3D-conformal, Cyberknife stereotactic (CK), or VMAT, as well as whole breast irradiation (WBI) delivering 42.5 Gy in 16 fractions.Results: WBI resulted in the highest total LAR, with 4.3% excess risk of secondary cancer for a patient treated at age 50 years. Lung cancers accounted for 75-97% of secondary malignancies. For a typical early stage patient irradiated at 50, the excess risks of secondary lung cancer were 1.1% for multicatheter HDR, between 2.2% and 2.5% for 3D-CRT or CK, 3.5% for VMAT APBI, and 3.8% for WBI.Conclusions: APBI reduces the risk of secondary cancer 2-4 fold compared to WBI. These techniques are well suited for long-living early stage breast cancer patients. HDR brachytherapy and 3D-conformal APBI achieve mean lung doses between 1 and 1.5 Gy, which could serve as reference. (C) 2018 Elsevier B.V. All rights reserved.

We report a well-differentiated liposarcoma and multiple lipomas in a patient with bilateral retinoblastoma at the age of two. Well-differentiated liposarcoma of the skin are rare and have a good prognosis. Lipomas are in those cases a good indicator for a higher risk of secondary cancer. There is no standardized aftercare program. We recommend therefore regular clinical-dermatological examinations every 6 months and if necessary an early excision of suspicious lesions.