title: Secondary malignancies from prostate cancer radiation treatment: a risk analysis of the influence of target margins and fractionation patterns.
abstract: OBJECTIVE
  This study explores the implications for cancer induction of treatment details such as fractionation, planning target volume (PTV) definition, and interpatient variations, which are relevant for the radiation treatment of prostate carcinomas.
  
  
  METHODS
  Treatment planning data from 100 patients have been analyzed with a risk model based on the United Nations Scientific Committee on the Effects of Atomic Radiation competition model. The risk model can account for dose heterogeneity and fractionation effects characteristic for modern radiotherapy. Biologically relevant parameters from clinical and experimental data have been used with the model.
  
  
  RESULTS
  The results suggested that changes in prescribed dose could lead to a modification of the risks for individual organs surrounding the clinical target volume (CTV) but that the total risk appears to be less affected by changes in the target dose. Larger differences are observed for modifications of the margins between the CTV and the PTV because these have direct impact onto the dose level and dose heterogeneity in the healthy tissues surrounding the CTV. Interpatient anatomic variations also have to be taken into consideration for studies of the risk for cancer induction from radiotherapy.
  
  
  CONCLUSIONS
  The results have shown the complex interplay between the risk for secondary malignancies, the details of the treatment delivery, and the patient heterogeneity that may influence comparisons between the long-term effects of various treatment techniques. Nevertheless, absolute risk levels seem very small and comparable to mortality risks from surgical interventions, thus supporting the robustness of radiation therapy as a successful treatment modality for prostate carcinomas.
authors.affiliation: Department of Radiation Sciences, Umeå University, and Department of Radiation Physics, Norrland University Hospital, Umeå, Sweden. alexandru.dasu@radfys.umu.se
authors.forename: Alexandru
authors.initials: A
authors.lastname: Daşu
authors.forename: Iuliana
authors.initials: I
authors.lastname: Toma-Daşu
authors.forename: Lars
authors.initials: L
authors.lastname: Franzén
authors.forename: Anders
authors.initials: A
authors.lastname: Widmark
authors.forename: Per
authors.initials: P
authors.lastname: Nilsson
mesh_terms: D000368:Aged; D019583:Dose Fractionation, Radiation; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009381:Neoplasms, Radiation-Induced / Q000209:etiology*; D016609:Neoplasms, Second Primary / Q000209:etiology*; D058958:Organs at Risk / Q000528:radiation effects; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D012004:Rectal Neoplasms / Q000209:etiology*; D012007:Rectum / Q000033:anatomy & histology / Q000528:radiation effects; D018570:Risk Assessment; D047368:Tumor Burden; D001743:Urinary Bladder / Q000033:anatomy & histology / Q000528:radiation effects; D001749:Urinary Bladder Neoplasms / Q000209:etiology*