title: Inter-Institutional Comparison of Personalized Risk Assessments for Second Malignant Neoplasms for a 13-Year-Old Girl Receiving Proton versus Photon Craniospinal Irradiation.
abstract: Children receiving radiotherapy face the probability of a subsequent malignant neoplasm (SMN). In some cases, the predicted SMN risk can be reduced by proton therapy. The purpose of this study was to apply the most comprehensive dose assessment methods to estimate the reduction in SMN risk after proton therapy vs. photon therapy for a 13-year-old girl requiring craniospinal irradiation (CSI). We reconstructed the equivalent dose throughout the patient's body from therapeutic and stray radiation and applied SMN incidence and mortality risk models for each modality. Excluding skin cancer, the risk of incidence after proton CSI was a third of that of photon CSI. The predicted absolute SMN risks were high. For photon CSI, the SMN incidence rates greater than 10% were for thyroid, non-melanoma skin, lung, colon, stomach, and other solid cancers, and for proton CSI they were non-melanoma skin, lung, and other solid cancers. In each setting, lung cancer accounted for half the risk of mortality. In conclusion, the predicted SMN risk for a 13-year-old girl undergoing proton CSI was reduced vs. photon CSI. This study demonstrates the feasibility of inter-institutional whole-body dose and risk assessments and also serves as a model for including risk estimation in personalized cancer care.
authors.affiliation: Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Unit 1202, 1515 Holcombe Blvd, Houston, TX 77030, USA. pt06@aub.edu.lb.|The University of Texas Graduate School of Biomedical Sciences at Houston, P.O. Box 20334, Houston, TX 77225, USA. pt06@aub.edu.lb.|Department of Radiation Oncology, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon. pt06@aub.edu.lb.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Taddei
authors.affiliation: Department of Radiation Oncology, Hôtel-Dieu de France Hospital, University of St. Joseph, P.O. Box 166830, Alfred Naccache Blvd, Beirut, Lebanon. nabil.khater@hdf.usj.edu.lb.
authors.forename: Nabil
authors.initials: N
authors.lastname: Khater
authors.affiliation: Medical Physics Program, Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Tower Dr., Baton Rouge, LA 70803, USA. rzhang@marybird.com.|Department of Physics, Mary Bird Perkins Cancer Center, 4950 Essen Lane, Baton Rouge, LA 70809, USA. rzhang@marybird.com.
authors.forename: Rui
authors.initials: R
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon. fg00@aub.edu.lb.
authors.forename: Fady B
authors.initials: FB
authors.lastname: Geara
authors.affiliation: Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Unit 1202, 1515 Holcombe Blvd, Houston, TX 77030, USA. amahajan@mdanderson.org.|The University of Texas Graduate School of Biomedical Sciences at Houston, P.O. Box 20334, Houston, TX 77225, USA. amahajan@mdanderson.org.
authors.forename: Anita
authors.initials: A
authors.lastname: Mahajan
authors.affiliation: Department of Radiation Oncology, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon. wj01@aub.edu.lb.
authors.forename: Wassim
authors.initials: W
authors.lastname: Jalbout
authors.affiliation: Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Unit 1202, 1515 Holcombe Blvd, Houston, TX 77030, USA.
authors.forename: Angélica
authors.initials: A
authors.lastname: Pérez-Andújar
authors.affiliation: Department of Radiation Oncology, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon. by04@aub.edu.lb.
authors.forename: Bassem
authors.initials: B
authors.lastname: Youssef
authors.affiliation: Medical Physics Program, Department of Physics and Astronomy, Louisiana State University, 202 Nicholson Hall, Tower Dr., Baton Rouge, LA 70803, USA. newhauser@lsu.edu.|Department of Physics, Mary Bird Perkins Cancer Center, 4950 Essen Lane, Baton Rouge, LA 70809, USA. newhauser@lsu.edu.
authors.forename: Wayne D
authors.initials: WD
authors.lastname: Newhauser