title: Radiotherapy for stage I seminoma of the testis: Organ equivalent dose to partially in-field structures and second cancer risk estimates on the basis of a mechanistic, bell-shaped, and plateau model.
abstract: OBJECTIVE
  The aim of the current study was to (a) calculate the organ equivalent dose (OED) and (b) estimate the associated second cancer risk to partially in-field critical structures from adjuvant radiotherapy for stage I seminoma of the testis on the basis of three different nonlinear risk models.
  
  
  METHODS
  Three-dimensional plans were created for twelve patients who underwent a treatment planning computed tomography of the abdomen. The plans for irradiation of seminoma consisted of para-aortic anteroposterior and posteroanterior fields giving 20 Gy to the target site with 6 MV photons. The OED of stomach, colon, liver, pancreas, and kidneys, that were partially included in the treatment volume, was calculated using differential dose-volume histograms. The mechanistic, bell-shaped, and plateau models were employed for these calculations provided that organ-specific parameters were available for the subsequent assessment of the excess absolute risk (EAR) for second cancer development. The estimated organ-specific lifetime risks were compared with the respective nominal intrinsic probabilities for cancer induction.
  
  
  RESULTS
  The mean OED, which was calculated from the patients' treatment plans, varied from 0.54 to 6.61 Gy by the partially in-field organ of interest and the model used for dosimetric calculations. The difference between the OED of liver derived from the mechanistic model with those from the bell-shaped and plateau models was less than 1.8%. An even smaller deviation of 1.0% was observed for colon. For the rest organs of interest, the differences between the OED values obtained by the examined models varied from 8.6% to 50.0%. The EAR for stomach, colon, liver, pancreas, and kidney cancer induction at an age of 70 yr because of treatment of a typical 39-yr-old individual was up to 4.24, 11.39, 0.91, 3.04, and 0.14 per 10 000 persons-yr, respectively. Patient's irradiation was found to elevate the lifetime intrinsic risks by 8.3%-63.0% depending upon the organ of interest and the model employed for risk analysis.
  
  
  CONCLUSIONS
  Radiotherapy for stage I seminoma of the testis may result in an excess risk for the appearance of secondary malignancies in partially in-field organs. The organ- and model-dependent second cancer risk assessments of this study may be of value for patient counseling and follow-up.
authors.affiliation: Department of Medical Physics, Faculty of Medicine, University of Crete, P.O. Box 2208, Iraklion, Crete 71003, Greece.
authors.forename: Michalis
authors.initials: M
authors.lastname: Mazonakis
authors.affiliation: Department of Radiotherapy and Oncology, University Hospital of Iraklion, Iraklion, Crete 71110, Greece.
authors.forename: Charalambos
authors.initials: C
authors.lastname: Varveris
authors.affiliation: Department of Radiotherapy and Oncology, University Hospital of Iraklion, Iraklion, Crete 71110, Greece.
authors.forename: Efrossyni
authors.initials: E
authors.lastname: Lyraraki
authors.affiliation: Department of Medical Physics, Faculty of Medicine, University of Crete, P.O. Box 2208, Iraklion, Crete 71003, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Damilakis
mesh_terms: D003198:Computer Simulation; D004307:Dose-Response Relationship, Radiation; D006801:Humans; D015994:Incidence; D008297:Male; D008954:Models, Biological; D015233:Models, Statistical; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D012062:Relative Biological Effectiveness; D018570:Risk Assessment / Q000379:methods; D018239:Seminoma / Q000453:epidemiology* / Q000473:pathology / Q000532:radiotherapy*; D013736:Testicular Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000532:radiotherapy*