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@ARTICLE{DeSaintHubert:284430,
      author       = {M. De Saint-Hubert and G. Boissonnat and U. Schneider and
                      C. Bäumer$^*$ and N. Verbeek and J. Esser and J. Wulff and
                      F. Stuckmann and F. Suesselbeck and R. Nabha and J. Dabin
                      and F. Vasi and S. Radonic and M. Rodriguez and A. C. Simon
                      and N. Journy and B. Timmermann$^*$ and I. Thierry-Chef and
                      L. Brualla$^*$},
      title        = {{C}omplete patient exposure during paediatric brain cancer
                      treatment for photon and proton therapy techniques including
                      imaging procedures.},
      journal      = {Frontiers in oncology},
      volume       = {13},
      issn         = {2234-943X},
      address      = {Lausanne},
      publisher    = {Frontiers Media},
      reportid     = {DKFZ-2023-02014},
      pages        = {1222800},
      year         = {2023},
      abstract     = {In radiotherapy, especially when treating children,
                      minimising exposure of healthy tissue can prevent the
                      development of adverse outcomes, including second cancers.
                      In this study we propose a validated Monte Carlo framework
                      to evaluate the complete patient exposure during paediatric
                      brain cancer treatment.Organ doses were calculated for
                      treatment of a diffuse midline glioma (50.4 Gy with 1.8 Gy
                      per fraction) on a 5-year-old anthropomorphic phantom with
                      3D-conformal radiotherapy, intensity modulated radiotherapy
                      (IMRT), volumetric modulated arc therapy (VMAT) and
                      intensity modulated pencil beam scanning (PBS) proton
                      therapy. Doses from computed tomography (CT) for planning
                      and on-board imaging for positioning (kV-cone beam CT and
                      X-ray imaging) accounted for the estimate of the exposure of
                      the patient including imaging therapeutic dose. For dose
                      calculations we used validated Monte Carlo-based tools
                      (PRIMO, TOPAS, PENELOPE), while lifetime attributable risk
                      (LAR) was estimated from dose-response relationships for
                      cancer induction, proposed by Schneider et al.Out-of-field
                      organ dose equivalent data of proton therapy are lower, with
                      doses between 0.6 mSv (testes) and 120 mSv (thyroid), when
                      compared to photon therapy revealing the highest
                      out-of-field doses for IMRT ranging between 43 mSv (testes)
                      and 575 mSv (thyroid). Dose delivered by CT ranged between
                      0.01 mSv (testes) and 72 mSv (scapula) while a single
                      imaging positioning ranged between 2 μSv (testes) and 1.3
                      mSv (thyroid) for CBCT and 0.03 μSv (testes) and 48 μSv
                      (scapula) for X-ray. Adding imaging dose from CT and daily
                      CBCT to the therapeutic demonstrated an important
                      contribution of imaging to the overall radiation burden in
                      the course of treatment, which is subsequently used to
                      predict the LAR, for selected organs.The complete patient
                      exposure during paediatric brain cancer treatment was
                      estimated by combining the results from different Monte
                      Carlo-based dosimetry tools, showing that proton therapy
                      allows significant reduction of the out-of-field doses and
                      secondary cancer risk in selected organs.},
      keywords     = {Monte Carlo simulation (Other) / imaging dosimetry (Other)
                      / out-of-field dosimetry (Other) / photon radiotherapy
                      (Other) / proton therapy (Other) / secondary cancer risk
                      (Other)},
      cin          = {ED01},
      ddc          = {610},
      cid          = {I:(DE-He78)ED01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:37795436},
      pmc          = {pmc:PMC10546320},
      doi          = {10.3389/fonc.2023.1222800},
      url          = {https://inrepo02.dkfz.de/record/284430},
}