Periodic Report Summary - ALLEGRO (Early and late health risks to normal/healthy tissues from the use of existing and emerging techniques for radiation therapy)
ALLEGRO - Early and late health risks to normal/healthy tissues from the use of existing and emerging techniques for radiation therapy
Andrea Ottolenghi
Vere Smyth
Klaus Trott
Introduction
Modern radiotherapy is a very successful cost-effective way of treating cancer. As the world population ages, there will be more and more cancer cases, and as many as 50 % will be treated with radiotherapy. So as new and even more effective radiotherapy technologies are developed, it is becoming more important not just to cure the cancer, but to look after the quality of life and survival of the patient in the decades following the treatment. How can we optimise the treatments now in order to minimise the risk of long-term normal tissue damage or a second cancer 20 years later? Should we be worrying about small tissue volumes getting a high dose more than large volumes getting a low dose? Should we spend the money and use protons or carbon ions rather than photons because they are safer? The answer is that we really don't know yet.
The ALLEGRO project has been funded by Euratom for two years to provide some initial answers and more importantly pointers for where the efforts should be put into new research. Research into the normal tissue risk from radiotherapy has the potential to complement and contribute to current Euratom initiatives in low-dose radiation risk research (e.g. Doremi). The ALLEGRO consortium is made up of 13 partners from 8 European countries. The partners are leading research institutes, hospitals, and university medical departments, all active in the development of new radiotherapy modalities, or optimising current modalities.
Project activities
The project is designed to cover every aspect of radiation damage to normal tissue from current and emerging treatment modalities. Measurements are being taken of the out-of-field radiation scattered from radiotherapy beams, including protons and carbon ions. The measurements are modelled using Monte Carlo methods to obtain information for assessment of the biological effectiveness of heavy particles and neutrons. Results will be used to verify the dose estimates reconstructed from clinical databases. The dose information will be applied to investigate current methods for modelling normal tissue complications and radiation-induced second cancers.
In the second year the results will be reviewed by experts from each of the participating institutions, together with a specially selected scientific advisory committee, to produce a series of focused documents defining the current state of knowledge and identifying all of the gaps that limit the confidence with which a clinician can predict the normal tissue response from a particular treatment on an individual patient.
Progress to date
The project has completed the first year, and work is on schedule in all work packages. Measurements of out of field doses on a linear accelerator have been completed, and modelled with the PHITS Monte Carlo code. Much of the time so far in the work packages dealing with analysis of clinical data has been spent gaining consistency of format and defining the structure of the case-control studies.
Expected results and impact
The ultimate purpose of the ALLEGRO project is to be able to take medium and long term normal tissue harm into account in making radiotherapy treatment decisions. It is essential to be able to predict medium and long term effects in order to plan treatments and evaluate the competing new technologies.
ALLEGRO will provide recommendations that will have an immediate impact on clinical practice and equipment design. But the most valuable contribution to society as a whole will be the demarcation of the gaps in the knowledge and the directions for future research.
Project website address: http://www.allegroproject.org/
Contact person: Andrea Ottolenghi andrea.ottolenghi@pv.infn.it
Andrea Ottolenghi
Vere Smyth
Klaus Trott
Introduction
Modern radiotherapy is a very successful cost-effective way of treating cancer. As the world population ages, there will be more and more cancer cases, and as many as 50 % will be treated with radiotherapy. So as new and even more effective radiotherapy technologies are developed, it is becoming more important not just to cure the cancer, but to look after the quality of life and survival of the patient in the decades following the treatment. How can we optimise the treatments now in order to minimise the risk of long-term normal tissue damage or a second cancer 20 years later? Should we be worrying about small tissue volumes getting a high dose more than large volumes getting a low dose? Should we spend the money and use protons or carbon ions rather than photons because they are safer? The answer is that we really don't know yet.
The ALLEGRO project has been funded by Euratom for two years to provide some initial answers and more importantly pointers for where the efforts should be put into new research. Research into the normal tissue risk from radiotherapy has the potential to complement and contribute to current Euratom initiatives in low-dose radiation risk research (e.g. Doremi). The ALLEGRO consortium is made up of 13 partners from 8 European countries. The partners are leading research institutes, hospitals, and university medical departments, all active in the development of new radiotherapy modalities, or optimising current modalities.
Project activities
The project is designed to cover every aspect of radiation damage to normal tissue from current and emerging treatment modalities. Measurements are being taken of the out-of-field radiation scattered from radiotherapy beams, including protons and carbon ions. The measurements are modelled using Monte Carlo methods to obtain information for assessment of the biological effectiveness of heavy particles and neutrons. Results will be used to verify the dose estimates reconstructed from clinical databases. The dose information will be applied to investigate current methods for modelling normal tissue complications and radiation-induced second cancers.
In the second year the results will be reviewed by experts from each of the participating institutions, together with a specially selected scientific advisory committee, to produce a series of focused documents defining the current state of knowledge and identifying all of the gaps that limit the confidence with which a clinician can predict the normal tissue response from a particular treatment on an individual patient.
Progress to date
The project has completed the first year, and work is on schedule in all work packages. Measurements of out of field doses on a linear accelerator have been completed, and modelled with the PHITS Monte Carlo code. Much of the time so far in the work packages dealing with analysis of clinical data has been spent gaining consistency of format and defining the structure of the case-control studies.
Expected results and impact
The ultimate purpose of the ALLEGRO project is to be able to take medium and long term normal tissue harm into account in making radiotherapy treatment decisions. It is essential to be able to predict medium and long term effects in order to plan treatments and evaluate the competing new technologies.
ALLEGRO will provide recommendations that will have an immediate impact on clinical practice and equipment design. But the most valuable contribution to society as a whole will be the demarcation of the gaps in the knowledge and the directions for future research.
Project website address: http://www.allegroproject.org/
Contact person: Andrea Ottolenghi andrea.ottolenghi@pv.infn.it
