Clinical simulations of prostate radiotherapy using BOMAB-like phantoms: Results for neutrons

This paper presents in-phantom photoneutron equivalent doses induced by external radiotherapy, these are necessary to assess organ-averaged equivalent doses to derive the risk of secondary cancer development, associated with non-target organ exposures. The measurements were performed by Working Group 9 "Radiation Protection Dosimetry in Medicine" of the European Radiation Dosimetry Group (EURADOS) for simulations of clinical radiotherapy treatments of prostate cancer. The photoneutron dose measurements were carried out in a BOMAB-like water-filled phantom, by means of superheated emulsions (superheated drop detectors SDD and bubble damage BTI^® detectors) and Poly-Allyl-Diglicol-Carbonate (PADC) solid state nuclear track detectors. Dose data were acquired in a three-dimensional matrix of reproducible measurement points, which are spaced according to detectors size. Four clinical protocols for the treatment of the prostate tumor were considered and compared, by measuring the doses delivered to the planning target volume (PTV) and to peripheral radiosensitive regions (i.e. colon-rectum and bladder). The clinical irradiations were performed in two clinical radiotherapy facilities based on Varian Clinac 2300 CD accelerator: Santa Chiara University Hospital (Pisa, Italy) and Centre of Oncology M. Skłodowska-Curie Memorial Institute (Krakow, Poland). An additional tomotherapy prostate cancer treatment was also simulated in Campo di Marte Hospital (Lucca, Italy). Radiation qualities of 6, 12, 15, 18 and 20 MV were used; all of these are capable of producing photoneutrons. Data from this work span most of the X-ray beam energies and prostate treatment modalities used in the current clinical practice. These data permit the assessment of doses absorbed by a radiotherapy patient either at the treatment volume or at out-of-field organs. Comparison of different dosimeters, under the same irradiation conditions, showed that dosimeters generally agreed within their 20% 1 SD uncertainty. Comparison of different treatment modalities in the two contributing clinical centers (Pisa and Krakow) were also possible, as well as a comparison of dose profiles resulting from the different treatment techniques, delivered at the same primary photon energy. It was in particular found that photon acceleration energies as low as 6 MV are able to produce a non-negligible photoneutron component, which causes an undue dose to the patient of the order of tens microsievert per unit photon dose delivered at the target volume.