Relative biological damage in and out of field of 6, 10 and 18 MV clinical photon beams

The lower energy of scattered radiation in and out of a megavoltage (MV) photon beam suggests that relative biological damage (RBD) may change from in- to out-of-field regions for unit absorbed dose. Because of high linear energy transfer (LET) and potential of causing severe damage to the DNA, low-energy (10 eV-1 keV) slowing down electrons should be included in radiation biological damage calculations. In this study RBD was calculated in and out of field of 6, 10 and 18 MV clinical photon beams including low-energy slowing down electrons in the track length estimated method. Electron spectra at energies higher than 2 keV were collected in a water phantom at different depths and off-axis points by using the MCNP code. A new extrapolation method was used to estimate the electron spectra at energies lower than 2 keV. The obtained spectra at energies lower than 2 keV merged with spectra at energies higher than 2 keV by using continuity of the spectra. These spectra were used as an input to a validated microdosimetric Monte Carlo (MC) code, MC damage simulation (MCDS), to calculate the RBD of induced DSB in DNA at points in and out of the primary radiation field under fully aerobic (100% O2 and anoxic (0% O2 conditions. There was an observable difference in the energy spectra for electrons for points in the primary radiation field and those points out of field. RBD had maximum variation, 11% in 6 MV photons at field size of 20×20 cm2. This variation was less than 11% for 10 and 18 MV photons and field sizes smaller than 20×20 cm2. Our simulations also showed that under the anoxic condition, RBD increases up to 6% for 6 and 10 MV photons and the 20×20 cm2 field size. This work supports the hypothesis that in megavoltage treatments out-of-field radiation quality can vary enough to have an impact on RBD per unit dose and that this may play a role as the radiation therapy community explores biological optimization as a tool to assist treatment planning.