Stovall Marilyn, Donaldson Sarah S, Weathers Rita E, Robison Leslie L, Mertens Ann C, Winther Jeanette Falck, Olsen Jorgen H, Boice John D
Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
Int J Radiat Oncol Biol Phys. 2004 Oct 1;60(2):542-52. doi: 10.1016/j.ijrobp.2004.03.017.
To estimate the doses of radiation to organs of interest during treatment of childhood cancer for use in an epidemiologic study of possible heritable diseases, including birth defects, chromosomal abnormalities, cancer, stillbirth, and neonatal and premature death.
The study population was composed of more than 25,000 patients with cancer in Denmark and the United States who were survivors of childhood cancer and subsequently had nearly 6,500 children of their own. Radiation therapy records were sought for the survivors who parented offspring who had adverse pregnancy outcomes (>300 offspring), and for a sample of all survivors in a case-cohort design. The records were imaged and centrally abstracted. Water phantom measurements were made to estimate doses for a wide range of treatments. Mathematical phantoms were used to apply measured results to estimate doses to ovaries, uterus, testes, and pituitary for patients ranging in age from newborn to 25 years. Gonadal shielding, ovarian pinning (oophoropexy), and field blocking were taken into account.
Testicular radiation doses ranged from <1 to 700 cGy (median, 7 cGy) and ovarian doses from <1 to >2,500 cGy (median, 13 cGy). Ten percent of the records were incomplete, but sufficient data were available for broad characterizations of gonadal dose. More than 49% of the gonadal doses were >10 cGy and 16% were >100 cGy.
Sufficient radiation therapy data exist as far back as 1943 to enable computation of gonadal doses administered for curative therapy for childhood cancer. The range of gonadal doses is broad, and for many cancer survivors, is high and just below the threshold for infertility. Accordingly, the epidemiologic study has >90% power to detect a 1.3-fold risk of an adverse pregnancy outcome associated with radiation exposure to the gonads. This study should provide important information on the genetic consequences of radiation exposure to humans.
估算儿童癌症治疗期间感兴趣器官所接受的辐射剂量，用于一项关于可能的遗传性疾病（包括出生缺陷、染色体异常、癌症、死产以及新生儿和早产死亡）的流行病学研究。
研究人群包括丹麦和美国的25000多名癌症患者，他们是儿童癌症幸存者，随后育有近6500名子女。对生育出有不良妊娠结局后代（超过300名后代）的幸存者以及病例队列设计中所有幸存者的一个样本，查找其放射治疗记录。对记录进行成像并集中提取信息。进行水模体测量以估算多种治疗的剂量。使用数学模体将测量结果应用于估算年龄从新生儿到25岁患者的卵巢、子宫、睾丸和垂体所接受的剂量。考虑了性腺屏蔽、卵巢固定术（卵巢固定）和射野阻挡。
睾丸辐射剂量范围为<1至700 cGy（中位数为7 cGy），卵巢剂量范围为<1至>2500 cGy（中位数为13 cGy）。百分之十的记录不完整，但有足够的数据可对性腺剂量进行广泛描述。超过49%的性腺剂量>10 cGy，16%的剂量>100 cGy。
早在1943年就有足够的放射治疗数据，能够计算出儿童癌症根治性治疗所给予的性腺剂量。性腺剂量范围很广，对于许多癌症幸存者来说，剂量较高且刚好低于不育阈值。因此，该流行病学研究有超过90%的把握度检测到与性腺辐射暴露相关的不良妊娠结局有1.3倍的风险。本研究应能提供有关人类辐射暴露遗传后果的重要信息。
