Kumar Rahul J, Zhai Huifang, Both Stefan, Tochner Zelig, Lustig Robert, Hill-Kayser Christine
Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia 10467, USA.
J Pediatr Hematol Oncol. 2013 Aug;35(6):462-7. doi: 10.1097/MPH.0b013e31829bcdf8.
Screening for secondary malignancies is paramount in the pediatric cancer survivorship population, but the risk of secondary breast cancer after craniospinal radiation has not been well characterized previously. The aim of this study was to examine the dose to the breast from craniospinal irradiation (CSI) delivered with x-ray therapy versus proton beam therapy to contribute to understanding the specific screening needs of this population.
Six female patients who received CSI with double-scattered proton therapy at the Children's Hospital of Philadelphia were identified. For each patient, photon and proton beam plans were designed in order to compare the radiation dose to the breast. A comprehensive literature review was also performed.
The dose to the breast tissues was near zero after proton therapy to the spine [average maximum and mean proton doses were 0.22 and 0.05 Gy(RBE), respectively]. In contrast, after photon treatment to the spine, average maximum and mean photon doses were 23 and 4 Gy, respectively (P<0.0001).
These data suggest that early screening for breast cancer may be unnecessary after CSI with proton beam therapy; however, after x-ray therapy, early breast cancer screening should be considered given doses to the breast that approach the Children's Oncology Group-recommended threshold.
对儿童癌症幸存者进行继发性恶性肿瘤筛查至关重要，但此前颅脊髓放疗后发生继发性乳腺癌的风险尚未得到充分描述。本研究的目的是比较X线治疗与质子束治疗进行颅脊髓照射（CSI）时乳腺所接受的剂量，以帮助了解该人群的具体筛查需求。
确定了6例在费城儿童医院接受双散射质子治疗CSI的女性患者。为每位患者设计了光子束和质子束计划，以比较乳腺所接受的辐射剂量。还进行了全面的文献综述。
质子治疗脊柱后，乳腺组织的剂量接近零[平均最大质子剂量和平均质子剂量分别为0.22和0.05 Gy（RBE）]。相比之下，光子治疗脊柱后，平均最大光子剂量和平均光子剂量分别为23和4 Gy（P<0.0001）。
这些数据表明，质子束治疗CSI后可能无需早期乳腺癌筛查；然而，X线治疗后，鉴于乳腺所接受的剂量接近儿童肿瘤学组推荐的阈值，应考虑早期乳腺癌筛查。
