乳腺癌三维适形放疗、调强放疗和容积调强弧形放疗后的第二原发癌风险
Second cancer risk after 3D-CRT, IMRT and VMAT for breast cancer.
作者信息
Abo-Madyan Yasser, Aziz Muhammad Hammad, Aly Moamen M O M, Schneider Frank, Sperk Elena, Clausen Sven, Giordano Frank A, Herskind Carsten, Steil Volker, Wenz Frederik, Glatting Gerhard
机构信息
Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; Department of Radiation Oncology and Nuclear Medicine (NEMROCK), Faculty of Medicine, Cairo University, Egypt.
Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany; Department of Physics, COMSATS Institute of Information and Technology, Islamabad, Pakistan.
出版信息
Radiother Oncol. 2014 Mar;110(3):471-6. doi: 10.1016/j.radonc.2013.12.002. Epub 2014 Jan 17.
PURPOSE
Second cancer risk after breast conserving therapy is becoming more important due to improved long term survival rates. In this study, we estimate the risks for developing a solid second cancer after radiotherapy of breast cancer using the concept of organ equivalent dose (OED).
MATERIALS AND METHODS
Computer-tomography scans of 10 representative breast cancer patients were selected for this study. Three-dimensional conformal radiotherapy (3D-CRT), tangential intensity modulated radiotherapy (t-IMRT), multibeam intensity modulated radiotherapy (m-IMRT), and volumetric modulated arc therapy (VMAT) were planned to deliver a total dose of 50 Gy in 2 Gy fractions. Differential dose volume histograms (dDVHs) were created and the OEDs calculated. Second cancer risks of ipsilateral, contralateral lung and contralateral breast cancer were estimated using linear, linear-exponential and plateau models for second cancer risk.
RESULTS
Compared to 3D-CRT, cumulative excess absolute risks (EAR) for t-IMRT, m-IMRT and VMAT were increased by 2 ± 15%, 131 ± 85%, 123 ± 66% for the linear-exponential risk model, 9 ± 22%, 82 ± 96%, 71 ± 82% for the linear and 3 ± 14%, 123 ± 78%, 113 ± 61% for the plateau model, respectively.
CONCLUSION
Second cancer risk after 3D-CRT or t-IMRT is lower than for m-IMRT or VMAT by about 34% for the linear model and 50% for the linear-exponential and plateau models, respectively.
目的
由于长期生存率的提高，保乳治疗后的二次癌症风险变得愈发重要。在本研究中，我们使用器官等效剂量（OED）的概念来估计乳腺癌放疗后发生实体二次癌症的风险。
材料与方法
本研究选取了10例有代表性的乳腺癌患者的计算机断层扫描图像。计划采用三维适形放疗（3D-CRT）、切线野调强放疗（t-IMRT）、多野调强放疗（m-IMRT）和容积调强弧形放疗（VMAT），以2Gy的分次剂量给予总剂量50Gy。创建了剂量差异体积直方图（dDVH）并计算了OED。使用二次癌症风险的线性、线性-指数和平台模型估计同侧、对侧肺部和对侧乳腺癌的二次癌症风险。
结果
与3D-CRT相比，对于线性-指数风险模型，t-IMRT、m-IMRT和VMAT的累积超额绝对风险（EAR）分别增加了2±15%、131±85%、123±66%；对于线性模型，分别增加了9±22%、82±96%、71±82%；对于平台模型，分别增加了3±14%、123±78%、113±61%。
结论
对于线性模型，3D-CRT或t-IMRT后的二次癌症风险比m-IMRT或VMAT低约34%；对于线性-指数和平台模型，分别低50%。
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