Filippi Andrea Riccardo, Ragona Riccardo, Piva Cristina, Scafa Davide, Fiandra Christian, Fusella Marco, Giglioli Francesca Romana, Lohr Frank, Ricardi Umberto
Department of Oncology, Radiation Oncology, University of Torino, Torino, Italy.
Department of Oncology, Radiation Oncology, University of Torino, Torino, Italy.
Int J Radiat Oncol Biol Phys. 2015 May 1;92(1):161-8. doi: 10.1016/j.ijrobp.2015.02.030.
The purpose of this study was to evaluate the risks of second cancers and cardiovascular diseases associated with an optimized volumetric modulated arc therapy (VMAT) planning solution in a selected cohort of stage I/II Hodgkin lymphoma (HL) patients treated with either involved-node or involved-site radiation therapy in comparison with 3-dimensional conformal radiation therapy (3D-CRT).
Thirty-eight patients (13 males and 25 females) were included. Disease extent was mediastinum alone (n=8, 21.1%); mediastinum plus unilateral neck (n=19, 50%); mediastinum plus bilateral neck (n=11, 29.9%). Prescription dose was 30 Gy in 2-Gy fractions. Only 5 patients had mediastinal bulky disease at diagnosis (13.1%). Anteroposterior 3D-CRT was compared with a multiarc optimized VMAT solution. Lung, breast, and thyroid cancer risks were estimated by calculating a lifetime attributable risk (LAR), with a LAR ratio (LAR(VMAT)-to-LAR(3D-CRT)) as a comparative measure. Cardiac toxicity risks were estimated by calculating absolute excess risk (AER).
The LAR ratio favored 3D-CRT for lung cancer induction risk in mediastinal alone (P=.004) and mediastinal plus unilateral neck (P=.02) presentations. LAR ratio for breast cancer was lower for VMAT in mediastinal plus bilateral neck presentations (P=.02), without differences for other sites. For thyroid cancer, no significant differences were observed, regardless of anatomical presentation. A significantly lower AER of cardiac (P=.038) and valvular diseases (P<.0001) was observed for VMAT regardless of disease extent.
In a cohort of patients with favorable characteristics in terms of disease extent at diagnosis (large prevalence of nonbulky presentations without axillary involvement), optimized VMAT reduced heart disease risk with comparable risks of thyroid and breast cancer, with an increase in lung cancer induction probability. The results are however strongly influenced by the different anatomical presentations, supporting an individualized approach.
本研究旨在评估在一组经受累淋巴结或受累部位放射治疗的Ⅰ/Ⅱ期霍奇金淋巴瘤（HL）患者中，与三维适形放射治疗（3D-CRT）相比，优化的容积调强弧形治疗（VMAT）计划方案与二次癌症和心血管疾病风险之间的关联。
纳入38例患者（13例男性和25例女性）。疾病范围仅为纵隔（n = 8，21.1%）；纵隔加单侧颈部（n = 19，50%）；纵隔加双侧颈部（n = 11，29.9%）。处方剂量为30 Gy，分2 Gy 分次给予。仅5例患者在诊断时有纵隔大包块疾病（13.1%）。将前后位3D-CRT与多弧优化VMAT方案进行比较。通过计算终身归因风险（LAR）来估计肺癌、乳腺癌和甲状腺癌风险，以LAR比值（LAR(VMAT)与LAR(3D-CRT)之比）作为比较指标。通过计算绝对超额风险（AER）来估计心脏毒性风险。
在仅纵隔（P = 0.004）和纵隔加单侧颈部（P = 0.02）的情况下，LAR比值显示3D-CRT在诱发肺癌风险方面更具优势。在纵隔加双侧颈部的情况下，VMAT的乳腺癌LAR比值较低（P = 0.02），其他部位无差异。对于甲状腺癌，无论解剖部位如何，均未观察到显著差异。无论疾病范围如何，VMAT的心脏（P = 0.038）和瓣膜疾病的AER均显著较低（P < 0.0001）。
在一组诊断时疾病范围特征良好（非大包块表现且无腋窝受累的患病率高）的患者中，优化的VMAT降低了心脏病风险，甲状腺癌和乳腺癌风险相当，但肺癌诱发概率增加。然而，结果受到不同解剖部位的强烈影响，支持个体化治疗方法。
