胰腺癌碳离子放疗后上消化道溃疡的剂量学分析。
Dosimetric analysis of upper gastrointestinal ulcer after carbon-ion radiotherapy for pancreatic cancer.
机构信息
Ion Beam Therapy Center, SAGA HIMAT Foundation, Tosu, Japan; Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Ion Beam Therapy Center, SAGA HIMAT Foundation, Tosu, Japan.
出版信息
Radiother Oncol. 2016 Jul;120(1):140-4. doi: 10.1016/j.radonc.2016.04.040. Epub 2016 May 10.
PURPOSE
The aim of this study was to clarify the incidence, clinical risk factors, and dose-volume relationship of upper gastrointestinal (GI) ulcer after carbon-ion radiotherapy (C-ion RT) for pancreatic cancer.
MATERIALS AND METHODS
Fifty-eight pancreatic cancer patients were treated with C-ion RT from April 2014 to December 2015. The total dose was 55.2Gy (RBE) in 12 fractions. D2cm3 of GI tracts were restricted under 46Gy (RBE); RBE-weighted absorbed dose. The association between dosimetric parameters (V10-50, Dmax, D1cm3, D2cm3) and GI ulcer was examined using Spearman's correlation. The incidence of GI ulcer was compared between the two groups divided by the cutoff value.
RESULTS
Twelve patients (21%) experienced gastric ulcer including only one (2%) grade 3 ulcer. There was no grade 4/5 toxicity or duodenal ulcer. V10-30 was significantly associated with gastric ulcer. The 1-year estimated risk of gastric ulcer for the determined cutoff values were 51% vs. 10% (V10, ⩾102cm(3) or less), 42% vs. 9% (V20, ⩾24cm(3) or less), 34% vs. 4% (V30, ⩾6cm(3) or less).
CONCLUSIONS
The incidence of GI ulcer after C-ion RT was very low with the dose constraint of D2cm3 <46Gy (RBE). To further minimize the risk of GI ulcer, V10-30 should also be reduced.
目的
本研究旨在阐明碳离子放疗（C-ion RT）治疗胰腺癌后上消化道（GI）溃疡的发生率、临床危险因素和剂量-体积关系。
材料和方法
58 例胰腺癌患者于 2014 年 4 月至 2015 年 12 月接受 C-ion RT 治疗。总剂量为 55.2Gy（RBE），分 12 次进行。GI 道的 D2cm3 限制在 46Gy（RBE）以下；RBE 加权吸收剂量。使用 Spearman 相关分析检查剂量学参数（V10-50、Dmax、D1cm3、D2cm3）与 GI 溃疡之间的相关性。根据截断值将患者分为两组，比较 GI 溃疡的发生率。
结果
12 例（21%）患者发生胃溃病，其中仅 1 例（2%）为 3 级溃疡。无 4/5 级毒性或十二指肠溃疡。V10-30 与胃溃病显著相关。确定的截断值下，胃溃病 1 年的估计风险分别为 51%比 10%（V10，≥102cm3 或更小）、42%比 9%（V20，≥24cm3 或更小）、34%比 4%（V30，≥6cm3 或更小）。
结论
C-ion RT 后 GI 溃疡的发生率非常低，D2cm3<46Gy（RBE）的剂量限制。为了进一步降低 GI 溃疡的风险，还应减少 V10-30。
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