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乳腺癌术中电子放疗后盆腔区域外周剂量的测量及癌症发生的相关风险

Measurement of peripheral dose to the pelvic region and the associated risk for cancer development after breast intraoperative electron radiation therapy.

作者信息

Mahdavi Seyed Rabie, Tutuni Mahdieh, Farhood Bagher, Nafisi Nahid, Ghasemi Shiva, Mirzaee Hamidreza, Ahmadi Soraya, Alizadeh Ahad

机构信息

Department of Medical Physics, Iran University of Medical Sciences, Tehran, Iran.

出版信息

J Radiol Prot. 2019 Mar;39(1):278-291. doi: 10.1088/1361-6498/aafdc8. Epub 2019 Jan 11.

Abstract

This study aimed to measure the received dose to the pelvic region of patients during breast intraoperative electron radiation therapy (IOERT). Furthermore, we compared the findings with those of external beam radiation therapy. Finally, secondary ovarian and uterus cancer risks following breast IOERT were estimated. In the current study, the received dose to the pelvic surface of 18 female patients during breast IOERT boosts were measured by thermoluminescent dosimeter (TLD-100) chips. All patients were treated with 12 Gy given in a single fraction. To estimate the dose to the ovary and uterus of the patients, conversion coefficients for depth from the surface dose were obtained in a Rando phantom. Given the received dose to the pelvic region of the patients, secondary ovarian and uterus cancer risks following breast IOERT were estimated. The received doses to the ovary and uterus surface of the patients were 0.260 ± 0.155 mGy to 31.460 ± 6.020 mGy and 0.485 ± 0.122 mGy to 22.387 ± 15.476 mGy, respectively. Corresponding intra-pelvic (ovary and uterus) regional doses were 0.012 ± 0.007 mGy to 1.479 ± 0.283 mGy and 0.027 ± 0.001 mGy to 1.164 ± 0.805 mGy, respectively. Findings demonstrated that the ratio of the received dose by the pelvic surface to the regional dose during breast IOERT was much less than external beam radiation therapy. The mean of the secondary cancer risks for the ovary in 8 and 10 MeV electron beam energies were 135.722 ± 117.331 × 10 and 69.958 ± 28.072 × 10, and for the uterus were 17.342 ± 10.583 × 10 and 2.971 ± 3.604 × 10, respectively. According to our findings, the use of breast IOERT in pregnant patients can be considered as a safe radiotherapeutic technique, because the received dose to the fetus was lower than 50 mGy. Furthermore, IOERT can efficiently reduce the unnecessary dose to the pelvic region and lowers the risk of secondary ovarian and uterus cancer following breast irradiation.

摘要

本研究旨在测量乳腺癌术中电子放疗(IOERT)期间患者盆腔区域所接受的剂量。此外,我们将研究结果与外照射放疗的结果进行了比较。最后,估算了乳腺癌IOERT后继发性卵巢癌和子宫癌的风险。在本研究中,通过热释光剂量计(TLD-100)芯片测量了18例女性患者在乳腺癌IOERT增敏期间盆腔表面所接受的剂量。所有患者均接受单次12 Gy的治疗。为了估算患者卵巢和子宫的剂量,在兰多人体模型中获得了从表面剂量到深度的转换系数。根据患者盆腔区域所接受的剂量,估算了乳腺癌IOERT后继发性卵巢癌和子宫癌的风险。患者卵巢和子宫表面所接受的剂量分别为0.260±0.155 mGy至31.460±6.020 mGy以及0.485±0.122 mGy至22.387±15.476 mGy。相应的盆腔内(卵巢和子宫)区域剂量分别为0.012±0.007 mGy至1.479±0.283 mGy以及0.027±0.001 mGy至1.164±0.805 mGy。研究结果表明,乳腺癌IOERT期间盆腔表面所接受的剂量与区域剂量之比远低于外照射放疗。8 MeV和10 MeV电子束能量下卵巢继发性癌症风险的平均值分别为135.722±117.331×10和69.958±28.072×10,子宫的分别为17.342±10.583×10和2.971±3.604×10​。根据我们的研究结果,对于孕妇使用乳腺癌IOERT可被视为一种安全的放射治疗技术,因为胎儿所接受的剂量低于50 mGy。此外,IOERT可有效减少盆腔区域不必要的剂量,并降低乳腺癌放疗后继发性卵巢癌和子宫癌的风险。

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