Taylor Sophie, Lim Pei, Ahmad Reem, Alhadi Ammar, Harris William, Rompokos Vasilis, D'Souza Derek, Gaze Mark, Gains Jennifer, Veiga Catarina
Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK.
Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK.
Phys Imaging Radiat Oncol. 2021 Jul 9;19:45-52. doi: 10.1016/j.phro.2021.06.003. eCollection 2021 Jul.
State-of-the-art radiotherapy modalities have the potential of reducing late effects of treatment in childhood cancer survivors. Our aim was to investigate the carcinogenic risk associated with 3D conformal (photon) radiation (3D-CRT), intensity modulated arc therapy (IMAT) and pencil beam scanning proton therapy (PBS-PT) in the treatment of paediatric abdominal neuroblastoma.
The risk of radiation-induced second malignant neoplasm (SMN) was estimated using the concept of organ equivalent dose (OED) for eleven organs (lungs, rectum, colon, stomach, small intestine, liver, bladder, skin, central nervous system (CNS), bone, and soft tissues). The risk ratio (RR) between radiotherapy modalities and lifetime absolute risks (LAR) were reported for twenty abdominal neuroblastoma patients (median, 4y; range, 1-9y) historically treated with 3D-CRT that were also retrospectively replanned for IMAT and PBS-PT.
The risk of SMN due to primary radiation was reduced in PBS-PT against 3D-CRT and IMAT for most patients and organs. The RR across all organs ranged from 0.38 ± 0.22 (bladder) to 0.98 ± 0.04 (CNS) between PBS-PT and IMAT, and 0.12 ± 0.06 (rectum and bladder) to 1.06 ± 0.43 (bone) between PBS-PT and 3D-CRT. The LAR for most organs was within 0.01-1% (except the colon) with a cumulative risk of 21 ± 13%, 35 ± 14% and 35 ± 16% for PBS-PT, IMAT and 3D-CRT, respectively.
PBS-PT was associated with the lowest risk of radiation-induced SMN compared to IMAT and 3D-CRT in abdominal neuroblastoma treatment. Other clinical endpoints and plan robustness should also be considered for optimal plan selection.
最新的放射治疗方式有降低儿童癌症幸存者治疗后期影响的潜力。我们的目的是研究三维适形（光子）放疗（3D-CRT）、调强弧形放疗（IMAT）和笔形束扫描质子治疗（PBS-PT）在治疗小儿腹部神经母细胞瘤时的致癌风险。
利用器官等效剂量（OED）概念估算了11个器官（肺、直肠、结肠、胃、小肠、肝、膀胱、皮肤、中枢神经系统（CNS）、骨骼和软组织）辐射诱发第二原发性恶性肿瘤（SMN）的风险。报告了20例腹部神经母细胞瘤患者（中位年龄4岁；范围1 - 9岁）放疗方式之间的风险比（RR）和终生绝对风险（LAR），这些患者既往接受过3D-CRT治疗，同时也对其进行了IMAT和PBS-PT的回顾性重新计划。
在大多数患者和器官中，与3D-CRT和IMAT相比，PBS-PT因原发辐射导致的SMN风险降低。PBS-PT与IMAT之间所有器官的RR范围为0.38±0.22（膀胱）至0.98±0.04（CNS），PBS-PT与3D-CRT之间为0.12±0.06（直肠和膀胱）至1.06±0.43（骨骼）。大多数器官的LAR在0.01 - 1%以内（结肠除外），PBS-PT、IMAT和3D-CRT的累积风险分别为21±13%、35±14%和35±16%。
在腹部神经母细胞瘤治疗中，与IMAT和3D-CRT相比，PBS-PT与辐射诱发SMN的风险最低相关。为了进行最佳计划选择，还应考虑其他临床终点和计划稳健性。
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