放疗的进展及其对第二原发癌风险的影响：一项前列腺癌患者的多中心队列研究。
Advances in radiotherapy and its impact on second primary cancer risk: A multi-center cohort study in prostate cancer patients.
机构信息
Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Department of Research & Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands; Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands.
出版信息
Radiother Oncol. 2023 Jun;183:109659. doi: 10.1016/j.radonc.2023.109659. Epub 2023 Mar 30.
BACKGROUND
Modelling studies suggest that advanced intensity-modulated radiotherapy may increase second primary cancer (SPC) risks, due to increased radiation exposure of tissues located outside the treatment fields. In the current study we investigated the association between SPC risks and characteristics of applied external beam radiotherapy (EBRT) protocols for localized prostate cancer (PCa).
METHODS
We collected EBRT protocol characteristics (2000-2016) from five Dutch RT institutes for the 3D-CRT and advanced EBRT era (N = 7908). From the Netherlands Cancer Registry we obtained patient/tumour characteristics, SPC data, and survival information. Standardized incidence ratios (SIR) were calculated for pelvis and non-pelvis SPC. Nationwide SIRs were calculated as a reference, using calendar period as a proxy to label 3D-CRT/advanced EBRT.
RESULTS
From 2000-2006, 3D-CRT with 68-78 Gy in 2 Gy fractions, delivered with 10-23 MV and weekly portal imaging was the most dominant protocol. By the year 2010 all institutes routinely used advanced EBRT (IMRT, VMAT, tomotherapy), mainly delivering 78 Gy in 2 Gy fractions, using various kV/MV imaging protocols. Sixteen percent (N = 1268) developed ≥ 1 SPC. SIRs for pelvis and non-pelvis SPC (all institutes, advanced EBRT vs 3D-CRT) were 1.17 (1.00-1.36) vs 1.39 (1.21-1.59), and 1.01 (0.89-1.07) vs 1.03 (0.94-1.13), respectively. Nationwide non-pelvis SIR was 1.07 (1.01-1.13) vs 1.02 (0.98-1.07). Other RT protocol characteristics did not correlate with SPC endpoints.
CONCLUSION
None of the studied RT characteristics of advanced EBRT was associated with increased out-of-field SPC risks. With constantly evolving EBRT protocols, evaluation of associated SPC risks remains important.
背景
模型研究表明，由于治疗野外组织的辐射暴露增加，高级强度调制放疗可能会增加第二原发癌（SPC）的风险。在目前的研究中，我们调查了局部前列腺癌（PCa）应用外照射放疗（EBRT）方案与 SPC 风险之间的关联。
方法
我们从荷兰的五个放射治疗研究所收集了 2000-2016 年 EBRT 方案特征（N=7908）。从荷兰癌症登记处，我们获得了患者/肿瘤特征、SPC 数据和生存信息。计算了骨盆和非骨盆 SPC 的标准化发病比（SIR）。使用日历时间作为标记 3D-CRT/高级 EBRT 的替代指标，计算了全国范围内的 SIR 作为参考。
结果
从 2000 年到 2006 年，使用 10-23MV 和每周进行端口成像的 68-78Gy 的 2Gy 分数的 3D-CRT 是最主要的方案。到 2010 年，所有研究所都常规使用高级 EBRT（调强放疗、VMAT、托姆治疗），主要使用各种 kV/MV 成像方案提供 78Gy 的 2Gy 分数。16%（N=1268）发生了≥1 种 SPC。所有研究所中，高级 EBRT 与 3D-CRT 相比，骨盆和非骨盆 SPC 的 SIR 分别为 1.17（1.00-1.36）和 1.39（1.21-1.59）和 1.01（0.89-1.07）和 1.03（0.94-1.13）。全国范围内非骨盆 SIR 为 1.07（1.01-1.13）和 1.02（0.98-1.07）。其他 RT 方案特征与 SPC 终点无关。
结论
高级 EBRT 的研究中没有任何 RT 特征与场外 SPC 风险增加相关。随着不断发展的 EBRT 方案，评估相关 SPC 风险仍然很重要。
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