Dosimetric evaluation of ovaries and pelvic bones associated with clinical outcomes in patients receiving total body irradiation with ovarian shielding.
Dosimetric evaluation of ovaries and pelvic bones associated with clinical outcomes in patients receiving total body irradiation with ovarian shielding.
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DOI：
10.1093/jrr/rrab066
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发表时间：
2021-09-13
影响因子：
2
通讯作者：
Kanda Y
中科院分区：
文献类型：
--
作者：
Akahane K;Shirai K;Wakatsuki M;Suzuki M;Hatanaka S;Takahashi Y;Kawahara M;Ogawa K;Takahashi S;Oyama-Manabe N;Ashizawa M;Kimura SI;Kako S;Kanda Y
全身照射（TBI）结合卵巢屏蔽有望在采用清髓性TBI方案的造血干细胞移植（HSCT）患者中保留生育能力。然而，对TBI中保留卵巢功能的卵巢辐射剂量仍然知之甚少。此外，还不确定被屏蔽器官的剂量是否与复发风险有关。在这里，我们回顾性地评估了生育能力和卵巢剂量之间的关系，以及复发风险和骨盆骨剂量之间的关系。共纳入20例标准风险血液病患者（中位年龄23岁）。中位随访时间为31.9个月。TBI处方剂量为12戈伊，分6次治疗3天。患者的卵巢用圆柱形铅块屏蔽。从剂量-体积直方图（DVH）中提取卵巢和骨盆骨的剂量-体积参数（D98%和Dmean）。所有患者的平均卵巢Dmean为2.4戈伊，18例患者恢复月经（90%）。月经恢复和未恢复患者的平均卵巢Dmean分别为2.4戈伊和2.4戈伊，差异无统计学意义（P = 0.998）。在5例患者中观察到血液学复发。复发和非复发患者的平均骨盆Dmean和骨盆D98%分别为11.6戈伊和11.7戈伊和5.6戈伊和5.3戈伊。两项参数均无显著性差异（P = 0.827，0.807）。总之，卵巢屏蔽的TBI将卵巢的辐射剂量降低到2.4戈伊，并保留生育能力而不增加复发的风险。
Total body irradiation (TBI) with ovarian shielding is expected to preserve fertility among hematopoietic stem cell transplant (HSCT) patients with myeloablative TBI-based regimens. However, the radiation dose to the ovaries that preserves ovarian function in TBI remains poorly understood. Furthermore, it is uncertain whether the dose to the shielded organs is associated with relapse risk. Here, we retrospectively evaluated the relationship between fertility and the dose to the ovaries, and between relapse risk and the dose to the pelvic bones. A total of 20 patients (median age, 23 years) with standard-risk hematologic diseases were included. Median follow-up duration was 31.9 months. The TBI prescribed dose was 12 Gy in six fractions for three days. Patients’ ovaries were shielded with cylinder-type lead blocks. The dose–volume parameters (D98% and Dmean) in the ovaries and the pelvic bones were extracted from the dose–volume histogram (DVH). The mean ovary Dmean for all patients was 2.4 Gy, and 18 patients recovered menstruation (90%). The mean ovary Dmean for patients with menstrual recovery and without recovery were 2.4 Gy and 2.4 Gy, respectively, with no significant difference (P = 0.998). Hematological relapse was observed in five patients. The mean pelvis Dmean and pelvis D98% for relapse and non-relapse patients were 11.6 Gy and 11.7 Gy and 5.6 Gy and 5.3 Gy, respectively. Both parameters showed no significant difference (P = 0.827, 0.807). In conclusion, TBI with ovarian shielding reduced the radiation dose to the ovaries to 2.4 Gy, and preserved fertility without increasing the risk of relapse.
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影响因子：
4.7
作者：
CHAMBERS, SK;CHAMBERS, JT;SCHWARTZ, PE
通讯作者：
SCHWARTZ, PE
影响因子：
2.6
作者：
Peters, N. H. G. M.;Patterson, A. J.;Sala, E.
通讯作者：
Sala, E.
影响因子：
6.1
作者：
Wallace, WHB;Thomson, AB;Kelsey, TW
通讯作者：
Kelsey, TW
影响因子：
4.3
作者：
Ashizawa, Masahiro;Akahoshi, Yu;Kanda, Yoshinobu
通讯作者：
Kanda, Yoshinobu
影响因子：
4.8
作者：
Jiang, Zujun;Jia, Junsong;Xiao, Haowen
通讯作者：
Xiao, Haowen