Radiation dose to the esophagus from breast cancer radiation therapy, 1943-1996: an international population-based study of 414 patients.
Radiation dose to the esophagus from breast cancer radiation therapy, 1943-1996: an international population-based study of 414 patients.
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DOI：
10.1016/j.ijrobp.2013.03.014
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发表时间：
2013-07-15
期刊：
影响因子：
--
通讯作者：
Morton LM
中科院分区：
文献类型：
--
作者：
Lamart S;Stovall M;Simon SL;Smith SA;Weathers RE;Howell RM;Curtis RE;Aleman BM;Travis L;Kwon D;Morton LM
通过重建1943-1996年期间在北美和欧洲接受乳腺癌放射治疗的414名妇女偶然输送到食管的辐射剂量，为乳腺癌幸存者中第二原发性食管癌风险的流行病学研究提供剂量学数据。我们从每个病人的放射治疗记录中提取放射治疗参数。治疗射野包括直接胸壁（37%的患者）、内侧和外侧切线（45%）、锁骨上（SCV，64%）、内乳（IM，44%）、SCV和IM一起（16%）、腋窝（52%）和乳房/胸壁提升（7%）。使用的射束类型为60 Co（45%的场）、正电压（33%）、兆伏光子（11%）和电子（10%）。靶体积的群体中位处方剂量范围为21戈伊至40戈伊。我们使用抽象的患者数据、水模测量和人体计算模型重建了食管长度上的剂量。85%的患者使用治疗SCV和/或IM淋巴结的射野，并在食管的3个区域内输送最高剂量：颈部（人群中位数38戈伊）、上胸部（32戈伊）和中胸部（25戈伊）。其他射野（直接胸壁、切线和腋窝）的剂量显著较低（约2戈伊）。颈部至胸部中段食管接受的剂量最高，因为其靠近SCV和IM野，胸部该部分的覆盖组织较少。SCV射野边界相对于中线的位置是食管剂量的最重要决定因素之一。在本研究中，当治疗SCV和/或IM淋巴结时，乳腺癌患者接受相对较高的食管偶发放射治疗剂量，而直接胸壁、切线和腋窝野的剂量较低。作者重建了1943-1996年期间在北美和欧洲接受放射治疗的乳腺癌患者偶然输送到食管的剂量。85%的患者使用了治疗锁骨上和/或内乳淋巴结的射野，并在食管的3个区域内输送了最高剂量：颈部（人群中位数38戈伊）、上部（32戈伊）和中部胸部（25戈伊）。其他射野（直接胸壁、切线和腋窝）的剂量显著较低（约2戈伊）。
To provide dosimetric data for an epidemiologic study on the risk of second primary esophageal cancer among breast cancer survivors, by reconstructing the radiation dose incidentally delivered to the esophagus of 414 women treated with radiation therapy for breast cancer during 1943–1996 in North America and Europe. We abstracted the radiation therapy treatment parameters from each patient’s radiation therapy record. Treatment fields included direct chest wall (37% of patients), medial and lateral tangentials (45%), supraclavicular (SCV, 64%), internal mammary (IM, 44%), SCV and IM together (16%), axillary (52%), and breast/chest wall boosts (7%). The beam types used were 60Co (45% of fields), orthovoltage (33%), megavoltage photons (11%), and electrons (10%). The population median prescribed dose to the target volume ranged from 21 Gy to 40 Gy. We reconstructed the doses over the length of the esophagus using abstracted patient data, water phantom measurements, and a computational model of the human body. Fields that treated the SCV and/or IM lymph nodes were used for 85% of the patients and delivered the highest doses within 3 regions of the esophagus: cervical (population median 38 Gy), upper thoracic (32 Gy), and middle thoracic (25 Gy). Other fields (direct chest wall, tangential, and axillary) contributed substantially lower doses (approximately 2 Gy). The cervical to middle thoracic esophagus received the highest dose because of its close proximity to the SCV and IM fields and less overlying tissue in that part of the chest. The location of the SCV field border relative to the midline was one of the most important determinants of the dose to the esophagus. Breast cancer patients in this study received relatively high incidental radiation therapy doses to the esophagus when the SCV and/or IM lymph nodes were treated, whereas direct chest wall, tangentials, and axillary fields contributed lower doses. The authors reconstructed doses incidentally delivered to the esophagus of breast cancer patients treated with radiation therapy during 1943–1996 in North America and Europe. Fields treating the supraclavicular and/or internal mammary lymph nodes were used for 85% of patients and delivered the highest doses within 3 regions of the esophagus: cervical (population median 38 Gy), upper (32 Gy), and middle thoracic (25 Gy). Other fields (direct chest wall, tangential, and axillary) contributed substantially lower doses (approximately 2 Gy).
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