Hodgkin's lymphoma emerging radiation treatment techniques: trade-offs between late radio-induced toxicities and secondary malignant neoplasms.
Hodgkin's lymphoma emerging radiation treatment techniques: trade-offs between late radio-induced toxicities and secondary malignant neoplasms.
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DOI：
10.1186/1748-717x-8-22
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发表时间：
2013-01-30
期刊：
影响因子：
--
通讯作者：
Pacelli R
中科院分区：
文献类型：
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作者：
Cella L;Conson M;Pressello MC;Molinelli S;Schneider U;Donato V;Orecchia R;Salvatore M;Pacelli R
本研究的目的是通过对一个具有代表性的临床模型进行全面的剂量学分析，探讨不同新兴放射治疗技术治疗霍奇金淋巴瘤(HL)的放射毒性和第二恶性肿瘤(SMN)诱发风险之间的权衡。三种不同的计划目标体积(PTVi)情景被用来作为本研究的模型。模拟了5种放射治疗技术：前后方平行对置(AP-PA)、正向强度调制(FIMRT)、反向强度调制(IMRT)、断层放射治疗(Tomo)、质子(PRO)技术。照射剂量为30Gy或CGE。计算PTV和危险器官(OAR)的剂量-体积直方图，并与可用的剂量-体积限制相关。乳房、甲状腺和肺的SMN风险通过器官当量剂量模型进行评估，该模型考虑了细胞再繁殖和不均匀的器官剂量。在PTVi覆盖水平相近的情况下，调强放疗、TOMO和PRO计划一般都减少了桨的剂量，从而减少了相关的放射毒性。然而，只有TOMO和PRO计划在所有情况下都符合所有限制条件。与AP-PA和FIMRT技术相比，IMRT和TOMO计划增加了乳房和肺SMN的发展风险。与AP-PA技术相比，只有PRO计划似乎降低了预测的SMN的风险。我们的基于模型的研究支持使用先进的RT技术来成功地备用桨并降低HL患者放射诱导毒性的风险。然而，在评估风险适应的治疗策略时，应仔细考虑Tomo和IMRT技术所固有的SMN风险的估计增加。
Purpose of this study is to explore the trade-offs between radio-induced toxicities and second malignant neoplasm (SMN) induction risk of different emerging radiotherapy techniques for Hodgkin’s lymphoma (HL) through a comprehensive dosimetric analysis on a representative clinical model. Three different planning target volume (PTVi) scenarios of a female patient with supradiaphragmatic HL were used as models for the purpose of this study. Five treatment radiation techniques were simulated: an anterior-posterior parallel-opposed (AP-PA), a forward intensity modulated (FIMRT), an inverse intensity modulated (IMRT), a Tomotherapy (TOMO), a proton (PRO) technique. A radiation dose of 30 Gy or CGE was prescribed. Dose-volume histograms of PTVs and organs-at-risk (OARs) were calculated and related to available dose-volume constraints. SMN risk for breasts, thyroid, and lungs was estimated through the Organ Equivalent Dose model considering cell repopulation and inhomogeneous organ doses. With similar level of PTVi coverage, IMRT, TOMO and PRO plans generally reduced the OARs’ dose and accordingly the related radio-induced toxicities. However, only TOMO and PRO plans were compliant with all constraints in all scenarios. For the IMRT and TOMO plans an increased risk of development of breast, and lung SMN compared with AP-PA and FIMRT techniques was estimated. Only PRO plans seemed to reduce the risk of predicted SMN compared with AP-PA technique. Our model–based study supports the use of advanced RT techniques to successfully spare OARs and to reduce the risk of radio-induced toxicities in HL patients. However, the estimated increase of SMNs’ risk inherent to TOMO and IMRT techniques should be carefully considered in the evaluation of a risk-adapted therapeutic strategy.