Lifetime attributable risk of radiation-induced secondary cancer from proton beam therapy compared with that of intensity-modulated X-ray therapy in randomly sampled pediatric cancer patients.
Lifetime attributable risk of radiation-induced secondary cancer from proton beam therapy compared with that of intensity-modulated X-ray therapy in randomly sampled pediatric cancer patients.
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DOI：
10.1093/jrr/rrw088
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发表时间：
2017-05-01
影响因子：
2
通讯作者：
Ito YM
中科院分区：
文献类型：
--
作者：
Tamura M;Sakurai H;Mizumoto M;Kamizawa S;Murayama S;Yamashita H;Takao S;Suzuki R;Shirato H;Ito YM
为了调查在儿科患者中使用质子束疗法 (PBT) 代替调强 X 射线疗法 (IMXT) 可以减少辐射诱发的继发性癌症的数量，我们分析了终生归因风险 (LAR)，作为这些治疗后继发性癌症的计算机替代标志物。从接受 PBT 治疗的 242 名儿童癌症患者中，分层后随机抽样选出 26 名患者，分为四类：(i) 脑部、头颈部、(ii) 胸部、(iii) 腹部和 (iv) 全颅脊髓 (WCNS) 照射。使用相同的计算机断层扫描和感兴趣区域重新规划 IMXT。使用 PBT 和 IMXT 的剂量体积直方图 (DVH)，Schneider 等人的 LAR。是针对同一名患者计算的。所有已发表的剂量反应模型都针对有风险的器官进行了测试。基于 DVH 计算 PBT 和 IMXT 的 LAR 对于所有患者都是可行的。四个类别的 PBT 和 IMXT 之间的累积 LAR 差异的平均值±标准差为 (i) 1.02 ± 0.52% (n = 7, P = 0.0021), (ii) 23.3 ± 17.2% (n = 8, P = 0.0065), (iii) 16.6 ± 19.9% (n = 8, P = 0.0497) 和 (iv) 50.0 ± 21.1% （n = 3，P = 0.0274）（单尾 t 检验）。对于 WCNS，需要治疗 (NNT) 的人数分别为 (i) 98.0、(ii) 4.3、(iii) 6.0 和 (iv) 2.0。在接受过 PBT 的儿科患者中，PBT 的 LAR 显着低于通过计算机模型估计的 IMXT 的 LAR。尽管需要进行验证研究，但有人建议 LAR 可用作由不同放射治疗技术诱发的继发性癌症的计算机替代标记。
To investigate the amount that radiation-induced secondary cancer would be reduced by using proton beam therapy (PBT) in place of intensity-modulated X-ray therapy (IMXT) in pediatric patients, we analyzed lifetime attributable risk (LAR) as an in silico surrogate marker of the secondary cancer after these treatments. From 242 pediatric patients with cancers who were treated with PBT, 26 patients were selected by random sampling after stratification into four categories: (i) brain, head and neck, (ii) thoracic, (iii) abdominal, and (iv) whole craniospinal (WCNS) irradiation. IMXT was replanned using the same computed tomography and region of interest. Using the dose–volume histograms (DVHs) of PBT and IMXT, the LARs of Schneider et al. were calculated for the same patient. All the published dose–response models were tested for the organs at risk. Calculation of the LARs of PBT and IMXT based on the DVHs was feasible for all patients. The means ± standard deviations of the cumulative LAR difference between PBT and IMXT for the four categories were (i) 1.02 ± 0.52% (n = 7, P = 0.0021), (ii) 23.3 ± 17.2% (n = 8, P = 0.0065), (iii) 16.6 ± 19.9% (n = 8, P = 0.0497) and (iv) 50.0 ± 21.1% (n = 3, P = 0.0274), respectively (one tailed t-test). The numbers needed to treat (NNT) were (i) 98.0, (ii) 4.3, (iii) 6.0 and (iv) 2.0 for WCNS, respectively. In pediatric patients who had undergone PBT, the LAR of PBT was significantly lower than the LAR of IMXT estimated by in silico modeling. Although a validation study is required, it is suggested that the LAR would be useful as an in silico surrogate marker of secondary cancer induced by different radiotherapy techniques.