The impact of dose escalation on secondary cancer risk after radiotherapy of prostate cancer
The impact of dose escalation on secondary cancer risk after radiotherapy of prostate cancer
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DOI：
10.1016/j.ijrobp.2007.02.029
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发表时间：
2007-07-01
影响因子：
7
通讯作者：
Kaser-Hotz, Barbara
中科院分区：
文献类型：
--
作者：
Schneider, Uwe;Lomax, Antony;Kaser-Hotz, Barbara
目的：估计继发性癌症的风险，由于剂量递增的前列腺癌患者接受三维适形放疗（3D-CRT），调强放疗（IMRT），和点扫描质子RT。方法和材料：器官等效剂量（OED）的概念与线性指数，高原，线性剂量反应曲线的剂量分布的23例接受RT前列腺癌。7例患者使用适形放疗，8例患者接受6-和15-MV光子调强放疗，8例患者接受点扫描质子治疗。我们应用的靶剂量范围从70戈伊到100戈伊。癌症风险被估计为目标剂量和肿瘤控制概率的函数。在100-戈伊靶剂量下，相对于70戈伊的3D治疗计划，继发性癌症风险为+18.4%（平台模型为15.0%，线性模型为22.3%），对于6 MV IMRT计划，+25.3% 15 MV IMRT计划的放射性治疗的放射性治疗率分别为17.0%、14.1%，点扫质子治疗的放射性治疗率分别为-40.7%、-41.3%、-40.0%。放射治疗后，随着剂量的增加，发展放射相关的恶性肿瘤的风险增加被平衡的增强治愈率在一个更大的dose.Conclusions：前列腺放射治疗剂量递增后的癌症风险预计等于或低于传统的3D治疗在70戈伊，独立的治疗方式或剂量反应模型。点扫描质子是剂量递增的治疗选择，因为这种疗法可以将继发性癌症的风险减半。(c)2007年爱思唯尔公司
Purpose: To estimate secondary cancer risk due to dose escalation in patients treated for prostatic carcinoma with three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated RT (IMRT), and spot-scanned proton RT.Methods and Materials: The organ equivalent dose (OED) concept with a linear-exponential, a plateau, and a linear dose-response curve was applied to dose distributions of 23 patients who received RT of prostate cancer. Conformal RT was used in 7 patients, 8 patients received IMRT with 6- and 15-MV photons, and 8 patients were treated with spot-scanned protons. We applied target doses ranging from 70 Gy to 100 Gy. Cancer risk was estimated as a function of target dose and tumor control probability.Results: At a 100-Gy target dose the secondary cancer risk relative to the 3D treatment plan at 70 Gy was +18.4% (15.0% for a plateau model, 22.3% for a linear model) for the 6-MV IMRT plan, +25.3% (17.0%, 14.1%) for the 15-MV IMRT plan, and -40.7% (-41.3%, -40.0%) for the spot-scanned protons. The increasing risk of developing a radiation-associated malignancy after RT with increasing dose was balanced by the enhanced cure rates at a larger dose.Conclusions: Cancer risk after dose escalation for prostate RT is expected to be equal to or lower than for conventional 3D treatment at 70 Gy, independent of treatment modality or dose-response model. Spot-scanned protons are the treatment of choice for dose escalation because this therapy can halve the risk of secondary cancers. (c) 2007 Elsevier Inc.