术后乳腺癌放疗中分割方案对继发性恶性肿瘤的影响
The impact of fractionation on secondary malignancies in postoperative breast cancer irradiation
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影响因子:7.9
分区:医学2区 / 妇产科学2区 肿瘤学2区
发表日期:2024 Dec
作者:
Sophia Kiesl, Mathias Düsberg, Sophie T Behzadi, Rebecca Moser, Jana Nano, Thomas Huber, Evelyn Klein, Marion Kiechle, Denise Bernhardt, Stephanie E Combs, Kai J Borm
DOI:
10.1016/j.breast.2024.103819
keywords:
摘要
随机研究显示，超短程（超）分割放疗在乳腺癌术后放疗中的肿瘤控制效果与传统5周方案相当。由于继发性恶性肿瘤的发生率低且潜伏期长，目前尚无关于分割方案对继发性恶性肿瘤发生影响的可靠临床数据。我们为20例左右侧或左侧乳腺癌患者制定了不同的放疗计划，采用3D-CRT（n=10）或VMAT（n=10），并在三种不同分割方案下进行：5周方案（50.4 Gy，1.8 Gy/次，共28次）、高分割方案（40.05 Gy，2.67 Gy/次，共15次）和超高分割方案（26 Gy，5.2 Gy/次，共5次）。利用剂量-反应模型计算不同方案下肺、对侧乳腺、食管、肝脏、甲状腺、脊髓、骨骼和软组织的绝对额外疾病发生率（EARs）。风险调节显示（超）短程分割放疗显著降低肺癌（LC）、对侧乳腺癌（CBC）和软组织肉瘤（STS）的EARs（p<.001）。在超高分割剂量方案中，LC、CBC和STS的中位EAR分别比常规方案低42.8%、39.4%和58.1%，比高分割方案低31.2%、25.7%和20.3%。在肺癌和对侧乳腺癌的风险中，3D-CRT的分割方案影响较VMAT更小，但在STS中，3D-CRT的影响更大。模拟结果显示，超高分割放疗可能与较低的继发性恶性肿瘤风险相关，优于传统的5周方案。
Abstract
Randomized studies demonstrated the oncological equivalence of (ultra-)hypofractionation compared to a 5-week schedule in postoperative radiotherapy of breast cancer. Due to the low incidence and long latency of secondary malignancies, there are currently no reliable clinical data regarding the influence of fractionation regimens on the development of secondary malignancies.For 20 patients with right or left-sided breast cancer, postoperative treatment plans were created using 3D-CRT (n = 10) or VMAT (n = 10) for three different fractionation schedules: 5-week schedule with 50.4Gy in 1.8Gy (28fx), hypofractionation with 40.05Gy in 2.67Gy (15fx) and ultra-hypofractionation with 26Gy in 5.2Gy (5fx). The EARs (absolute additional cases of disease per 10,000 patient-years) for secondary malignancies in the lung, contralateral breast, esophagus, liver, thyroid, spinal cord, bones and soft tissue were calculated using a fraction-dependent dose-response model.Based on risk modulation, (ultra-)hypofractionation resulted in significantly lower EARs for lung cancer (LC), contralateral breast cancer (CBC) and soft tissue sarcoma (STS) (p < .001). For the ultra-hypofractionated dose concept the median EARs for LC, CBC and STS were 42.8 %, 39.4 % and 58.1 % lower compared to conventional fractionation and 31.2 %, 25.7 % and 20.3 % compared to hypofractionation. The influence of fractionation on the risk of secondary malignancies for LC and CBC was less pronounced with 3D-CRT than with VMAT. For STS, however, the influence of fractionation was greater with 3D-CRT than with VMAT.Based on this simulation study (ultra-)hypofractionated postoperative breast cancer irradiation may be associated with a lower risk of secondary malignancies compared to a 5-week schedule.