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用当前和以前的放射治疗方案治疗的半瘤患者的第二次原发性癌症风险:一个系统的文献审查
Wilma D Heemsbergen1, Sofia Spampinato1, Maarten Dirkx1
1Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
概括
半瘤的放射治疗增加了第二种癌症的风险. 现代协议和质子疗法旨在减少器官的辐射剂量,降低胰腺和脏瘤等二次癌症的风险.
科学领域:
- 在瘤学瘤学.
- 辐射瘤学 辐射瘤学
- 癌症流行病学 癌症流行病学
背景情况:
- 术后放射疗法 (RT) 使用准大风脉 (PAO) 和/或准阴脉场对精髓瘤有效.
- 这种治疗与在下腹膜器官中发生辐射诱导的第二次原发性癌症 (SPC) 的显著终身风险有关.
- 了解这些风险和不断发展的RT协议对于患者的治疗结果至关重要.
研究的目的:
- 系统地审查风险器官 (OAR) 剂量,相关的SPC风险,以及对半瘤患者的RT协议的变化.
- 评估质子疗法在减少OAR剂量和随后的SPC风险方面的潜力.
主要方法:
- 从1990年到2024年,按照PRISMA指南进行了系统的文献搜索.
- 确定并分析了11项报告SPC风险和RT-协议变化的队列研究.
主要成果:
- 在RT后,观察到胰腺,脏,胃,膀和结肠直肠持续过多的SPC风险.
- 关键的RT协议变化包括剂量降低 (30-40 Gy到20-26 Gy),放弃选择性PAO用于I阶段精子瘤,转为积极监测,并引入质子疗法.
- 与光子疗法相比,质子疗法在规划研究中表现出一致的OAR剂量减少.
结论:
- 已确定的SPC风险已经影响了半瘤患者的临床实践,仍然与当前的RT相关.
- 质子疗法在降低OAR剂量方面表现有前途,可能减轻SPC风险.
- 为了改善风险评估,需要进一步研究分离RT和质子疗法SPC的剂量反应关系.
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