宫颈癌IMRT、VMAT诱发第二肿瘤重点分析.docVIP

A comparison of the risks of radiation-induced malignancies from volumetric-modulated arc therapy and step-and-shoot intensity-modulated radiation therapy for cervical cancer 【Abstract】Objective The aim of this study was to investigate and compare the risks of radiation-induced malignancies from volumetric-modulated arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) for patients with cervical cancer. Methods Nine patients with cervical cancer were planned and treated using both VMAT and IMRT. Each patient’s personal dose equivalent (Hp[10]) was measured in vivo using thermoluminescent dosimeters placed at the xiphoid process and glabella during IMRT and VMAT. Measurements were taken during 3 radiation sessions. The associated risk of radiation-induced secondary malignancies was estimated based on the whole-body dose equivalent represented by the measured Hp(10) received by the patient and the nominal probability coefficient of 5% per Sv, as recommended by ICRP 60. Results The Hp(10) values measured at the xiphoid process and glabella of every patient were lower for VMAT than for IMRT. If the average of the Hp(10) values measured for the prescribed dose of 50 Gy at the xiphoid process alone is considered representative of the whole-body dose equivalent, the dose was 364 mSv for VMAT and 538 mSv for IMRT. The associated risk of radiation-induced malignancy was 1.82% for VMAT and 2.69% for IMRT. If the average of the Hp(10) values measured at both the xiphoid process and glabella is considered representative of the whole-body dose equivalent, the dose was 200 mSv for VMAT and 314 mSv for IMRT. The associated risk of radiation-induced malignancy was 1.00% for VMAT and 1.57% for IMRT. Conclusion VMAT resulted in a lower whole-body dose equivalent to patients compared with IMRT. The decreased whole-body dose equivalent delivered by VMAT may reduce the likelihood of a radiation-induced secondary malignancy. 【Keywords】 cervical cancer; volumetric modulated