文章：

最小化原发性纵隔B细胞淋巴瘤患者接受现代放疗的长期毒性：单中心生物物理风险评估结果

Minimizing Long-Term Toxicities for Patients with Primary Mediastinal B-Cell Lymphoma Undergoing Modern Radiotherapy: Results from a Monocentric Biophysical Risk Evaluation

原文发布日期：22 December 2024

DOI: 10.3390/cancers16244265

类型: Article

开放获取: 是

英文摘要：

Introduction:Primary mediastinal B-cell lymphoma (PMBCL) is a rare form of aggressive B-cell lymphoma with a predominant onset in young patients. The minimization of potential (late) side effects is of cardinal interest for these patients. An anticipation of the individual risk profile is desirable to counsel the patient on the putative impact of radiotherapy (RT).Methods:RT plans for a cohort of 25 patients with PMBCL were prospectively designed. One plan with two parallel- opposing fields (APPA) and another with volume-modulated arc therapy (VMAT) technique with 40 Gy in 2 Gy fractions each. Normal The normal tissue complication probability (NTCP) was calculated using the Lyman-–Kutcher-–Burman model for heart, lung and oesophageal toxicity.Results:APPA planning resulted in lower median doses (Dmedian) for the heart and lungs, whereas all other dose metrics for heart, lungs and esophagus were lower in VMAT planning. A significant difference in the mean NTCPs when comparing the APPA to VMAT plans was seen for increased cardiac mortality, pneumonitis and esophagitis. PTV size correlated with increased cardiac mortality and esophagitis in both plan variations and with pneumonitis for VMAT plans. Dmean, Dmedian, and V20Gy correlated with the risk for pneumonitis, and Dmean, Dmedian, and V1% with the risk for esophagitis in both variants.Conclusions:We showed decreased risk of different NTCPs for VMAT and APPA planning for thoracic toxicities. The use of an IMRT technique like VMAT showed advantages for several DVH metrics in organs at risk and should therefore be recommended for radiation treatment of PMBCL.

摘要翻译： 

引言：原发性纵隔B细胞淋巴瘤（PMBCL）是一种罕见的侵袭性B细胞淋巴瘤，主要发病于年轻患者。对于这些患者而言，最大限度地减少潜在（晚期）副作用至关重要。为向患者说明放疗（RT）可能产生的影响，预估个体风险特征具有重要价值。 方法：前瞻性设计了一组25例PMBCL患者的放疗计划。其中一项计划采用两个平行对穿野（APPA）技术，另一项采用容积旋转调强放疗（VMAT）技术，均以2 Gy分次剂量照射至总剂量40 Gy。采用Lyman-Kutcher-Burman模型计算心脏、肺和食管毒性的正常组织并发症概率（NTCP）。 结果：APPA计划使心脏和肺的中位剂量（Dmedian）较低，而VMAT计划中所有其他心脏、肺和食管的剂量指标均较低。比较APPA与VMAT计划时，在心脏死亡率增加、放射性肺炎和食管炎方面，平均NTCP存在显著差异。计划靶区（PTV）大小与两种计划变体中心脏死亡率增加和食管炎风险相关，并与VMAT计划中的肺炎风险相关。两种计划变体中，平均剂量（Dmean）、中位剂量（Dmedian）和V20Gy与肺炎风险相关，而Dmean、Dmedian和V1%与食管炎风险相关。 结论：研究表明，对于胸部毒性，VMAT和APPA计划可降低不同NTCP的风险。采用VMAT等调强放疗技术，在危及器官的多个剂量体积直方图（DVH）指标上显示出优势，因此应推荐用于PMBCL的放射治疗。

原文链接：

Minimizing Long-Term Toxicities for Patients with Primary Mediastinal B-Cell Lymphoma Undergoing Modern Radiotherapy: Results from a Monocentric Biophysical Risk Evaluation