基于Halcyon 3.0医用直线加速器的早期鼻腔NK/T细胞淋巴瘤放疗剂量学与放射诱发二次癌风险

Radiotherapy dosimetry and secondary radiation-induced cancer risk for early-stage nasal NK/T-cell lymphoma treated with the Halcyon 3.0 medical linear accelerator

摘要

目的：评估Halcyon 3.0医用直线加速器在早期鼻腔NK/T细胞淋巴瘤调强放射治疗（IMRT）中的剂量学特性及放射诱发二次癌风险。方法：回顾性纳入22例早期鼻腔NK/T细胞淋巴瘤患者，为每例患者均设计基于Varian Edge和Halcyon 3.0平台的固定野IMRT计划，分别为IMRT（Edge）与IMRT（Halcyon）。评估两组计划在靶区覆盖质量和危及器官受照剂量的差异，并采用超额绝对风险（EAR）模型对口咽、甲状腺及双侧唾液腺的放射所致二次癌风险进行量化比较。结果：与IMRT（Edge）相比，IMRT（Halcyon）在靶区剂量分布上表现出更优的均匀性（降低8.51%,P=0.018），但其适形度稍逊（降低1.70%,P=0.011）。在危及器官保护方面，IMRT（Halcyon）显著降低视交叉、视神经、眼球、晶状体、脊髓和脑干的受量（降幅5.22%~33.42%,P<0.01）。然而，该计划也导致双侧腮腺平均剂量显著增加（左侧增加32.71%，右侧增加36.13%,P<0.001）。值得注意的是，IMRT（Halcyon）还显著提高所有评估器官的二次癌风险，口咽、甲状腺、左侧唾液腺和右侧唾液腺的EAR值分别增加17.47%、53.42%、51.75%和55.23%（P<0.001）。结论：Halcyon 3.0平台在早期鼻腔NK/T细胞淋巴瘤放疗中表现出更优的靶区剂量均匀性和对多数危及器官的保护能力，但也存在腮腺受量增加和远处危及器官二次癌风险升高的问题。

Abstract

Objective To evaluate the dosimetric characteristics and secondary radiation-induced cancer risk in patients with early-stage nasal NK/T-cell lymphoma receiving intensity-modulated radiotherapy (IMRT) delivered on the Halcyon 3.0 medical linear accelerator. Methods A retrospective study was conducted on 22 patients with early-stage nasal NK/T-cell lymphoma. For each patient, fixed-field IMRT plans were created on both Varian Edge and Halcyon 3.0 platforms, denoted IMRT (Edge) and IMRT (Halcyon), respectively. Differences in target coverage and organ-at-risk (OAR) doses were evaluated. An excess absolute risk (EAR) model was applied to quantify and compare secondary cancer risks for the oropharynx, thyroid, and bilateral salivary glands. Results Compared with IMRT (Edge), IMRT (Halcyon) demonstrated superior target dose homogeneity (reduced by 8.51%,P=0.018), though with slightly inferior conformity (reduced by 1.70%,P=0.011). Regarding OAR sparing, IMRT (Halcyon) significantly reduced doses delivered to the optic chiasm, optic nerves, ocular globes, lenses, spinal cord, and brainstem, with reductions ranging from 5.22% to 33.42% (P<0.01). However, it also led to a significant increase in the mean dose to the bilateral parotid glands, with increases of 32.71% in the left parotid and 36.13% in the right parotid (P<0.001). Notably, IMRT (Halcyon) significantly elevated secondary cancer risks across all evaluated organs, with EAR values rising by 17.47% for the oropharynx, 53.42% for the thyroid, 51.75% for the left salivary gland, and 55.23% for the right salivary gland (P<0.001). Conclusion The Halcyon 3.0 platform provides superior target dose homogeneity and better protection for most OAR in radiotherapy for early-stage nasal NK/T-cell lymphoma. However, it is associated with increased parotid gland doses and elevated secondary cancer risks in distant OAR.

关键词

鼻腔NK/T细胞淋巴瘤 / 调强放射治疗 / 放疗剂量 / 二次癌风险

Key words

nasal NK/T-cell lymphoma / intensity-modulated radiotherapy / radiotherapy dosimetry / secondary cancer risk

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基金资助

国家自然科学基金(82203821)

重庆市自然科学基金(cstc2021jcyj-msxmX0587)

重庆市科研机构绩效激励引导专项(cstc2019jxjl130031)