针对年轻乳腺癌患者，10MU每日影像剂量显著增加二次癌症风险。
Optimizing MV CBCT Imaging Protocols Using NTCP and Secondary Cancer Risk: A Multi-Site Study in Breast, Pelvic, and Head & Neck Radiotherapy
- 基于NTCP和二次癌症风险模型评估不同影像剂量
- 40岁以下乳腺癌患者二次癌症风险超15/10,000人年
- 建议按年龄与部位个性化放疗影像协议
目的：评估每日兆伏锥形束计算机断层扫描（MV-CBCT）累积辐射生物效应，基于正常组织并发症概率（NTCP）和二次恶性肿瘤的超额绝对风险（EAR），研究对象为乳腺、盆腔及头颈部癌症放疗患者。探究是否应根据患者年龄、治疗部位及器官放射敏感性对影像方案进行个性化调整。方法：回顾性纳入乳腺（n=30）、盆腔（n=17）、头颈部（n=20）癌症患者，接受每日MV-CBCT照射，分析两种常见剂量方案（每分次5 MU和10 MU）。采用逻辑回归与Lyman-Kutcher-Burman（LKB）模型估算NTCP，使用Schneider的器官等效剂量（OED）模型计算EAR。统计分析采用配对t检验，并按年龄分层（<40岁、40–60岁、>60岁）。结果：乳腺癌患者在10 MU方案下肺部NTCP显著升高（p<0.001）。年轻乳腺癌患者（<40岁）的EAR明显升高，部分超过15例/10,000人年。盆腔和头颈部组中，NTCP与EAR均较低（<1%），各方案间无临床显著差异。所有部位中，年轻患者二次癌症风险更高。结论：对于盆腔和头颈部放疗，每日10 MU MV-CBCT风险极低；但对40岁以下乳腺癌患者，该剂量显著提升二次癌症风险及肺部NTCP。建议根据年龄、治疗部位与器官敏感性制定个性化影像协议。
原文摘要 · Abstract (English)
Purpose: To evaluate the cumulative radiobiological impact of daily Megavoltage Cone-Beam Computed Tomography (MV-CBCT) imaging dose based on Normal Tissue Complication Probability (NTCP) and Excess Absolute Risk (EAR) of secondary malignancies among radiotherapy patients treated for breast, pelvic, and head and neck cancers. This study investigated whether MV-CBCT imaging dose warrants protocol personalization according to patient age, anatomical treatment site, and organ-specific radiosensitivity. Methods: This retrospective study included cohorts of breast (n=30), pelvic (n=17), and head and neck (n=20) cancer patients undergoing radiotherapy with daily MV-CBCT. Imaging plans using two common protocols (5 MU and 10 MU per fraction) were analyzed. NTCP values were estimated using logistic and Lyman-Kutcher-Burman (LKB) models, while EAR was calculated using Schneider's Organ Equivalent Dose (OED)-based model. Statistical analysis used paired t-tests, and results were further stratified by age (under 40, 40 to 60, over 60 years). Results: In breast cancer patients, NTCP for lung increased significantly under the 10 MU protocol (p<0.001). EAR was elevated in younger breast patients (under 40 years), with some exceeding 15 cases per 10,000 person-years. In pelvic and head and neck groups, NTCP and EAR remained low (under 1 percent), with no clinically meaningful differences between protocols. Across all sites, younger age correlated with higher secondary cancer risk. Conclusion: Daily 10 MU MV-CBCT presents minimal additional risk in pelvic and head and neck radiotherapy. For breast cancer patients under 40, however, it significantly increases secondary cancer risk and lung NTCP. Personalized imaging protocols are recommended based on age, treatment site, and radiosensitivity.
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