Overview of clinical experiences on carbon ion radiotherapy at MRS
Overview of clinical experiences on carbon ion radiotherapy at MRS
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DOI：
10.1016/s0167-8140(04)80012-4
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发表时间：
2004-12-01
影响因子：
5.7
通讯作者：
Miyamoto, T
中科院分区：
文献类型：
--
作者：
Tsujii, H;Mizoe, J;Miyamoto, T
背景和目的：碳离子束比光子具有物理和生物学上的优势。本研究总结了国立放射线科学研究所千叶重离子医用加速器（HIMAC）碳离子放射治疗的经验。材料和方法：1994年6月至2003年8月，共有1,601例不同类型的恶性肿瘤患者参加了I/II期剂量递增研究和临床11期研究。除恶性胶质瘤患者外，所有患者均接受单独的碳离子放射治疗，每个肿瘤部位的分数和总治疗时间固定，每天一个野，每周3或4天。在剂量递增研究中，总剂量递增5或10%的增量，以确保一个安全的患者治疗，并确定适当的剂量levels.Results：在初始剂量递增研究中，观察到严重的晚期并发症的直肠乙状结肠和食管。在接受高剂量水平治疗的前列腺癌、宫颈癌和食道癌患者中，然而，由于确定了安全剂量水平和改进了辐照方法，这种不利影响很快就消失了。碳离子放射治疗已显示改善肿瘤实体的结果：a）局部晚期头颈部肿瘤，特别是具有非鳞状细胞组织学的肿瘤，包括腺癌、腺样囊性癌和恶性黑色素瘤; B）早期NSCLC和局部晚期NSCLC; c）不适合手术切除的局部晚期骨和软组织肉瘤; d）局部晚期肝细胞癌; e）局部晚期前列腺癌，特别是高危患者; f）颅底和颈椎的脉络膜和软骨肉瘤，和g）直肠癌术后盆腔复发。恶性胶质瘤、胰腺癌、宫颈癌和食管癌的治疗正在剂量递增研究中进行研究。由于高LET射束的上级剂量定位和独特的生物学特性，使用短程RT方案是有道理的。这已在NSCLC和肝癌的治疗中得到证实，其中分数数量已成功减少至4个，类似于在1至3周内递送的12个分数。即使对于其他类型的肿瘤，包括前列腺癌、骨/软组织肉瘤和头颈部肿瘤，与传统RT方案相比，同样可以在更短的治疗时间内应用该疗法。结论：碳离子放射治疗，由于其物理和生物学上的优势，光子，提供了改善的结果方面：最小化的毒性和高局部控制率的局部晚期肿瘤和病理非鳞状细胞型肿瘤。使用碳离子放射治疗，与常规放射治疗相比，能够实现每部分应用更大剂量的低分割放射治疗和减少总治疗时间。
Background and purpose: Carbon ion beams provide physical and biological advantages over photons. This study summarizes the experiences of carbon ion radiotherapy at the Heavy Ion Medical Accelerator in Chiba (HIMAC) at the National Institute of Radiological SciencesMaterials and Methods: Between June 1994 and August 2003, a total of 1,601 patients with various types of malignant tumors were enrolled in phase I/II dose-escalation studies and clinical phase 11 studies. All but malignant glioma patients received carbon ion radiotherapy alone with a fraction number and overall treatment time being fixed for each tumor site, given to one field per day and 3 or 4 days per week. In dose-escalation studies, the total dose was escalated by 5 or 10% increments to ensure a safe patient treatment and to determine appropriate dose levels.Results: In the initial dose-escalation studies, severe late complications of the recto-sigmoid colon and esophagus were observed. in those patients who received high dose levels for prostate, uterine cervix and esophageal cancer. Such adverse effects, however, did shortly disappear as a result of determining safe dose levels and because of improvements in the irradiation method. Carbon ion radiotherapy has shown improvement of outcome for tumor entities: a) locally advanced head and neck tumors, in particular those with non-squamous cell histology including adenocarcinoma, adenoid cystic carcinoma, and malignant melanoma; b) early stage NSCLC and locally advanced NSCLC; c) locally advanced bone and soft tissue sarcomas not suited for surgical resection; d) locally advanced hepatocellular carcinomas; e) locally advanced prostate carcinomas, in particular for high-risk patients; f) chordoma and chondrosarcoma of the skull base and cervical spine, and g) post-operative pelvic recurrence of rectal cancer. Treatment of malignant gliomas, pancreatic, uterine cervix, and esophageal cancer is being investigated within dose-escalation studies. There is a rationale for the use of short-course RT regimen due to the superior dose localization and the unique biological properties of high-LET beams. This has been proven in treatment of NSCLC and hepatoma, where the fraction number has been successfully reduced to 4 similar to 12 fractions delivered within 1 similar to 3 weeks. Even for other types of tumors including prostate cancer, bone/soft tissue sarcoma and head/neck tumors, it was equally possible to apply the therapy in much shorter treatment times as compared to conventional RT regimen. Conclusion: Carbon ion radiotherapy, due to its physical and biologic advantages over photons, has provided improved outcome in terms:of minimized toxicity and high local control rates for locally advanced tumors and pathologically non-squamous cell type of tumors. Using carbon ion radiotherapy, hypofractionated radiotherapy with application of larger doses per fraction and a reduction of overall treatment times as compared to conventional radiotherapy was enabled.