Proton beam radiation therapy results in significantly reduced toxicity compared with intensity-modulated radiation therapy for head and neck tumors that require ipsilateral radiation.
Proton beam radiation therapy results in significantly reduced toxicity compared with intensity-modulated radiation therapy for head and neck tumors that require ipsilateral radiation.
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与需要同侧放射的头颈部肿瘤的调强放射治疗相比，质子束放射治疗的毒性显着降低。
DOI：
10.1016/j.radonc.2015.12.008
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发表时间：
2016-02
期刊：
影响因子：
--
通讯作者：
Lee NY
中科院分区：
文献类型：
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作者：
Romesser PB;Cahlon O;Scher E;Zhou Y;Berry SL;Rybkin A;Sine KM;Tang S;Sherman EJ;Wong R;Lee NY
由于与调强放射治疗（IMRT）相比，质子束放射治疗（PBRT）可以更好地保留正常组织，因此我们比较了接受PBRT或IMRT治疗同侧头颈部的患者之间的剂量测定和治疗相关毒性。2011年1月至2014年3月，41例连续患者因大涎腺癌或皮肤鳞状细胞癌接受同侧放疗。在此期间，PBRT的可用性导致从IMRT到PBRT的实践立即转变，而靶区勾画没有任何变化。使用美国国家癌症研究所不良事件通用术语标准4.0版评估急性毒性。23例（56.1%）患者接受调强放疗，18例（43.9%）患者接受PBRT。各组在基线、治疗和靶体积特征方面平衡。调强放射治疗计划有更大的中位数最大脑干（29.7戈伊vs. 0.62戈伊（RBE），P < 0.001），最大脊髓（36.3戈伊vs. 1.88戈伊（RBE），P < 0.001），平均口腔（20.6戈伊vs. 0.94戈伊（RBE），P < 0.001），平均对侧腮腺（1.4戈伊vs. 0.0戈伊（RBE），P < 0.001）和平均对侧颌下（4.1戈伊vs. 0.0戈伊（RBE），P < 0.001）剂量。PBRT组2级或以上急性味觉障碍（5.6% vs. 65.2%，P < 0.001）、粘膜炎（16.7% vs. 52.2%，P = 0.019）和恶心（11.1% vs. 56.5%，P = 0.003）的发生率显著降低。PBRT的独特性质允许在照射同侧头颈部时在不牺牲靶覆盖的情况下更大程度地保留正常组织。这种剂量测定优势似乎转化为较低的急性治疗相关毒性发生率。
As proton beam radiation therapy (PBRT) may allow greater normal tissue sparing when compared with intensity-modulated radiation therapy (IMRT), we compared the dosimetry and treatment-related toxicities between patients treated to the ipsilateral head and neck with either PBRT or IMRT. Between 01/2011 and 03/2014, 41 consecutive patients underwent ipsilateral irradiation for major salivary gland cancer or cutaneous squamous cell carcinoma. The availability of PBRT, during this period, resulted in an immediate shift in practice from IMRT to PBRT, without any change in target delineation. Acute toxicities were assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0. Twenty-three (56.1%) patients were treated with IMRT and 18 (43.9%) with PBRT. The groups were balanced in terms of baseline, treatment, and target volume characteristics. IMRT plans had a greater median maximum brainstem (29.7 Gy vs. 0.62 Gy (RBE), P < 0.001), maximum spinal cord (36.3 Gy vs. 1.88 Gy (RBE), P < 0.001), mean oral cavity (20.6 Gy vs. 0.94 Gy (RBE), P < 0.001), mean contralateral parotid (1.4 Gy vs. 0.0 Gy (RBE), P < 0.001), and mean contralateral submandibular (4.1 Gy vs. 0.0 Gy (RBE), P < 0.001) dose when compared to PBRT plans. PBRT had significantly lower rates of grade 2 or greater acute dysgeusia (5.6% vs. 65.2%, P < 0.001), mucositis (16.7% vs. 52.2%, P = 0.019), and nausea (11.1% vs. 56.5%, P = 0.003). The unique properties of PBRT allow greater normal tissue sparing without sacrificing target coverage when irradiating the ipsilateral head and neck. This dosimetric advantage seemingly translates into lower rates of acute treatment-related toxicity.