Improving the Therapeutic Ratio of Proton Radiation Therapy

质子比光子（X射线）具有物理剂量优势，光子是最常用的放射性核素类型。 癌症患者的放射治疗，因为它们不会超出肿瘤靶区， 正常组织较少。正常组织的辐射对患者没有可能的益处;它只能增加 治疗期间和治疗结束后很长时间内治疗相关副作用的风险。虽然质子辐射 我们相信，在选择性的临床部位使用这种疗法，临床结果得到了显著改善， 研究更好地控制患者体内质子的有限范围可以产生额外的临床效果， 收益.本计画之主要目的为提高台湾地区质子放射治疗之治疗率， 临床研究中心，是进行临床试验，采用改进的质子范围控制， 具有挑战性的临床场景。我们认为，这些研究进展应该转化为进一步的研究。 不仅在这些特定疾病中，而且在多个其他解剖部位， 质子放射治疗正越来越多地被采用。对公众健康的潜在影响更大 癌症治愈率和/或减少治疗副作用，特别是在儿童中，他们是最高风险的 晚期放射治疗引起的副作用，这可以通过使用质子来减少。 具体目标是在不可切除的肝肿瘤患者中进行II期临床研究， 小儿髓母细胞瘤和横纹肌肉瘤，脊柱和颅底肉瘤，鼻窦 我们将（1）更有效地使用质子范围的末端，（2）研究 磁扫描质子束和强度调制质子治疗，（3）确认耐受性 大分割放射剂量递增治疗不可切除的肝肿瘤的有效性，（4）严重 评估适应性质子放射治疗策略对肿瘤和正常 一个解剖部位对放射治疗的组织反应，以及（5）比较治疗相关的发病率， 光子和质子在这些选定的儿科恶性肿瘤和成人鼻窦肿瘤。的 将在项目3和4中研究实现这些临床目标所需的物理工具。初始 在项目2中使用这些物理工具中的许多工具对于它们以后在项目1中的使用将是重要的，质子剂量 非小细胞肺癌的递增和质子与光子随机试验。

Protons have a physical dose advantage over photons (x-rays), the most commonly used type of radiation therapy for cancer patients, because they do not exit beyond the tumor target and thus irradiate less normal tissue. Irradiation of normal tissue yields no possible benefit for the patient; it can only increase the risk of treatment related side effects during and long after the end of treatment. While proton radiation therapy has been used in selective clinical sites with significant improvements in clinical outcome, we believe that research into better control of the finite range of the proton in the patient can yield additional clinical gains. The major objective of this project, Improving the Therapeutic Ratio of Proton Radiation Therapy in Challenging Clinical Sites, is to perform clinical trials employing improved control of the proton range in challenging clinical scenarios. We believe that these research advances should translate into further improvement in outcome in not only these particular diseases, but at multiple other anatomic sites where proton radiation therapy is increasingly being employed. The potential impact for public health is higher cancer cure rates and/or reduced treatment side effects, particularly in children, who are at the highest risk of late radiation therapy-induced side effects, which can be reduced with the use of protons. The specific aims are to conduct phase II clinical studies in patients with unresectable liver tumors, pediatric medulloblastoma and rhabdomyosarcoma, spine and skull base sarcomas, and paranasal sinus tumors in which we will (1) use the end of range of the proton more effectively, (2) investigate the clinical use of magnetically scanned proton beams and intensity-modulated proton therapy, (3) confirm the tolerability and effectiveness of hypofractionated radiation dose escalation for unresectable liver tumors, (4) critically assess the importance of an adaptive proton radiation therapy strategy in response to tumor and normal tissue responses to radiation therapy in one anatomic site, and (5) compare treatment-related morbidity with photons and protons in these selected pediatric malignancies and in adult paranasal sinus tumors. The physical tools necessary to achieve these clinical goals will be investigated in Projects 3 and 4. The initial use of many of these physical tools in Project 2 will be important for their later use in Project 1, Proton Dose Escalation and Proton vs. Photon Randomized Trials for Non-Small Cell Lung Cancer.