Improving the Therapeutic Ratio of Proton Radiation Therapy

与光子(x射线)相比，质子具有物理剂量优势，光子是最常用的 癌症患者的放射治疗，因为他们不会超出肿瘤靶点而受到照射 较少的正常组织。对正常组织的照射对患者没有潜在的好处；它只会增加 治疗风险与治疗期间和治疗结束后很长一段时间内的副作用有关。而质子辐射 我们相信，这种疗法已经在有选择的临床地点得到了应用，临床结果有了显著的改善。 更好地控制患者体内质子的有限范围的研究可以产生额外的临床效果。 收获。本项目的主要目标是提高儿童质子放射治疗的治疗率。 挑战临床站点，是执行临床试验，使用改进的质子范围控制在 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 不仅这些特定疾病的预后改善，而且在其他多个解剖部位也是如此 质子放射治疗正越来越多地被使用。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，他们是癌症的最高风险 晚期放射治疗引起的副作用，可以通过使用质子来减少。 具体目标是在不能切除的肝肿瘤患者中进行II期临床研究， 儿童髓母细胞瘤和横纹肌肉瘤、脊柱和颅底肉瘤以及副鼻窦 在肿瘤中我们将(1)更有效地使用质子射程的末端，(2)研究其临床用途 磁扫描质子束和强度调制质子治疗，(3)确认耐受性 以及低分割放射剂量递增治疗不能切除的肝肿瘤的有效性，(4)危重 评估自适应质子放射治疗策略在肿瘤和正常反应中的重要性 在一个解剖部位对放射治疗的组织反应，以及(5)与治疗相关的发病率与 这些选定的儿童恶性肿瘤和成人副鼻窦肿瘤中的光子和质子。这个 实现这些临床目标所需的物理工具将在项目3和4中进行调查。 在项目2中使用这些物理工具中的许多工具对于以后在项目1质子剂量中使用它们将是重要的 非小细胞肺癌的升级和质子与光子的随机试验。

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.