质子束疗法一定比光子照射好吗?两个案例的启示

IF 1.8 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Journal of Medical Radiation Sciences Pub Date : 2024-03-20 DOI:10.1002/jmrs.773
Michelle P Li MBBS, MPH, FRANZCR, Adam Yeo MSc, PhD, Roshini Gunewardena BAppSc (MedRad), Gabrielle Drum BHSc, MRadTher, Kirsty Wiltshire MBBS, FRANZCR, Claire Phillips MBBS, FRANZCR, Joseph Sia MBBS, PhD, FRANZCR, Greg Wheeler MBBS, FRANZCR, Lisa Hall BSc(Therapeutic) (Hons)
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引用次数: 0

摘要

质子束疗法(PBT)越来越多地用于治疗癌症,尤其是儿科和青少年癌症患者。随着质子束疗法越来越普及,确定何时使用质子束疗法取代光子照射可能会很困难。在做出这一决定时,需要平衡患者、肿瘤和治疗因素。在这一过程中,比较这两种方式的剂量测定起着重要作用。PBT可以减少危险器官(OAR)的中低剂量,但光子照射有其剂量学优势。我们介绍了两个脑肿瘤病例,一个是儿童病例,一个是青少年病例,在这两个病例中,光子和质子治疗方案的比较显示了光子照射的剂量学优势。第一个病例是一名 18 个月大的儿童,被诊断为后窝上皮瘤,需要进行辅助放疗。使用体积调制弧治疗(VMAT)进行光子照射,海马的剂量较低,但垂体的剂量较高。第二个病例是一名21岁的视神经通路胶质瘤患者。采用分次立体定向放射治疗比采用光子放射治疗能更好地保护重要的视神经结构和垂体。在这些病例中,光子照射的剂量学优势已被证明优于 PBT。这凸显了质子-光子对比治疗计划的作用,可以更好地了解哪些患者可能会从光子照射和PBT治疗中获益。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Is proton beam therapy always better than photon irradiation? Lessons from two cases

Proton beam therapy (PBT) is increasingly used to treat cancers, especially in the paediatric and adolescent and young adult (AYA) population. As PBT becomes more accessible, determining when PBT should be used instead of photon irradiation can be difficult. There is a need to balance patient, tumour and treatment factors when making this decision. Comparing the dosimetry between these two modalities plays an important role in this process. PBT can reduce low to intermediate doses to organs at risk (OAR), but photon irradiation has its dosimetric advantages. We present two cases with brain tumours, one paediatric and one AYA, in which treatment plan comparison between photons and protons showed dosimetric advantages of photon irradiation. The first case was an 18-month-old child diagnosed with posterior fossa ependymoma requiring adjuvant radiotherapy. Photon irradiation using volumetric modulated arc therapy (VMAT) had lower doses to the hippocampi but higher doses to the pituitary gland. The second case was a 21-year-old with an optic pathway glioma. There was better sparing of the critical optic structures and pituitary gland using fractionated stereotactic radiation therapy over PBT. The dosimetric advantages of photon irradiation over PBT have been demonstrated in these cases. This highlights the role of proton-to-photon comparative treatment planning to better understand which patients might benefit from photon irradiation versus PBT.

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来源期刊
Journal of Medical Radiation Sciences
Journal of Medical Radiation Sciences RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
CiteScore
3.20
自引率
4.80%
发文量
69
审稿时长
8 weeks
期刊介绍: Journal of Medical Radiation Sciences (JMRS) is an international and multidisciplinary peer-reviewed journal that accepts manuscripts related to medical imaging / diagnostic radiography, radiation therapy, nuclear medicine, medical ultrasound / sonography, and the complementary disciplines of medical physics, radiology, radiation oncology, nursing, psychology and sociology. Manuscripts may take the form of: original articles, review articles, commentary articles, technical evaluations, case series and case studies. JMRS promotes excellence in international medical radiation science by the publication of contemporary and advanced research that encourages the adoption of the best clinical, scientific and educational practices in international communities. JMRS is the official professional journal of the Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) and the New Zealand Institute of Medical Radiation Technology (NZIMRT).
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