质子治疗在当代肿瘤学中不断演变的角色。
完整摘要 · 中文译文
质子治疗相较于光子放疗具有独特的物理优势：通过布拉格峰在靶区内的剂量集中，同时相较于光子具有更低的积分剂量、有限的射程和更锐利的半影，总体上减少了对周围正常组织的辐射暴露，并可能改善治疗比。然而，这一优势受到不确定性因素的影响，包括射程不确定性和可变的相对生物效应。在这篇综述中，作者总结了支持质子治疗用于儿科、中枢神经系统（CNS）、头颈部、胸部、乳腺、胃肠道、泌尿生殖系统和血液系统恶性肿瘤以及再照射的当代证据。证据的强度因疾病部位而有显著差异。质子治疗在儿童癌症和部分中枢神经系统肿瘤中已得到充分确立，在这些情况下，最小化积分剂量和晚期毒性尤为重要。随机试验已在特定情境中证明了具有临床意义的获益，包括质子颅脊髓照射治疗软脑膜转移瘤可改善疾病控制和生存，以及在口咽癌中降低毒性同时保持疾病控制和生存获益。相反，局限性前列腺癌的随机数据显示，与调强光子放疗相比，患者报告结局并未改善。正在进行中的多个疾病部位的3期试验有望通过阐明比较效果、毒性降低和成本效益 r 来进一步确定质子治疗的作用。 相对于先进的光子技术。未来的进展将取决于更好的患者选择、稳健的治疗计划以及新兴技术，包括自适应质子治疗、质子弧治疗和FLASH放射治疗。
完整摘要 · 英文原文
Proton therapy offers a distinct physical advantage over photon radiotherapy through the Bragg peak dose concentration in target with both lower integral dose and finite path length, and sharper penumbra as compared to photons, collectively reducing radiation exposure to surrounding normal tissues and potentially improving the therapeutic ratio. However, this advantage is tempered by uncertainties, including range uncertainty and variable relative biological effectiveness. In this review, the authors summarize contemporary evidence supporting proton therapy across pediatric, central nervous system (CNS), head and neck, thoracic, breast, gastrointestinal, genitourinary, and hematologic malignancies, as well as reirradiation. The strength of evidence varies substantially by disease site. Proton therapy is well established in pediatric cancers and selected CNS tumors, where minimizing integral dose and late toxicity is especially important. Randomized trials have demonstrated clinically meaningful benefits in selected settings, including improved disease control and survival with proton craniospinal irradiation for leptomeningeal metastases and reduced toxicity with preserved disease control and survival benefit in oropharyngeal cancer. Conversely, randomized data in localized prostate cancer have not shown improved patient reported outcomes compared with intensity modulated photon therapy. Ongoing phase 3 trials across multiple disease sites are expected to further define the role of protons by clarifying comparative effectiveness, toxicity reduction, and cost-effectiveness relative to advanced photon techniques. Future progress will depend on improved patient selection, robust treatment planning, and emerging technologies including adaptive proton therapy, proton arc therapy, and FLASH radiotherapy.