多场优化调强质子治疗头颈部肿瘤：转化为实践。
Multifield optimization intensity modulated proton therapy for head and neck tumors: a translation to practice.
机构信息
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
出版信息
Int J Radiat Oncol Biol Phys. 2014 Jul 15;89(4):846-53. doi: 10.1016/j.ijrobp.2014.04.019. Epub 2014 May 24.
BACKGROUND
We report the first clinical experience and toxicity of multifield optimization (MFO) intensity modulated proton therapy (IMPT) for patients with head and neck tumors.
METHODS AND MATERIALS
Fifteen consecutive patients with head and neck cancer underwent MFO-IMPT with active scanning beam proton therapy. Patients with squamous cell carcinoma (SCC) had comprehensive treatment extending from the base of the skull to the clavicle. The doses for chemoradiation therapy and radiation therapy alone were 70 Gy and 66 Gy, respectively. The robustness of each treatment plan was also analyzed to evaluate sensitivity to uncertainties associated with variations in patient setup and the effect of uncertainties with proton beam range in patients. Proton beam energies during treatment ranged from 72.5 to 221.8 MeV. Spot sizes varied depending on the beam energy and depth of the target, and the scanning nozzle delivered the spot scanning treatment "spot by spot" and "layer by layer."
RESULTS
Ten patients presented with SCC and 5 with adenoid cystic carcinoma. All 15 patients were able to complete treatment with MFO-IMPT, with no need for treatment breaks and no hospitalizations. There were no treatment-related deaths, and with a median follow-up time of 28 months (range, 20-35 months), the overall clinical complete response rate was 93.3% (95% confidence interval, 68.1%-99.8%). Xerostomia occurred in all 15 patients as follows: grade 1 in 10 patients, grade 2 in 4 patients, and grade 3 in 1 patient. Mucositis within the planning target volumes was seen during the treatment of all patients: grade 1 in 1 patient, grade 2 in 8 patients, and grade 3 in 6 patients. No patient experienced grade 2 or higher anterior oral mucositis.
CONCLUSIONS
To our knowledge, this is the first clinical report of MFO-IMPT for head and neck tumors. Early clinical outcomes are encouraging and warrant further investigation of proton therapy in prospective clinical trials.
背景
我们报告了首例头颈部肿瘤多野优化（MFO）调强质子治疗（IMPT）的临床经验和毒性。
方法和材料
15 例连续的头颈部癌症患者接受了主动扫描束质子治疗的 MFO-IMPT。鳞状细胞癌（SCC）患者的综合治疗范围从颅底延伸到锁骨。放化疗和单纯放疗的剂量分别为 70Gy 和 66Gy。还分析了每个治疗计划的稳健性，以评估对与患者体位变化相关的不确定性以及质子束射程不确定性对患者的影响的敏感性。治疗过程中质子束能量范围为 72.5-221.8MeV。根据靶区的深度和深度，光斑大小会有所不同，扫描喷嘴以“逐点”和“逐层”的方式输送点扫描治疗。
结果
10 例患者为 SCC，5 例为腺样囊性癌。所有 15 例患者均能完成 MFO-IMPT 治疗，无需中断治疗，无需住院治疗。无治疗相关死亡，中位随访时间为 28 个月（范围为 20-35 个月），总临床完全缓解率为 93.3%（95%置信区间为 68.1%-99.8%）。15 例患者均出现口干：10 例患者为 1 级，4 例患者为 2 级，1 例患者为 3 级。所有患者在治疗过程中均出现计划靶区黏膜炎：1 例患者为 1 级，8 例患者为 2 级，6 例患者为 3 级。无患者出现 2 级或更高级别的前口腔黏膜炎。
结论
据我们所知，这是首例头颈部肿瘤 MFO-IMPT 的临床报告。早期临床结果令人鼓舞，值得进一步在前瞻性临床试验中研究质子治疗。
Zotero 插件