现代质子放疗和光子放疗的争论与思考

doi:10.3760/cma.j.cn371439-20240619-00068

摘要/Abstract

摘要：

关于质子放疗与光子放疗优劣的争论已持续20多年，主要体现在剂量分布与临床结果的比较。由于剂量优势并不总能转化为更好的临床结果，目前西方国家展开了多项3期对比性临床研究。但这些临床研究的结果对放疗的改进意义如何，以及能否让这场争论尘埃落定，都值得讨论。这是因为治疗的效果不仅取决于射线种类，还取决于所使用的技术。因此探讨的重点不应该是哪一种射线更优越，而应是如何避免其缺点的同时充分利用每种射线的剂量特性。质子治疗和光子治疗都将在未来的肿瘤治疗中发挥重要作用，有限的资源应该用于最大限度地提高每种射线的有效性。随着放疗技术及系统性药物治疗包括免疫治疗的飞速发展，降低治疗分次（SRS/SBRT）将是放疗的必然趋势。对剂量聚焦的需求将推动光子治疗向使用更多非共面射野的4π放疗方向发展，而更高的几何精度要求也会让基于人工智能的在线自适应放疗更为普及。

关键词: 质子疗法, 临床研究, 人工智能, 光子放疗, 剂量聚焦, 非共面射野, 在线自适应治疗

Abstract:

The debate on the merits of proton radiotherapy and photon radiotherapy has lasted for more than 20 years， mainly reflected in the comparison of dose distribution and clinical outcomes. Because dosimetric advantages do not always translate to better clinical outcomes， several phase Ⅲ comparative clinical studies are being conducted in Western countries. However， it is highly questionable that these studies will bring great value to the advancement of radiation therapy or settle the debate. This is because the effectiveness of the treatment depends not only on the type of radiation， but also on the technology used. Therefore， the focus of the research should not be which type of radiation is superior， but how to avoid its disadvantages while taking full advantage of the dose characteristics of each type of radiation. Both proton therapy and photon therapy will play an important role in cancer treatment in the future， and limited resources should be applied to maximize the effectiveness of each. With the rapid development of radiotherapy technology and systemic therapies including immunotherapy， reducing treatment fractions in the form of stereotactic radiosurgery and stereotactic body radiotherapy （SRS/SBRT） will be the inevitable trend. The need for dose focusing will drive photon therapy toward 4π radiotherapy using more non-coplanar fields， while higher geometric accuracy requirements will cause wide adoption of artificial intelligence-based online adaptive radiotherapy.

Key words: Proton therapy, Clinical study, Artificial intelligence, Photon radiotherapy, Dose focusing, Non-coplanar fields, Online adaptive radiotherapy

于新生, 任磊, 卢晓光. 现代质子放疗和光子放疗的争论与思考[J]. 国际肿瘤学杂志, 2024, 51(7): 411-416.

Yu Cedric, Ren Lei, Lu Xiaoguang. Debates and reflection on modern proton radiotherapy and photon radiotherapy[J]. Journal of International Oncology, 2024, 51(7): 411-416.

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