突破与挑战：恶性肿瘤质子重离子放疗的临床应用与进展

doi:10.3760/cma.j.cn371439-20240621-00069

摘要/Abstract

摘要：

粒子射线放疗（PBRT）是基于质子和重离子（目前临床以碳离子为主）射线的放疗技术，通过扩展Bragg峰实现卓越的剂量分布，实现靶向肿瘤部位并保护周围正常组织，从而提供精准的肿瘤治疗。在生物效应方面，质子射线的相对生物效应（RBE）为1.1，略高于光子射线；而碳离子为高传能线密度射线，RBE一般为2~3，针对放射抗性和乏氧肿瘤更具优势。PBRT临床应用包括单线束放疗和混合线束放疗，后者综合不同粒子的优势，是肿瘤治疗研究的重要方向。目前PBRT仍面临着众多挑战，技术上如运动靶区、剂量的不确定性，因此需要呼吸门控和自适应计划等先进技术；临床上，有限的随机对照试验（RCT）限制了PBRT的临床验证。现有的RCT研究，如美国MD安德森癌症中心的研究，虽观察到PBRT的获益，但也表明仍需进一步研究来确认其长期疗效和安全性。未来的研究除将PBRT与光子治疗进行比较外，还应探索将PBRT与免疫治疗等全身治疗相结合的治疗获益。回顾PBRT的临床实践和研究概况，并进一步讨论其在肿瘤治疗中的成本效益，有助于为读者提供全面的理解，推动PBRT在肿瘤治疗中的发展和应用。

关键词: 质子疗法, 重离子放射疗法, 临床研究, 费用效益分析, 粒子射线放疗, 临床应用

Abstract:

Particle beam radiation therapy （PBRT）， using proton and heavy ion （mainly carbon ion in clinical practice） beams， provides precise cancer treatment by targeting tumor sites while sparing healthy tissues， by leveraging the Bragg peak for superior dose distribution. Proton beams have a relative-biological-effectiveness （RBE） of 1.1， which is slightly higher than that of photon beams. And carbon ions have an RBE of 2-3 due to their high linear energy transfer， thus being more advantageous for radioresistant and hypoxic tumors. Treatment strategies include single-beam and mixed-beam approaches， the latter of which combines the advantages of different particles and is an important direction of cancer treatment research. PBRT faces challenges such as managing moving targets and dose uncertainties， requiring advanced techniques like respiratory gating and adaptive planning. Additionally， the scarcity of randomized clinical trials （RCTs） limits PBRT's clinical validation. Existing RCTs， such as those from MD Anderson， indicate the benefits， as well as the need for further studies to confirm PBRT's long-term efficacy and safety. Future research should compare PBRT to photon therapy and explore the therapeutic benefit of combining PBRT with systemic therapies like immunotherapy. Reviewing the clinical practice and research of PBRT， and further discussing its cost-effectiveness in tumor treatment， can provide readers with a comprehensive understanding and promote the development and application of PBRT in cancer treatment.

Key words: Proton therapy, Heavy ion radiotherapy, Clinical study, Cost-benefit analysis, Particle beam radiation therapy, Clinical application

孔琳, 陆嘉德. 突破与挑战：恶性肿瘤质子重离子放疗的临床应用与进展[J]. 国际肿瘤学杂志, 2024, 51(7): 417-423.

Kong Lin, Lu Jiade. Breakthroughs and challenges： clinical application and progress of proton and heavy ion radiotherapy for malignant tumors[J]. Journal of International Oncology, 2024, 51(7): 417-423.

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