The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK.
Cancer J. 2009 Jul-Aug;15(4):319-24. doi: 10.1097/PPO.0b013e3181b6127c.
Proton beam therapy provides the opportunity for more localized delivery of ionizing radiation with the potential for improved normal tissue avoidance to reduce treatment related morbidity and to allow for dose escalation to improve disease control and survival without increased toxicity. However, a systematic review of published peer-reviewed literature reported previously and updated here is devoid of any clinical data demonstrating benefit in terms of survival, tumor control, or toxicity in comparison with best conventional treatment for any of the tumors so far treated including skull base and ocular tumors, prostate cancer and childhood malignancies. The current lack of evidence for benefit of protons should provide a stimulus for continued research. Well designed in silico clinical trials using validated normal tissue complication probability-models are important to predict the magnitude of benefit for individual tumor sites but the future use of protons should be guided by clear evidence of benefit demonstrated in well-designed prospective studies, away from commercial influence, and this is likely to require international collaboration. Any complex and expensive technology, including proton therapy, should not be employed on the basis of belief alone and requires testing to avoid inappropriate use of potential detriment to future patients.
质子束治疗提供了更局部递送电离辐射的机会，有可能更好地避免正常组织损伤，从而降低治疗相关的发病率，并允许提高剂量以改善疾病控制和生存率，而不会增加毒性。然而，对先前发表的同行评议文献进行的系统评价和此处更新的结果表明，与迄今为止治疗的任何肿瘤（包括颅底和眼部肿瘤、前列腺癌和儿童恶性肿瘤）的最佳常规治疗相比，质子治疗在生存、肿瘤控制或毒性方面都没有任何临床获益的证据。目前缺乏质子治疗获益的证据应该为持续研究提供动力。使用经过验证的正常组织并发症概率模型进行精心设计的计算机模拟临床试验对于预测个体肿瘤部位的获益程度非常重要，但质子的未来应用应该以在精心设计的前瞻性研究中证明的明确获益为指导，避免受到商业利益的影响，这可能需要国际合作。任何复杂和昂贵的技术，包括质子治疗，都不应仅仅基于信念而采用，需要进行测试以避免对未来患者造成不必要的损害。
