Li Jia-min, Yu Jin-ming, Liu Su-wen, Chen Qing, Mu Xiang-kui, Jiang Qi-an, Zhao Mei-hong, Zhang Jian-guang
Shandong University School of Medicine, Jinan 250012, China.
Zhonghua Yi Xue Za Zhi. 2009 Dec 8;89(45):3201-6.
A comparative dose distribution study has been undertaken between proton beam therapy (PBT), 3-dimensional conformal radiation therapy (3D-CRT) and intensity-modulated radiation therapy (IMRT) in the treatment of hepatocellular carcinoma (HCC), so as to assess the potential advantages of PBT.
Dose volume histograms (DVHs) were compared between PBT and 3D-CRT or IMRT planning at total dose of 66 Gy and 86 Gy in stage I patients (n = 10, diameter < or = 5 cm), 60 Gy and 72 Gy in stage IIA patients (n = 12, diameter = 5.1-10 cm).
For patients with stage I, the mean liver dose (Dmean), V10, V20 and V30 were 13.01 Gy, 51.89%, 36.13% and 21.24% for 3D-CRT, whereas they were 6.34 Gy, 30.23%, 17.86% and 10.66%, respectively, for PBT (P < 0.002). With dose escalation to 86 Gy, the Dmean, V10, V20 and V30 were 16.91 Gy, 67.51%, 46.84% and 27.61% for 3D-CRT, whereas they were 8.26 Gy, 39.31%, 23.22% and 13.86%, respectively, for PBT (P < 0.002). Compared with 3D-CRT with dose of 66 Gy, PBT reduced the Dmean, V10, V20 and V30 even with dose escalation to 86 Gy (P < 0.042). For patients with stage IIA, the Dmean, V10, V20 and V30 were 29.18 Gy, 72.25%, 58.17%, 44.01% and 24.92 Gy, 73.32%, 56.15%, 37.75% for 3D-CRT and IMRT, respectively, with dose of 60 Gy, whereas they were 16.28 Gy, 43.93%, 33.54% and 22.78%, respectively, for PBT (P < 0.002). With dose escalation to 72 Gy, the Dmean, V10, V20, V30 were 35.02 Gy, 86.70%, 69.80%, 52.81% and 29.90 Gy, 87.98%, 67.74% and 45.30% for 3D-CRT and IMRT, respectively, whereas they were 19.54 Gy, 52.72%, 40.25% and 27.34%, respectively, for PBT (P < 0.002). Compared with 3D-CRT and IMRT with total dose of 60 Gy, PBT reduced the Dmean, V10, V20 and V30 even with dose escalation to 72 Gy (P < 0.05). In all of the 22 cases, compared with 3D-CRT, PBT reduced the doses to the nonliver OARs (organs at risks) including spinal cord, right kidney and stomach (P < 0.002). Compared with IMRT, PBT also reduced the dose to the right kidney and stomach significantly, while no significant difference was found respect to the dose to spinal cord (P > 0.05).
Compared with 3D-CRT, PBT reduced the dose to the normal liver tissues and nonliver OARs significantly, even with 20 to 30.3 percent of dose escalation. Compared with IMRT, PBT reduced the dose to the normal liver tissues significantly, even with 20 to 30.3 percent of dose escalation. PBT reduced the dose to the right kidney and stomach significantly. No significant difference was observed respect to the dose to spinal cord.
开展一项关于质子束治疗（PBT）、三维适形放射治疗（3D-CRT）和调强放射治疗（IMRT）在肝细胞癌（HCC）治疗中剂量分布的对比研究，以评估PBT的潜在优势。
比较I期患者（n = 10，直径≤5 cm）接受66 Gy和86 Gy总剂量、IIA期患者（n = 12，直径 = 5.1 - 10 cm）接受60 Gy和72 Gy总剂量时PBT与3D-CRT或IMRT计划的剂量体积直方图（DVH）。
对于I期患者，3D-CRT的平均肝脏剂量（Dmean）、V10、V20和V30分别为13.01 Gy、51.89%、36.13%和21.24%，而PBT分别为6.34 Gy、30.23%、17.86%和10.66%（P < 0.002）。当剂量增至86 Gy时，3D-CRT的Dmean、V10、V20和V30分别为16.91 Gy、67.51%、46.84%和27.61%，而PBT分别为8.26 Gy、39.31%、23.22%和13.86%（P < 0.002）。与66 Gy剂量的3D-CRT相比，即使剂量增至86 Gy，PBT的Dmean、V10、V20和V30仍降低（P < 0.042）。对于IIA期患者，60 Gy剂量时3D-CRT和IMRT的Dmean、V10、V20和V30分别为29.18 Gy、72.25%、58.17%、44.01%和24.92 Gy、73.32%、56.15%、37.75%，而PBT分别为16.28 Gy、43.93%、33.54%和22.78%（P < 0.002）。当剂量增至72 Gy时，3D-CRT和IMRT的Dmean、V10、V20、V30分别为35.02 Gy、86.70%、69.80%、52.81%和29.90 Gy、87.98%、67.74%和45.30%，而PBT分别为19.54 Gy、52.72%、40.25%和27.34%（P < 0.002）。与60 Gy总剂量的3D-CRT和IMRT相比，即使剂量增至72 Gy，PBT的Dmean、V10、V20和V30仍降低（P < 0.05）。在全部22例患者中，与3D-CRT相比，PBT降低了包括脊髓、右肾和胃在内的非肝脏危及器官（OARs）的剂量（P < 0.002）。与IMRT相比，PBT也显著降低了右肾和胃的剂量，而与脊髓剂量相比无显著差异（P > 0.05）。
与3D-CRT相比，即使剂量增加20%至30.3%，PBT仍显著降低了正常肝脏组织和非肝脏OARs的剂量。与IMRT相比，即使剂量增加20%至30.3%，PBT仍显著降低了正常肝脏组织的剂量。PBT显著降低了右肾和胃的剂量。与脊髓剂量相比未观察到显著差异。
