复发性头颈部癌的再放疗：强适形调强质子治疗计划与螺旋断层调强放疗的比较。
Re-irradiation of recurrent head and neck carcinomas: comparison of robust intensity modulated proton therapy treatment plans with helical tomotherapy.
机构信息
Department of Radiotherapy, University Duisburg-Essen, Essen, Germany.
出版信息
Radiat Oncol. 2013 Apr 20;8:93. doi: 10.1186/1748-717X-8-93.
BACKGROUND
To test the hypothesis that the therapeutic ratio of intensity-modulated photon therapy using helical tomotherapy (HT) for retreatment of head and neck carcinomas can be improved by robust intensity-modulated proton therapy (IMPT).
METHODS
Comparative dose planning with robust IMPT was performed for 7 patients retreated with HT.
RESULTS
On average, HT yielded dose gradients steeper in a distance ≤ 7.5 mm outside the target (p<0.0001, F-test) and more conformal high dose regions down to the 50% isodose than IMPT. Both methods proved comparably robust against set-up errors of up to 2 mm, and normal tissue exposure was satisfactory. The mean body dose was smaller with IMPT.
CONCLUSIONS
IMPT was found not to be uniformly superior to HT and the steeper average dose fall-off around the target volume is an argument pro HT under the methodological implementations used. However, looking at single organs at risk, the normal tissue sparing of IMPT can surpass tomotherapy for an individual patient. Therefore, comparative dose planning is recommended, if both methods are available.
背景
为了验证假设，即通过强大的强度调制质子治疗（IMPT），可以提高螺旋断层调强放疗（HT）治疗头颈部癌后复发的强度调制光子治疗的治疗比率。
方法
对 7 例接受 HT 治疗后复发的患者进行了比较剂量规划的强大 IMPT。
结果
平均而言，HT 在目标外 7.5mm 以内的距离产生的剂量梯度更陡（p<0.0001，F 检验），并且比 IMPT 更符合高剂量区域下降到 50%等剂量线。两种方法都证明在高达 2mm 的设置误差下具有相当的稳健性，并且正常组织暴露情况令人满意。IMPT 的平均身体剂量较小。
结论
IMPT 并不始终优于 HT，在使用的方法实施下，目标体积周围的平均剂量下降更陡峭是 HT 的一个优点。然而，对于单个危险器官，IMPT 的正常组织保护可以超过调强治疗。因此，如果两种方法都可用，建议进行比较剂量规划。
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