Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA.
Pediatr Blood Cancer. 2013 Oct;60(10):1606-11. doi: 10.1002/pbc.24606. Epub 2013 Jun 4.
Proton therapy for treatment for high-risk neuroblastoma may offer sparing of organs at risk (OAR) when compared to intensity-modulated X-ray therapy (IMXT).
Double-scattered proton plans and IMXT plans delivering 2,160 cGy to the primary tumor site and other residual disease were developed for 13 consecutive HR-NBL patients. Radiation doses to target volumes and OAR were calculated to determine the optimal modality for each.
All patients received radiation (5/13 ≥ 2 sites). No patient has experienced local recurrence or clinical organ toxicity. Coverage was excellent using both protons and IMXT: median % dose delivered to 95% clinical target volume was 99% and 100%, respectively. For nine patients with lateralized disease, proton therapy offered sparing of the contralateral kidney both with regard to median dose and dose to 20% (median <1 cGy vs. 362 cGy, P = 0.01; median 100 cGy vs. 634 cGy, P = 0.02, respectively). Proton therapy did not reduce ipsilateral kidney dose, and for 2 select patients with lateralized disease IMXT improved overall bilateral renal sparing. Proton therapy improved median bowel (median 33 cGy vs. 590 cGy, P = 0.01), total body (median <1 cGy vs. 30 cGy, P = 0.15), and liver dose (median <1 cGy vs. 529, P < 0.001). When chest RT was required, proton therapy decreased median heart dose and mean lung dose.
For most patients (11/13), proton therapy offered the optimal combination of target coverage and organ sparing, and is a feasible treatment for HR-NBL. We recommend a customized approach with careful evaluation of renal dosimetry; IMXT may be preferred for select patients.
与强度调制 X 射线治疗（IMXT）相比，质子治疗高危神经母细胞瘤（HR-NBL）可能在保护危及器官（OAR）方面具有优势。
为 13 例连续 HR-NBL 患者制定了双散射质子计划和 IMXT 计划，为原发肿瘤部位和其他残留病灶提供 2160cGy 的剂量。计算靶区和 OAR 的辐射剂量，以确定每种治疗方式的最佳方案。
所有患者均接受了放疗（13 例中有 5 例≥2 个部位）。没有患者出现局部复发或临床器官毒性。质子治疗和 IMXT 均具有优异的覆盖范围：95%临床靶区的中位剂量百分比分别为 99%和 100%。对于 9 例单侧疾病患者，质子治疗在中位剂量和 20%剂量方面均能保护对侧肾脏（中位数分别为<1cGy 和 362cGy，P=0.01；中位数 100cGy 和 634cGy，P=0.02）。质子治疗并未降低同侧肾脏的剂量，对于 2 例单侧疾病的选择性患者，IMXT 可改善双侧肾脏的总体保护。质子治疗可降低中位肠道剂量（中位数 33cGy 和 590cGy，P=0.01）、全身体剂量（中位数<1cGy 和 30cGy，P=0.15）和肝脏剂量（中位数<1cGy 和 529cGy，P<0.001）。当需要胸部放疗时，质子治疗可降低中位心脏剂量和平均肺剂量。
对于大多数患者（11/13），质子治疗在靶区覆盖和器官保护方面提供了最佳组合，是 HR-NBL 的一种可行治疗方法。我们建议采用定制化方法，并仔细评估肾脏剂量学；对于某些患者，IMXT 可能更优。
