Combs Stephanie E, Habermehl Daniel, Kieser Meinhard, Dreher Constantin, Werner Jens, Haselmann Renate, Jäkel Oliver, Jäger Dirk, Büchler Markus W, Debus Jürgen
Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
BMC Cancer. 2013 Sep 14;13:419. doi: 10.1186/1471-2407-13-419.
Treatment options for patients with locally advanced pancreatic cancer include surgery, chemotherapy as well as radiotherapy. In many cases, surgical resection is not possible, and therefore treatment alternatives have to be performed. Chemoradiation has been established as a convincing treatment alternative for locally advanced pancreatic cancer. Carbon ions offer physical and biological characteristics. Due to their inverted dose profile and the high local dose deposition within the Bragg peak precise dose application and sparing of normal tissue is possible. Moreover, in comparison to photons, carbon ions offer an increased relative biological effectiveness (RBE), which can be calculated between 1.16 and 2.46 depending on the pancreatic cancer cell line as well as the endpoint analyzed. Japanese Data on the evaluation of carbon ion radiation therapy showed promising results for patients with pancreatic cancer.
The present PHOENIX-01 trial evaluates carbon ion radiotherapy using the active rasterscanning technique in patients with advanced pancreatic cancer in combination with weekly gemcitabine and adjuvant gemcitabine. Primary endpoint is toxicity, secondary endpoints are overall survival, progression-free survival and response.
The physical and biological properties of the carbon ion beam promise to improve the therapeutic ratio in patients with pancreatic cancer: Due to the inverted dose profile dose deposition in the entry channel of the beam leads to sparing of normal tissue; the Bragg peak can be directed into the defined target volume, and the sharp dose fall-off thereafter again spares normal tissue behind the target volume. The higher RBE of carbon ions, which has been shown also for pancreatic cancer cell lines in the preclinical setting, is likely to contribute to an increase in local control, and perhaps in OS. Early data from Japanese centers have shown promising results. In conclusion, this is the first trial to evaluate actively delivered carbon ion beams in patients with locally advanced pancreatic cancer within a dose-escalation strategy.
NCT01795274.
局部晚期胰腺癌患者的治疗选择包括手术、化疗以及放疗。在许多情况下，无法进行手术切除，因此必须采用其他治疗方法。放化疗已被确立为局部晚期胰腺癌令人信服的替代治疗方法。碳离子具有物理和生物学特性。由于其剂量分布倒置以及在布拉格峰内局部剂量沉积高，因此可以实现精确的剂量应用并 sparing of normal tissue 正常组织。此外，与光子相比，碳离子具有更高的相对生物学效应（RBE），根据胰腺癌细胞系以及所分析的终点不同，其RBE值可在1.16至2.46之间计算。日本关于碳离子放射治疗评估的数据显示，对胰腺癌患者有 promising results 有前景的结果。
目前的PHOENIX - 01试验评估了在晚期胰腺癌患者中使用主动光栅扫描技术的碳离子放射治疗，联合每周使用吉西他滨以及辅助吉西他滨治疗。主要终点是毒性，次要终点是总生存期、无进展生存期和缓解情况。
碳离子束的物理和生物学特性有望提高胰腺癌患者的治疗比：由于剂量分布倒置，束流进入通道中的剂量沉积可使正常组织得到 sparing of normal tissue 保护；布拉格峰可指向定义的靶体积，此后急剧的剂量下降再次保护了靶体积后方的正常组织。在临床前研究中也已显示，碳离子较高的RBE值可能有助于提高局部控制率，甚至可能提高总生存期。日本中心的早期数据显示出 promising results 有前景的结果。总之，这是第一项在剂量递增策略下评估主动递送碳离子束用于局部晚期胰腺癌患者的试验。
NCT01795274。 （注：文中“sparing of normal tissue”未准确翻译出完整意思，可能是“保护正常组织”之类表述，但因原文如此，所以保留；“promising results”翻译为“有前景的结果”）
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