Gomez Daniel R, Chang Joe Y
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
J Thorac Dis. 2014 Apr;6(4):348-55. doi: 10.3978/j.issn.2072-1439.2013.11.07.
Local tumor control remains challenging in many cases of non-small cell lung cancer (NSCLC), particularly those that involve large or centrally located tumors. Concurrent chemotherapy and radiation can maximize tumor control and survival for patients with locally advanced disease, but a substantial proportion of such patients cannot tolerate this therapy, and sequential chemoradiation regimens or radiation given alone at conventionally fractionated doses produces suboptimal results. An alternative approach is the use of hypofractionated proton beam therapy (PBT). The energy distribution of protons can be exploited to reduce involuntary irradiation of normal tissues, particularly the low-dose irradiation problematic in intensity-modulated (photon) radiation therapy (IMRT). Here we summarize current evidence on the use of hypofractionated PBT for both early-stage and locally advanced NSCLC, and the possibility of using hypofractionated regimens for patients who are not candidates for concurrent chemotherapy.
在许多非小细胞肺癌（NSCLC）病例中，局部肿瘤控制仍然具有挑战性，特别是那些涉及大肿瘤或中心型肿瘤的病例。同步放化疗可使局部晚期疾病患者的肿瘤控制和生存率最大化，但相当一部分此类患者无法耐受这种治疗，而序贯放化疗方案或按传统分割剂量单独进行放疗的效果并不理想。一种替代方法是使用大分割质子束治疗（PBT）。质子的能量分布可用于减少对正常组织的非自愿照射，尤其是在调强（光子）放射治疗（IMRT）中存在问题的低剂量照射。在此，我们总结了关于大分割PBT用于早期和局部晚期NSCLC的当前证据，以及对不适合同步化疗的患者使用大分割方案的可能性。
