Eaton Bree R, Yock Torunn
From the Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
Cancer J. 2014 Nov-Dec;20(6):403-8. doi: 10.1097/PPO.0000000000000079.
Radiation therapy (RT) plays a critical role in the local tumor control of benign and low-grade central nervous system tumors in children but is not without the risk of long-term treatment-related sequelae. Proton therapy (PRT) is an advanced RT modality with a unique dose-deposition pattern that allows for treatment of a target volume with reduced scatter dose delivered to normal tissues compared with conventional photon RT and is now increasingly utilized in children with the hope of mitigating radiation-induced late effects. This article reviews the current literature evaluating the use of PRT in benign and low-grade pediatric central nervous system tumors such as low-grade glioma, craniopharyngioma, and ependymoma. Multiple dosimetric studies support the use of PRT by demonstrating the ability of PRT to better spare critical structures important for cognitive development, endocrine function, and hearing preservation and to reduce the total body dose associated with second malignancy risk. Early clinical data demonstrate that PRT is well tolerated with rates of local tumor control comparable to conventional photon RT series, and long-term clinical data are awaited.
放射治疗（RT）在儿童良性和低级别中枢神经系统肿瘤的局部肿瘤控制中起着关键作用，但并非没有长期治疗相关后遗症的风险。质子治疗（PRT）是一种先进的放射治疗方式，具有独特的剂量沉积模式，与传统光子放射治疗相比，它能够在向正常组织传递较少散射剂量的情况下治疗靶体积，目前越来越多地用于儿童，以期减轻辐射诱发的晚期效应。本文综述了当前评估PRT在儿童良性和低级别中枢神经系统肿瘤（如低级别胶质瘤、颅咽管瘤和室管膜瘤）中应用的文献。多项剂量学研究支持PRT的应用，这些研究表明PRT能够更好地保护对认知发育、内分泌功能和听力保留至关重要的关键结构，并降低与二次恶性肿瘤风险相关的全身剂量。早期临床数据表明，PRT耐受性良好，局部肿瘤控制率与传统光子放射治疗系列相当，长期临床数据有待进一步观察。
