Schwarz Marco, Molinelli Silvia
Protontherapy Department, Trento Hospital, Via Al Desert 14, 38123 Trento, Italy; Trento Institute for Fundamental Physics and Applications (TIFPA), National Institute of Nuclear Physics (INFN), Via Sommarive 14, 38123 Trento, Italy.
Medical Physics Unit, CNAO Foundation, Strada Campeggi 53, I-27100 Pavia, Italy.
Phys Med. 2016 Mar;32(3):485-91. doi: 10.1016/j.ejmp.2016.03.017. Epub 2016 Apr 6.
The treatment of prostate cancer with either protons or carbon ions is not a novelty, and several thousands of patients were treated with hadrontherapy in the past decades. The standard treatment approach consisted in two lateral opposed fields for both protons and carbon ions, mostly delivered with scattered beams and using conventional fractionation and hypofractionation for protons and carbon ions, respectively. Similar (RBE-weighted and BED) doses to photon therapy (XRT) have been delivered, with comparable results in terms of both local control and toxicity. The advancements in dose deposition and image guidance of the early '00s that improved the quality of XRT treatments and then allowed for hypofractionation, are being matched with some delay by hadrontherapy in these very years. Pencil beam scanning is now the norm in proton therapy, and volumetric image guidance is being developed in all new hadrontherapy facilities. There is therefore the possibility of truly taking advantage of superior dose distributions of hadrons and safely apply it to innovative treatment protocols, such as an intraprostatic boost and the treatment of larger volume for advanced stage disease. This full integration between the best of technology and new clinical approaches is probably necessary in order to obtain clinical results that are truly superior to the current state of the art of XRT.
用质子或碳离子治疗前列腺癌并非新鲜事，在过去几十年里，已有数千名患者接受了强子治疗。标准治疗方法是质子和碳离子均采用两个对侧野，大多使用散射束，质子和碳离子分别采用传统分割和大分割方式。已给予与光子治疗（XRT）相似（RBE加权和生物等效剂量）的剂量，在局部控制和毒性方面取得了相当的结果。21世纪初剂量沉积和图像引导技术的进步提高了XRT治疗的质量，进而实现了大分割，而这些年强子治疗在这方面的发展有所滞后。笔形束扫描现在是质子治疗的标准方法，所有新建的强子治疗设施都在开发容积图像引导技术。因此，有可能真正利用强子优越的剂量分布，并将其安全地应用于创新的治疗方案，如前列腺内推量照射和晚期疾病更大体积的治疗。为了获得真正优于当前XRT技术水平的临床结果，技术优势与新临床方法的充分整合可能是必要的。
