食管癌质子治疗后束入路笔形束扫描：临床结果、剂量学及可行性
Proton therapy posterior beam approach with pencil beam scanning for esophageal cancer : Clinical outcome, dosimetry, and feasibility.
作者信息
Zeng Yue-Can, Vyas Shilpa, Dang Quang, Schultz Lindsay, Bowen Stephen R, Shankaran Veena, Farjah Farhood, Oelschlager Brant K, Apisarnthanarax Smith, Zeng Jing
机构信息
Department of Medical Oncology, Cancer Center, Shengjing Hospital of China Medical University, 39 Huaxiang Road, 110022, Shenyang, China.
Department of Radiation Oncology, University of Washington Medical Center, 1959 NE Pacific Street, Campus Box 356043, 98195, Seattle, WA, USA.
出版信息
Strahlenther Onkol. 2016 Dec;192(12):913-921. doi: 10.1007/s00066-016-1034-4. Epub 2016 Sep 5.
PURPOSE
The aim of this study is to present the dosimetry, feasibility, and preliminary clinical results of a novel pencil beam scanning (PBS) posterior beam technique of proton treatment for esophageal cancer in the setting of trimodality therapy.
METHODS
From February 2014 to June 2015, 13 patients with locally advanced esophageal cancer (T3-4N0-2M0; 11 adenocarcinoma, 2 squamous cell carcinoma) were treated with trimodality therapy (neoadjuvant chemoradiation followed by esophagectomy). Eight patients were treated with uniform scanning (US) and 5 patients were treated with a single posterior-anterior (PA) beam PBS technique with volumetric rescanning for motion mitigation. Comparison planning with PBS was performed using three plans: AP/PA beam arrangement; PA plus left posterior oblique (LPO) beams, and a single PA beam. Patient outcomes, including pathologic response and toxicity, were evaluated.
RESULTS
All 13 patients completed chemoradiation to 50.4 Gy (relative biological effectiveness, RBE) and 12 patients underwent surgery. All 12 surgical patients had an R0 resection and pathologic complete response was seen in 25 %. Compared with AP/PA plans, PA plans have a lower mean heart (14.10 vs. 24.49 Gy, P < 0.01), mean stomach (22.95 vs. 31.33 Gy, P = 0.038), and mean liver dose (3.79 vs. 5.75 Gy, P = 0.004). Compared to the PA/LPO plan, the PA plan reduced the lung dose: mean lung dose (4.96 vs. 7.15 Gy, P = 0.020) and percentage volume of lung receiving 20 Gy (V; 10 vs. 17 %, P < 0.01).
CONCLUSION
Proton therapy with a single PA beam PBS technique for preoperative treatment of esophageal cancer appears safe and feasible.
目的
本研究旨在介绍一种新型笔形束扫描（PBS）后束技术用于食管癌三联疗法中质子治疗的剂量测定、可行性及初步临床结果。
方法
2014年2月至2015年6月，13例局部晚期食管癌患者（T3 - 4N0 - 2M0；11例腺癌，2例鳞状细胞癌）接受了三联疗法（新辅助放化疗后行食管切除术）。8例患者采用均匀扫描（US），5例患者采用单一前后（PA）束PBS技术并进行容积再扫描以减轻运动影响。使用三种计划进行PBS对比计划：前后/前后束排列；前后束加左后斜（LPO）束，以及单一前后束。评估患者结局，包括病理反应和毒性。
结果
所有13例患者均完成了50.4 Gy（相对生物效应，RBE）的放化疗，12例患者接受了手术。所有12例手术患者均实现R0切除，25%出现病理完全缓解。与前后/前后计划相比，前后计划的平均心脏剂量较低（14.10 vs. 24.49 Gy，P < 0.01），平均胃剂量较低（22.95 vs. 31.33 Gy，P = 0.038），平均肝脏剂量较低（3.79 vs. 5.75 Gy，P = 0.004）。与前后/LPO计划相比，前后计划降低了肺剂量：平均肺剂量（4.96 vs. 7.15 Gy，P = 0.020）以及接受20 Gy的肺体积百分比（V；10% vs. 17%，P < 0.01）。
结论
采用单一前后束PBS技术的质子治疗用于食管癌术前治疗似乎是安全可行 的。
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