Petera Jiří
Klin Onkol. 2017 Winter;31(1):24-27. doi: 10.14735/amko201824.
Proton beam therapy (PBT) is one of the most discussed topics in contemporary oncology. PBT is characterized by certain physical properties that make it theoretically better as a treatment than standard photon therapy. On the other hand, there are some uncertainties regarding the localization of the dose peak (Bragg peak) in real clinical situations and the value of radiobiological effectiveness at the end of proton beam. Unfortunately, the high expectations of PBT have not been fulfilled in published clinical studies.
In the present article, the results of PBT are compared with those of standard photon therapy for the treatment of low-and high-grade gliomas, pituitary adenomas, vestibular schwannomas, chordomas and chondrosarcomas, and pediatric central nervous system tumors. PBT was not better in tumor control or in reducing toxicity than photon therapy. The higher risk of post-radiation brain tissue necrosis after PBT is alarming. PBT is mostly considered for pediatric tumors, because the radiobiological models predict lower damage to neurocognitive functions and a reduction in secondary malignancies. However, this hypothesis has its opponents and sufficient clinical data to justify the models are still lacking. The cost of PBT is several times higher than that of photon therapy.
PBT is a revolutionary technology in modern radiotherapy, but so far, clinical data have not proved it to be superior to that of standard photon therapy. PBT should be considered on an individual basis in cases where modern photon therapy cannot meet the dose limits of healthy tissues.Key words: proton therapy - neoplasms - central nervous systemSubmitted: 24. 10. 2017Accepted: 23. 11. 2017 The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.
质子束治疗（PBT）是当代肿瘤学中讨论最多的话题之一。PBT具有某些物理特性，从理论上讲，这些特性使其作为一种治疗方法比标准光子治疗更好。另一方面，在实际临床情况下，剂量峰值（布拉格峰）的定位以及质子束末端的放射生物学有效性的值存在一些不确定性。不幸的是，已发表的临床研究并未实现对PBT的高度期望。
在本文中，将PBT与标准光子治疗在治疗低级别和高级别胶质瘤、垂体腺瘤、前庭神经鞘瘤、脊索瘤和软骨肉瘤以及小儿中枢神经系统肿瘤方面的结果进行了比较。PBT在肿瘤控制或降低毒性方面并不比光子治疗更好。PBT后放射性脑组织坏死的较高风险令人担忧。PBT主要被考虑用于小儿肿瘤，因为放射生物学模型预测其对神经认知功能的损害较小且继发性恶性肿瘤减少。然而，这一假设存在反对者，并且仍然缺乏足以证明这些模型合理性的临床数据。PBT的成本比光子治疗高出几倍。
PBT是现代放射治疗中的一项革命性技术，但到目前为止，临床数据尚未证明它优于标准光子治疗。在现代光子治疗无法满足健康组织剂量限制的情况下，应根据个体情况考虑PBT。
质子治疗 - 肿瘤 - 中枢神经系统
2017年10月24日
2017年11月23日
作者声明他们在研究中使用的药物、产品或服务方面没有潜在的利益冲突。编辑委员会声明该手稿符合ICMJE对生物医学论文的推荐标准。
