Tryggestad Erik J, Liu Wei, Pepin Mark D, Hallemeier Christopher L, Sio Terence T
Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN, USA.
Department of Radiation Oncology, Mayo Clinic Phoenix, Phoenix, AZ, USA.
J Gastrointest Oncol. 2020 Feb;11(1):212-224. doi: 10.21037/jgo.2019.11.07.
In recent years, there has been rapid adaption of proton beam radiotherapy (RT) for treatment of various malignancies in the gastrointestinal (GI) tract, with increasing number of institutions implementing intensity modulated proton therapy (IMPT). We review the progress and existing literature regarding the technical aspects of RT planning for IMPT, and the existing tools that can help with the management of uncertainties which may impact the daily delivery of proton therapy. We provide an in-depth discussion regarding range uncertainties, dose calculations, image guidance requirements, organ and body cavity filling consideration, implanted devices and hardware, use of fiducials, breathing motion evaluations and both active and passive motion management methods, interplay effect, general IMPT treatment planning considerations including robustness plan evaluation and optimization, and finally plan monitoring and adaptation. These advances have improved confidence in delivery of IMPT for patients with GI malignancies under various scenarios.
近年来，质子束放射治疗（RT）已迅速应用于胃肠道（GI）各种恶性肿瘤的治疗，越来越多的机构开始实施调强质子治疗（IMPT）。我们回顾了关于IMPT放射治疗计划技术方面的进展和现有文献，以及有助于管理可能影响质子治疗日常实施的不确定性的现有工具。我们深入讨论了射程不确定性、剂量计算、图像引导要求、器官和体腔填充考虑因素、植入装置和硬件、基准标记的使用、呼吸运动评估以及主动和被动运动管理方法、相互作用效应、IMPT治疗计划的一般考虑因素，包括稳健性计划评估和优化，最后是计划监测和调整。这些进展提高了在各种情况下为胃肠道恶性肿瘤患者实施IMPT的信心。
