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探索碳离子对头颈部癌症再放疗临床潜力的方法：作为前瞻性随机 CARE 试验的一部分，进行剂量学比较和局部失败模式分析。

Ways to unravel the clinical potential of carbon ions for head and neck cancer reirradiation: dosimetric comparison and local failure pattern analysis as part of the prospective randomized CARE trial.

机构信息

Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.

Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.

出版信息

Radiat Oncol. 2022 Jul 8;17(1):121. doi: 10.1186/s13014-022-02093-4.

DOI:10.1186/s13014-022-02093-4
PMID:35804448
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9264522/
Abstract

BACKGROUND

Carbon ion radiotherapy (CIRT) yields biophysical advantages compared to photons but randomized studies for the reirradiation setting are pending. The aim of the current project was to evaluate potential clinical benefits and drawbacks of CIRT compared to volumetric modulated arc therapy (VMAT) in recurrent head and neck cancer.

METHODS

Dose-volume parameters and local failure patterns of CIRT compared to VMAT were evaluate in 16 patients from the randomized CARE trial on head and neck cancer reirradiation.

RESULTS

Despite an increased target dose, CIRT resulted in significantly reduced organ at risk (OAR) dose across all patients (- 8.7% Dmean). The dose-volume benefits were most pronounced in the brainstem (- 20.7% Dmax) and the optic chiasma (- 13.0% Dmax). The most frequent local failure was type E (extraneous; 50%), followed type B (peripheral; 33%) and type A (central; 17%). In one patient with type A biological and/or dosimetric failure after CIRT, mMKM dose recalculation revealed reduced target coverage.

CONCLUSIONS

CIRT resulted in highly improved critical OAR sparing compared to VMAT across all head and neck cancer reirradiation scenarios despite an increased prescription dose. Local failure pattern analysis revealed further potential CIRT specific clinical benefits and potential pitfalls with regard to image-guidance and biological dose-optimization.

摘要

背景

与光子相比，碳离子放射治疗（CIRT）具有生物物理优势，但针对再照射情况的随机研究仍在进行中。本研究旨在评估 CIRT 与容积调强弧形治疗（VMAT）相比在复发性头颈部癌症中的潜在临床获益和风险。

方法

在头颈部癌症再照射的随机 CARE 试验中，评估了 16 例患者的 CIRT 与 VMAT 的剂量-体积参数和局部失败模式。

结果

尽管靶区剂量增加，但 CIRT 使所有患者的危及器官（OAR）剂量显著降低（-8.7% Dmean）。脑干（-20.7% Dmax）和视交叉（-13.0% Dmax）的剂量-体积获益最为明显。最常见的局部失败类型为 E 型（旁线；50%），其次是 B 型（周边；33%）和 A 型（中线；17%）。在一名接受 CIRT 后发生 A 型生物和/或剂量学失败的患者中，mMKM 剂量重新计算显示靶区覆盖率降低。

结论

尽管处方剂量增加，但与 VMAT 相比，CIRT 使所有头颈部癌症再照射情况下的关键 OAR 保护得到显著改善。局部失败模式分析显示，CIRT 在图像引导和生物剂量优化方面具有潜在的临床获益和风险。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/07c6/9264522/dae74020016f/13014_2022_2093_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/07c6/9264522/972398ab6745/13014_2022_2093_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/07c6/9264522/a6e81a9bf634/13014_2022_2093_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/07c6/9264522/990445d14105/13014_2022_2093_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/07c6/9264522/dae74020016f/13014_2022_2093_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/07c6/9264522/972398ab6745/13014_2022_2093_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/07c6/9264522/a6e81a9bf634/13014_2022_2093_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/07c6/9264522/990445d14105/13014_2022_2093_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/07c6/9264522/dae74020016f/13014_2022_2093_Fig4_HTML.jpg

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