Fukumitsu Nobuyoshi, Kubota Hikaru, Mima Masayuki, Demizu Yusuke, Suzuki Takeshi, Hasegawa Daiichiro, Kosaka Yoshiyuki, Kawamura Atsufumi, Soejima Toshinori
Departments of Radiation Oncology.
Anesthesiology, Kobe Proton Center, Kobe, Japan.
Adv Radiat Oncol. 2023 Apr 23;8(5):101251. doi: 10.1016/j.adro.2023.101251. eCollection 2023 Sep-Oct.
This study compared craniospinal irradiation using proton beam therapy (PBT) according to irradiation method and investigated the initial effects.
Twenty-four pediatric patients (1-24 years old) who received proton craniospinal irradiation were examined. Passive scattered PBT (PSPT) and intensity modulated PBT (IMPT) were used in 8 and 16 patients, respectively. The whole vertebral body technique was used for 13 patients <10 years old, and the vertebral body sparing (VBS) technique was used for the remaining 11 patients aged ≥10 years. The follow-up period was 17 to 44 (median, 27) months. Organ-at-risk and planning target volume (PTV) doses and other clinical data were examined.
The maximum lens dose using IMPT was lower than that using PSPT ( = .008). The mean thyroid, lung, esophagus, and kidney doses were lower in patients treated using the VBS technique compared with the whole vertebral body technique (all < .001). The minimum PTV dose of IMPT was higher than that of PSPT ( = .01). The inhomogeneity index of IMPT was lower than that of PSPT ( = .004).
IMPT is better than PSPT at reducing the dose to the lens. The VBS technique can decrease the doses to neck-chest-abdomen organs. The PTV coverage of IMPT is superior to that of PSPT.
本研究根据照射方法比较了质子束治疗（PBT）的颅脊髓照射，并研究了其初始效果。
对24例接受质子颅脊髓照射的儿科患者（1 - 24岁）进行了检查。分别有8例和16例患者使用了被动散射质子束治疗（PSPT）和调强质子束治疗（IMPT）。13例年龄<10岁的患者采用了全椎体技术，其余11例年龄≥10岁的患者采用了椎体保留（VBS）技术。随访期为17至44个月（中位数为27个月）。检查了危及器官和计划靶体积（PTV）剂量以及其他临床数据。
使用IMPT时的最大晶状体剂量低于使用PSPT时的剂量（P = 0.008）。与全椎体技术相比，采用VBS技术治疗的患者甲状腺、肺、食管和肾脏的平均剂量更低（均P < 0.001）。IMPT的最小PTV剂量高于PSPT（P = 0.01）。IMPT的不均匀性指数低于PSPT（P = 0.004）。
在降低晶状体剂量方面，IMPT优于PSPT。VBS技术可降低颈部 - 胸部 - 腹部器官的剂量。IMPT的PTV覆盖优于PSPT。
