Tilbæk Sofie, Muren Ludvig Paul, Vestergaard Anne, Stolarczyk Liliana, Rønde Heidi S, Johansen Tanja S, Søndergaard Jimmi, Høyer Morten, Alsner Jan, Bentzen Lise Nørgaard, Petersen Stine Elleberg
Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus Denmark.
Clin Transl Radiat Oncol. 2023 Apr 25;41:100632. doi: 10.1016/j.ctro.2023.100632. eCollection 2023 Jul.
The Danish Prostate Cancer Group is launching the randomized trial, PROstate PROTON Trial 1 (NCT05350475), that compares photons and protons to the prostate and pelvic lymph nodes in treatment of high-risk prostate cancer. The aim of the work described in this paper was, in preparation of this trial, to establish a strategy for conventionally fractionated proton therapy of prostate and elective pelvic lymph nodes that is feasible and robust. Proton treatments are image-guided based on gold fiducial markers and on-board imaging systems in line with current practice. Our established proton beam configuration consists of four coplanar fields; two posterior oblique fields and two lateral oblique fields, chosen to minimize range uncertainties associated with penetrating a varying amount of material from both treatment couch and patient body. Proton plans are robustly optimized to ensure target coverage while keeping normal tissue doses as low as is reasonably achievable throughout the course of treatment. Specific focus is on dose to the bowel as a reduction in gastrointestinal toxicity is the primary endpoint of the trial. Strategies have been established using previously treated patients and will be further investigated and evaluated through the ongoing pilot phase of the trial.
丹麦前列腺癌研究小组正在开展一项随机试验——前列腺质子试验1（NCT05350475），该试验比较光子和质子对高危前列腺癌患者的前列腺及盆腔淋巴结的治疗效果。本文所述工作的目的是，在筹备该试验时，制定一种适用于前列腺及选择性盆腔淋巴结常规分割质子治疗的策略，该策略需切实可行且稳健可靠。质子治疗采用图像引导，基于金标基准标记物和机载成像系统，与当前实践一致。我们确定的质子束配置由四个共面野组成；两个后斜野和两个侧斜野，这样选择是为了尽量减少因穿透治疗床和患者身体不同厚度物质而产生的射程不确定性。质子计划经过稳健优化，以确保靶区覆盖，同时在整个治疗过程中将正常组织剂量保持在合理可及的最低水平。特别关注肠道剂量，因为降低胃肠道毒性是该试验的主要终点。已利用先前治疗过的患者制定了策略，并将通过试验正在进行的试点阶段进一步研究和评估。
