Winter Sebastian F, Vaios Eugene J, Shih Helen A, Grassberger Clemens, Parsons Michael W, Gardner Melissa M, Ehret Felix, Kaul David, Boehmerle Wolfgang, Endres Matthias, Dietrich Jorg
Department of Neurology and MGH Cancer Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117, Berlin, Germany.
Curr Treat Options Oncol. 2023 Nov;24(11):1524-1549. doi: 10.1007/s11864-023-01131-x. Epub 2023 Sep 20.
Central nervous system (CNS) radiotoxicity remains a challenge in neuro-oncology. Dose distribution advantages of protons over photons have prompted increased use of brain-directed proton therapy. While well-recognized among pediatric populations, the benefit of proton therapy among adults with CNS malignancies remains controversial. We herein discuss the role of protons in mitigating late CNS radiotoxicities in adult patients. Despite limited clinical trials, evidence suggests toxicity profile advantages of protons over conventional radiotherapy, including retention of neurocognitive function and brain volume. Modelling studies predict superior dose conformality of protons versus state-of-the-art photon techniques reduces late radiogenic vasculopathies, endocrinopathies, and malignancies. Conversely, potentially higher brain tissue necrosis rates following proton therapy highlight a need to resolve uncertainties surrounding the impact of variable biological effectiveness of protons on dose distribution. Clinical trials comparing best photon and particle-based therapy are underway to establish whether protons substantially improve long-term treatment-related outcomes in adults with CNS malignancies.
中枢神经系统（CNS）放射性毒性仍然是神经肿瘤学中的一个挑战。质子相对于光子的剂量分布优势促使脑定向质子治疗的使用增加。虽然在儿科人群中已得到充分认可，但质子治疗在患有中枢神经系统恶性肿瘤的成人中的益处仍存在争议。我们在此讨论质子在减轻成年患者晚期中枢神经系统放射性毒性方面的作用。尽管临床试验有限，但有证据表明质子相对于传统放疗在毒性特征方面具有优势，包括神经认知功能和脑容量的保留。模型研究预测，与最先进的光子技术相比，质子具有更好的剂量适形性，可减少晚期放射性血管病变、内分泌病变和恶性肿瘤。相反，质子治疗后潜在的更高脑组织坏死率凸显了需要解决围绕质子可变生物学效应剂量分布影响的不确定性。比较最佳光子治疗和基于粒子治疗的临床试验正在进行中，以确定质子是否能显著改善患有中枢神经系统恶性肿瘤的成人的长期治疗相关结果。
