Holtzman Adam L, Mohammadi Homan, Furutani Keith M, Koffler Daniel M, McGee Lisa A, Lester Scott C, Gamez Mauricio E, Routman David M, Beltran Chris J, Liang Xiaoying
Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL 32224, USA.
Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ 85054, USA.
Cancers (Basel). 2024 May 21;16(11):1947. doi: 10.3390/cancers16111947.
Proton therapy has emerged as a crucial tool in the treatment of head and neck and skull-base cancers, offering advantages over photon therapy in terms of decreasing integral dose and reducing acute and late toxicities, such as dysgeusia, feeding tube dependence, xerostomia, secondary malignancies, and neurocognitive dysfunction. Despite its benefits in dose distribution and biological effectiveness, the application of proton therapy is challenged by uncertainties in its relative biological effectiveness (RBE). Overcoming the challenges related to RBE is key to fully realizing proton therapy's potential, which extends beyond its physical dosimetric properties when compared with photon-based therapies. In this paper, we discuss the clinical significance of RBE within treatment volumes and adjacent serial organs at risk in the management of head and neck and skull-base tumors. We review proton RBE uncertainties and its modeling and explore clinical outcomes. Additionally, we highlight technological advancements and innovations in plan optimization and treatment delivery, including linear energy transfer/RBE optimizations and the development of spot-scanning proton arc therapy. These advancements show promise in harnessing the full capabilities of proton therapy from an academic standpoint, further technological innovations and clinical outcome studies, however, are needed for their integration into routine clinical practice.
质子治疗已成为头颈部和颅底癌症治疗中的关键工具，与光子治疗相比，在降低积分剂量以及减少急性和晚期毒性方面具有优势，如味觉障碍、依赖饲管、口干症、继发性恶性肿瘤和神经认知功能障碍。尽管质子治疗在剂量分布和生物学有效性方面具有优势，但其应用受到相对生物学有效性（RBE）不确定性的挑战。克服与RBE相关的挑战是充分实现质子治疗潜力的关键，与基于光子的治疗相比，质子治疗的潜力不仅限于其物理剂量学特性。在本文中，我们讨论了RBE在头颈部和颅底肿瘤管理中治疗体积和相邻危险系列器官内的临床意义。我们回顾了质子RBE的不确定性及其建模，并探讨了临床结果。此外，我们强调了计划优化和治疗实施方面的技术进步和创新，包括线性能量传递/RBE优化以及点扫描质子弧形治疗的发展。从学术角度来看，这些进展有望充分发挥质子治疗的全部能力，然而，要将它们整合到常规临床实践中，还需要进一步的技术创新和临床结果研究。
