Melbourne Medical School, The University of Melbourne, Melbourne, VIC 3052, Australia.
Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, VIC 3052, Australia.
Medicina (Kaunas). 2024 Aug 31;60(9):1426. doi: 10.3390/medicina60091426.
: Conventional radiotherapies used in the current management of rectal cancer commonly cause iatrogenic radiotoxicity. Proton beam therapy has emerged as an alternative to conventional radiotherapy with the aim of improving tumour control and reducing off-set radiation exposure to surrounding tissue. However, the real-world treatment and oncological outcomes associated with the use of proton beam therapy in rectal cancer remain poorly characterised. This systematic review seeks to evaluate the radiation dosages and safety of proton beam therapy compared to conventional radiotherapy in patients with non-metastatic rectal cancer. : A computer-assisted search was performed on the Medline, Embase and Cochrane Central databases. Studies that evaluated the adverse effects and oncological outcomes of proton beam therapy and conventional radiotherapy in adult patients with non-metastatic rectal cancer were included. : Eight studies were included in this review. There was insufficient evidence to determine the adverse treatment outcomes of proton beam therapy versus conventional radiotherapy. No current studies assessed radiotoxicities nor oncological outcomes. Pooled dosimetric comparisons between proton beam therapy and various conventional radiotherapies were associated with reduced radiation exposure to the pelvis, bowel and bladder. : This systematic review demonstrates a significant paucity of evidence in the current literature surrounding adverse effects and oncological outcomes related to proton beam therapy compared to conventional radiotherapy for non-metastatic rectal cancer. Pooled analyses of dosimetric studies highlight greater predicted radiation-sparing effects with proton beam therapy in this setting. This evidence, however, is based on evidence at a moderate risk of bias and clinical heterogeneity. Overall, more robust, prospective clinical trials are required.
常规放射疗法在目前直肠癌的治疗中常引起医源性放射毒性。质子束疗法已作为常规放射疗法的替代方法出现，其目的是提高肿瘤控制率并减少对周围组织的放射暴露。然而，质子束疗法在直肠癌中的实际治疗和肿瘤学结果仍然描述不足。本系统评价旨在评估质子束疗法与常规放射疗法在非转移性直肠癌患者中的放射剂量和安全性。
计算机辅助检索了 Medline、Embase 和 Cochrane Central 数据库。纳入了评估质子束疗法和常规放射疗法对非转移性直肠癌成年患者不良影响和肿瘤学结果的研究。
本综述纳入了 8 项研究。目前尚无足够证据确定质子束疗法与常规放射疗法治疗结果的不良影响。没有当前研究评估放射毒性或肿瘤学结果。质子束疗法与各种常规放射疗法之间的剂量学比较表明，盆腔、肠道和膀胱的放射暴露减少。
本系统评价表明，与常规放射疗法相比，目前质子束疗法治疗非转移性直肠癌的不良反应和肿瘤学结果的文献证据非常有限。在这种情况下，剂量学研究的汇总分析强调了质子束疗法具有更大的预测放射保护作用。然而，这一证据基于中度偏倚风险和临床异质性的证据。总体而言，需要更稳健的前瞻性临床试验。
