Kang Minglei, Taylor Paige A, Shen Jiajian, Zhou Jun, Saini Jatinder, Hong Theodore S, Higgins Kristin, Liu Wei, Xiao Ying, Simone Charles B, Lin Liyong
New York Proton Center, New York, NY 10035, USA.
Department of Human Oncology, University of Wisconsin, Madison, WI 53792, USA.
Cancers (Basel). 2025 Jul 17;17(14):2369. doi: 10.3390/cancers17142369.
Proton therapy delivers highly conformal doses to the target area without producing an exit dose, minimizing cumulative doses to healthy liver tissue. This study aims to evaluate current practices, challenges, and variations in the implementation of proton stereotactic body radiation therapy (SBRT) and hypofractionated therapy for liver malignancies, with the goal of providing a technical assessment to promote broader adoption and support future clinical trials. : An extensive survey was conducted by NRG Oncology across North American proton treatment centers to assess the current practices of proton liver SBRT and hypofractionated therapy. The survey focused on key aspects, including patient selection, prescription and normal tissue constraints, simulation and motion management, treatment planning, quality assurance (QA), treatment delivery, and the use of image-guided radiation therapy (IGRT). This survey captures the current practice patterns and status of proton SBRT and hypofractionated therapy in liver cancer treatment. Proton therapy is increasingly preferred for treating inoperable liver malignancies due to its ability to minimize healthy tissue exposure. However, the precision required for proton therapy presents challenges, particularly in managing uncertainties and target motion during high-dose fractions and short treatment courses. Survey findings revealed significant variability in clinical practices across centers, highlighting differences in motion management, dose fractionation schedules, and QA protocols. Proton SBRT and hypofractionated therapy offer significant potential for treating liver malignancies. A comprehensive approach involving precise patient selection, treatment planning, and QA is essential for ensuring safety and effectiveness. This survey provides valuable insights into current practices and challenges, offering a foundation for technical recommendations to optimize the use of proton therapy and guide future clinical trials.
质子治疗能够向靶区提供高度适形的剂量，且不会产生出射剂量，从而将对健康肝组织的累积剂量降至最低。本研究旨在评估质子立体定向体部放射治疗（SBRT）和低分割治疗在肝恶性肿瘤治疗中的当前实践、挑战及实施差异，目的是提供一项技术评估，以促进更广泛的应用并支持未来的临床试验。NRG肿瘤学组织在北美各质子治疗中心开展了一项广泛的调查，以评估质子肝脏SBRT和低分割治疗的当前实践。该调查聚焦于关键方面，包括患者选择、处方及正常组织限制、模拟和运动管理、治疗计划、质量保证（QA）、治疗实施以及图像引导放射治疗（IGRT）的使用。这项调查掌握了质子SBRT和低分割治疗在肝癌治疗中的当前实践模式和现状。由于质子治疗能够将健康组织暴露降至最低，因此在治疗无法手术的肝恶性肿瘤方面越来越受到青睐。然而，质子治疗所需的精度带来了挑战，尤其是在高剂量分次和短疗程治疗期间管理不确定性和靶区运动方面。调查结果显示各中心的临床实践存在显著差异，突出表现在运动管理、剂量分割方案和QA协议方面的不同。质子SBRT和低分割治疗在治疗肝恶性肿瘤方面具有巨大潜力。采用包括精确患者选择、治疗计划和QA在内的综合方法对于确保安全性和有效性至关重要。这项调查为当前实践和挑战提供了宝贵见解，为优化质子治疗使用并指导未来临床试验的技术建议奠定了基础。
