| 陈剑,麻宁一,卢艳,Kambiz Shahnazi,赵静芳,陆嘉德,蒋国梁,茅静芳.胸腺肿瘤质子碳离子放疗的剂量对比研究及短期疗效观察[J].中华放射医学与防护杂志,2020,40(3):221-226 |
| 胸腺肿瘤质子碳离子放疗的剂量对比研究及短期疗效观察 |
| Dosimetric comparison study and short-term clinical outcomes of proton and carbon ion radiotherapy for thymic malignancies |
| 投稿时间：2019-04-11 |
| DOI：10.3760/cma.j.issn.0254-5098.2020.03.011 |
| 中文关键词: 胸腺肿瘤 质子 碳离子 放射治疗 笔形束扫描 |
| 英文关键词:Thymic malignancies Proton Carbon ion Radiotherapy Pencil beam scanning |
| 基金项目:上海市"科技创新行动计划"医学和农业领域科技支撑项目（15411950100）；上海市自然科学基金项目（16ZR1433600、18ZR1436300）；上海市卫生和计划生育委员会项目（201840155） |
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| 中文摘要: |
| 目的 对比光子和质子碳离子（粒子）放疗计划在有可见胸腺肿瘤患者中危及器官受量的差异，并观察粒子射束放射治疗胸腺肿瘤的近期疗效和不良反应。方法 回顾性分析19例于2015年9月至2018年8月接受非姑息性粒子放疗、至少经过1次随访的胸腺肿瘤患者。肿瘤分期涵盖Ⅰ~ⅣB期，其中Ⅲ~ⅣB期15例。所有患者均经病理学证实，包括10例胸腺瘤，6例胸腺癌和3例胸腺神经内分泌肿瘤。对13例有可见肿瘤的患者进行光子调强、质子和碳离子笔形束扫描放疗计划对比，光子和质子的处方为66 GyE/33次，碳离子为66 GyE/22次。未经手术的5例初治和7例术后肉眼肿瘤残留（R2切除）患者，接受根治性放疗：质子44.0~48.4 GyE/20~22次加碳离子推量21.0~23.1 GyE/7次；1例完整切除（R0）术后患者，质子45 GyE/25次；5例术后显微镜下残留（R1切除）者，质子60.0~61.6 GyE/28~30次；1例术后放疗后复发者，碳离子60 GyE/20次。结果 中位随访时间19.0（2.4~42.9）个月。13例可见肿瘤患者肿块最大径中位数5.7（2.7~12.8）cm；剂量对比研究显示粒子计划可显著降低脊髓最大剂量、肺、心、食管等危及器官的平均剂量、以及受照区域积分剂量，仅约为光子计划的25%~65%。除1例心肌梗死（4级晚期反应）可能与放疗相关外，未发现其他≥ 3级放疗相关不良反应。所有患者无局部复发，4例Ⅲ~ⅣB期患者在放疗开始后6.1~22.8个月出现区域淋巴结、肺、胸膜、颅底、骨和肝等部位转移。2年局部控制率和总生存率均为100%，无疾病进展生存率和无远处转移生存率均为64.6%。结论 对胸腺肿瘤的剂量对比分析显示，质子碳离子放疗的正常组织受量仅为光子计划的25%~65%；临床结果提示短期疗效好、不良反应轻微。 |
| 英文摘要: |
| Objective To compare dose distributions between photon versus proton and carbon ion radiotherapy (particle therapy, PT) among patients with gross tumors, and to evaluate the safety and efficacy of PT for thymic malignancies (TM). Methods From Sept 2015 to Aug 2018, 19 patients with TM who underwent non-palliative PT using pencil beam scanning technique in our hospital and had at least one follow-up were retrospectively analyzed. Diseases staged from Ⅰ-ⅣB including 15 Ⅲ-ⅣB. All the patients had pathological diagnosis with 10 thymomas, 6 carcinomas and 3 neuroendocrine tumors of the thymus. A set of dosimetric comparisons were conducted in patients with gross tumors at a total dose of 66 GyE, in 33 fractions for photon or proton beams and in 22 fractions for carbon ion beams. Five patients without any local treatment and 7 patients after R2 resection received radical radiotherapy of proton 44.0-48.4 GyE in 20-22 fractions plus carbon ion 21.0-23.1 GyE in 7 fractions, 1 case after complete resection (R0 resection) had proton 45 GyE in 25 fractions, 5 cases after R1 resection had proton 60.0-61.6 GyE in 28-30 fractions and 1 case of recurrence after postoperative radiotherapy had only carbon ion 60 GyE in 20 fractions. Results The median follow up time was 19.0 (2.4-42.9) months. There were 13 patients with gross tumors, with a median largest diameter of 5.7 (2.7-12.8) cm. The dosimetric study showed that proton and carbon-ion plans significantly reduced the maximum dose to the spinal cord, the mean doses to the organs at risk (OARs) including the lung/heart/esophagus, and the integral dose of the exposed area about 25%-65% compared to photon plans. No other toxicities ≥ grade 3 were observed except one myocardial infarction (grade 4 late toxicity). There was no local failure observed. Metastasis to regional lymph node, lung, pleura, skull base, bone or liver occurred in 4 patients with Ⅲ-ⅣB stage disease in 6.1-22.8 months after treatment. The 2-year local control and overall survival rates were 100%, disease free survival and distant metastasis free survival rates were 64.6%. Conclusions For TMs, PT has significant advantages over photon in terms of sparing OARs, and is safe and effective in patients with TMs after short-time follow-up. |
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