| 刘磊,马涛,卢晓明,等.巨块型肿瘤质子空间分割放射治疗临床初步探索[J].中华放射医学与防护杂志,2025,45(9):863-869.Liu Lei,Ma Tao,Lu Xiaoming,et al.Spatially fractionated proton therapy (SFPT) for bulky tumors: A preliminary clinical exploration[J].Chin J Radiol Med Prot,2025,45(9):863-869 |
| 巨块型肿瘤质子空间分割放射治疗临床初步探索 |
| Spatially fractionated proton therapy (SFPT) for bulky tumors: A preliminary clinical exploration |
| 投稿时间：2025-03-13 |
| DOI：10.3760/cma.j.cn112271-20250313-00087 |
| 中文关键词: 质子治疗 空间分割放射治疗 巨块型肿瘤 |
| 英文关键词:Proton therapy Spatially fractionated radiation therapy(SFRT) Bulky tumor |
| 基金项目:国家自然科学基金重点项目(U24A20733);国家自然科学基金(82473235) |
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| 中文摘要: |
| 目的 报道利用空间分割放射治疗(SFPT)治疗巨块型肿瘤患者的单中心初步临床探索结果。方法 回顾性收集2024年4月至2024年12月在中国科学技术大学附属第一医院离子医学中心(合肥离子医学中心)放疗科行SFPT巨块型肿瘤患者的病例资料,包括临床、肿瘤特征及剂量学参数等信息。SFPT主要使用三维Lattice放疗(LRT)方式,利用笔形束扫描技术进行多野鲁棒性优化。SFPT靶区(STV)定义为直径1.0 cm的球体。主要观察指标为肿瘤相关症状缓解率,次要观察指标为局部肿瘤控制率。结果 共12例患者纳入本研究,中位年龄为61岁(28~85岁),其中6例原发肿瘤为肝癌,3例为肉瘤,2例为肺癌,其他1例。12例患者中有8例患者联合了全身治疗。SFPT治疗计划中,中位大体肿瘤体积 (GTV)为429.63 cm3(120.60~2 053.30 cm3),STV中位个数为8个(3~20个),STV的单次剂量均为10 GyE,中位照射次数为6次(3~8次),中位STV体积为8 cm3(3~20 cm3),中位STV体积占比为2.09%(0.62%~3.30%),中位单个STV对应GTV体积为52.91 cm3(30.25~159.82 cm3),中位峰谷剂量比为3.37(2.29~7.60)。所有患者都联合标准分次的质子治疗,中位处方剂量为50 GyE(40~60 GyE)。中位随访时间为174 d(133~235 d),肿瘤相关症状缓解率为75%,局部肿瘤控制率为100%,4例患者出现1~2级治疗相关不良反应,总体耐受性良好。结论 SFPT 是一种很有前景的技术,在临床治疗巨块型肿瘤中有良好的控制率和耐受性,可为肿瘤患者迅速缓解症状和控制肿瘤进展提供了可能。 |
| 英文摘要: |
| Objective To report the preliminary clinical exploration result of spatially fractionated radiation therapy (SFPT) using the pencil-beam-scanning (PBS) technique at a single center for the treatment of patients with bulky tumors. Methods Data on the clinical characteristics, tumor characteristics, and dosimetric parameters were retrospectively collected from patients with bulky tumors at the Radiation Oncology Department, Ion Medical Center, First Affiliated Hospital of University of Science and Technology of China (i.e., the Hefei Ion Medical Center) from April 2024 to December 2024. Three-dimensional lattice radiotherapy (LRT) was primarily utilized in the SFRT, with multi-field robust optimization performed using pencil beam scanning. SFRT target volumes (STVs) were defined as 1.0 cm-diameter spheres. Primary observation indicators included the remission rate of tumor-associated symptoms, followed by the local tumor control rate. Results A total of 12 patients were enrolled in this study, with a median age of 61 years (28-85 years). The primary tumors included hepatocellular carcinoma (six patients), sarcomas (three patients), and lung cancer (two patients). Eight patients received concurrent systemic therapy. The SFRT plans showed a median gross tumor volume (GTV) of 429.63 cm3 (120.60-2053.30 cm3), a median STV number of 8 (3-20), a single-fraction dose to STVs of 10 GyE, a median irradiation quantity of 6 (3-8), a median STV of 8 cm3 (3-20 cm3), a median STV proportion of 2.09% (0.62%-3.30%), a median GTV corresponding to a single STV of 52.91 cm3 (30.25-159.82 cm3), and a median peak-to-valley dose ratio of 3.37 (2.29-7.60). All patients received conventionally fractionated proton therapy (CFPT), with a median prescription dose of 50 GyE (40-60 GyE). Furthermore, these patients showed a median follow-up time of 174 d (133-235 d), a remission rate of tumor-associated symptoms of 75%, and a local control rate of 100%. Four patients experienced grade 1-2 treatment-related adverse events, suggesting high overall tolerability of the patients. Conclusions SFRT represents a promising technique with high control rates and tolerability for bulky tumors, providing the possibility for quick symptom relief and the control of tumor progression. |
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