In the academic conference of "Malignant Tumor Standardization and Progress Tour" (Zhuozhou Station) jointly organized by the China Medical and Health Development Association, the Beijing Breast Disease Prevention and Treatment Society and Yizhou Cancer Hospital, Professor Zou Yue, deputy director of the Radiotherapy Center of Yizhou Cancer Hospital, gave a report entitled "Characteristics of Proton ** and Advantages in Tumor Radiotherapy", explaining the status and role of proton ** in radiotherapy to the guests, and making beneficial popularization and promotion of the standardization of malignant tumors.
At the meeting, the chair of the meeting, Peking University Cancer HospitalDi LijunThe professor introduced Professor Zou Yue to the guests.
Zou YueProfessor, Chief Physician, Doctor of Medicine, Master's Supervisor;He served as the deputy director of the Radiotherapy Center of Yizhou Cancer Hospital and the former director of the Radiotherapy Center of the Rocket Army General HospitalHis main social positions include members of the Standing Committee of the Ion Radiation ** Branch of the China Medical Equipment Association, a member of the Standing Committee of the Radiation Oncology Professional Committee of the Military Medical Science and Technology Committee, a director of the Beijing Anti-Cancer Association, a member of the Proton and Heavy Ion Expert Advisory Committee of the Radiation Oncology Branch of the Beijing Medical Association, a member of the Radiation Oncology Expert Committee of the Beijing Medical Doctor Association, and a member of the Standing Committee of the Medical Radiation Equipment Protection and Testing Professional Committee of the China Medical Equipment Association.
Professor Zou Yue, who has been engaged in radiotherapy for more than 30 years, has accumulated rich clinical experience in various tumor radiotherapy cases, and is proficient in tumor proton radiotherapy and conventional radiotherapy, especially good at proton radiotherapy for liver cancer, breast cancer, lung cancer, pancreatic cancer, rectal cancer, bone tumors, soft tissue sarcoma, etc., and has rich experience in radiotherapy, chemotherapy, and targeted comprehensive therapy.
As an academic authority, Professor Zou Yue introduced the development and advantages of proton ** to the guests from both academic and clinical aspects.
In response to the problems of social concern, Professor Zou Yue first described the difference between protons and carbon ions (heavy ions), the proton volume is smaller, and there is no long-tail effect in Bragg Peak, and the toxicity is smaller.
In terms of technical characteristics, proton can effectively make up for the shortcomings of conventional photon radiotherapy and achieve better results1.More accurate;2.Less damage to normal tissues;3.Induces fewer second tumors;4.The disease control rate is higher, with a five-year survival rate of over 80%.
As a new type of radiological technology, proton ** is not very popular in the medical community at present, and many people, including doctors, do not have a comprehensive understanding of proton**. However, in the actual clinical application, the number of tumor patients receiving proton ** is showing an explosive growth trend, which urgently requires the medical community to understand more about the role of proton ** and jointly promote the development of proton**.
According toInternational Proton** Collaborative CommitteeAccording to the latest data released by PTCOG, a total of 325,000 patients worldwide received particles** at the end of 2021, an increase of 33,819 cases from the end of 2020Among them, 280,000 patients received proton**, accounting for 86 of the total2%, an increase of 31,619 cases from the end of 2020.
The total number of patients with particle ** in China was 9,974 (including 6474 cases of particle ** in Chinese mainland;Taiwan**3,500 cases), an increase of 25 from the end of 20205%。
Proton ** has a wide range of indications, according to:MD Anderson Cancer CenterAccording to the statistics of the University of Texas MD Anderson Cancer Center, proton** indications include central nervous system tumors, head and neck tumors, thoracic tumors, gastrointestinal tumors, genitourinary system tumors, hematological tumors, breast cancer, pediatric tumors, etc., all of which are suitable for protons**.
In terms of clinical application of proton, proton** has been included in head and neck tumors, esophageal cancer and hepatobiliary tumorsNCCN Guidelines
In terms of clinical benefit:
ibaThe publication of Proton for Head and Neck Tumors: Current Clinical Practice, Opportunities and Challenges improves local control and survival of paranasal sinus tumors. Previous meta-analyses have also shown that proton** nasal and paranasal sinus tumors were superior to IMRT in terms of disease-free survival and tumor control (5-year disease-free survival: 72 vs 50, tumor control rate: 81 vs 64).
Massachusetts General Hospital, Harvard Medical SchoolAnnie WChan, "Recent Advances and Applications of Proton Beam Radiotherapy for Head and Neck Cancer": For nasopharyngeal carcinoma, MGH conducted a phase proton** clinical trial, which enrolled 23 patients with stage B-B disease, and the results showed that the 4-year local control rate of all patients was 91%, the overall survival rate was 91%, and the metastasis-free survival rate was 86%. In terms of toxicity, there was no grade 3 xerostomia, 1 patient needed to use a gastric feeding tube at 6 and 12 months after **, and 22 patients with normal penetration-aspiration score (PA score) at baseline had a PA score that was always in the normal range throughout the whole process.
MD Anderson Cancer CenterIn the study by Blanchard et al., 50 patients with OPC received IMPT and 100 patients with OPC received IMRT. The results showed similar local control rates, overall survival, and progression-free survival between the two groups, and there were no significant differences in grade 3 dermatitis or mucositis. However, grade 3 weight loss and gavage dependence in the IMPT group were significantly lower than those in the IMRT group at 3 months after radiotherapy, with a ratio of 044(18.0% vs 34.0%), and the ratio was 0 at 1 year after radiotherapy23(8.0% vs 24.7%)；The incidence of grade 2 dry mouth was also significantly lower than that in the IMRT group, with a ratio of 038(42.0% vs 61.2%)。These results suggest that IMRT significantly reduces the incidence of dry mouth, gavage-dependent, and severe weight loss in radiotherapy patients compared with IMRT without impairing survival.
InBreast cancerfield, the Breast Cancer Subcommittee of the International Federation of Ions (PTCOG) has issued the Consensus Statement on Breast Cancer Protons.
In terms of the clinical benefits of proton ** for breast cancer, the main benefits include:
Cardiotoxicity: For every 1 Gy increase in the mean cardiac dose, the probability of MCES increases by 74%。There is a significant relationship between cardiac dose and major coronary events (MCES), and there is no defined threshold, making there no risk below this threshold. Therefore, chest radiotherapy should use heart-sparing techniques. Compared to conventional radiotherapy, Proton** lowers the dose to the heart.
Radiation pneumonitis: Proton** reduces the dose of radiation to the lungs from early and locally advanced breast cancer compared to 3D-CRT and IMRT.
Contralateral breast cancer: Proton** Conventional beam distribution allows the contralateral breast to be almost completely unexposed to any dose. Model studies have shown that proton** reduces the lifetime risk of contralateral second primary breast cancer by reducing the dose of irradiation to the contralateral breast compared to 3DCRT and IMRT.
ForTumors of the digestive systemThe advantages of proton**, according to a follow-up analysis of hepatocellular carcinoma by the University of Tsukuba, Japan.
Protons can be used for large tumors: Proton Radiotherapy**Large hepatocellular carcinoma can achieve an ideal dose distribution with very little damage to normal hepatocytes from radiation. Sugahara et al. received a median dose of 72 on 226 GY, 22 fractions (Dose 47.)3gy-89.1 GY, 10-35 fractions) proton** tumors The results of the study in patients with 10 cm hepatocellular carcinoma showed that the 2-year local control rate and overall survival rate of these patients were 87% and 36%, respectively, and no serious ** related toxicities were found.
Patients with hepatocellular carcinoma with portocarcinoma and inferior vena cava thrombosis may choose proton**: One pair accepts 22 divisions 72In a study of 6GY proton ** in patients with hepatocellular carcinoma with portal vein cancer thrombus, researchers found that 29 of 35 patients responded well to **, with 2- and 5-year overall survival rates of 48% and 21%, median survival of 22 months (2-88 months), and no serious toxicity.
Proton Radiotherapy**Hepatocellular carcinoma is less limited by liver functionHATA et al. analyzed the efficacy of 19 patients with hepatocellular carcinoma (HCC) with a history of cirrhosis and Child-PUGH grade C who received 3-5 fractions with a total dose of 50-84 GY proton radiation** from 1990 to 2000, and found no grade 3 or higher toxicity. There was no decrease in the Child-PUGH score after all patients**, but on the contrary, there was an improvement in the score after 14 patients**. The 2-year overall survival rate was 42%, and the objective response rate was 63%.
Researchers at MD Anderson Cancer Center recently reported the results of a retrospective analysis of protons** in 46 patients with different fractionation protocols, including radiation doses of 58 Gye 15 F and 675gye 15 F ** scheme (56). They noted that for patients with a bed of 90 gye, the medianOverall survival from 158 months to 499 months(p=0.037), indicating the presence of a dose-response effect.
InLung cancerIn terms of proton, proton** is increasingly and maturely used in non-small cell lung cancer, small cell lung cancer, and metastatic lung cancer. Compared with conventional photon radiotherapy, proton** is effective in early-stage non-small cell lung cancer, locally advanced non-small cell lung cancer, and regionally local** non-small cell lung cancerThe local control rate, survival rate and toxicity rate all showed advantages
According to the mediastinal lymphoma proton guidelines, for:Mediastinal Hodgkin and non-Hodgkin lymphomaIn patients, reducing the dose of irradiation to organ-threatening organs (OARS) is a decisive factor in the choice of radiotherapy. Proton proton increases the rate and reduces the risk of related fatal events, especially heart disease and secondary malignancies. However, because proton** is different from traditional radiotherapy, it is important to identify the patient group and specific condition that are suitable for proton**.
Patients with lymphoma who may benefit from proton** include:
Mediastinal lymphomaIt has spread to the lower end of the left main coronary artery, where it originates, and the tumor is anterior, posterior, or left of the heart.
Young female patients, protons** may reduce their breast radiation dose and risk of developing secondary breast cancer.
Patients who have received a large number of ** in the pastRadiotherapy-related toxicities, including those in the bone marrow, heart, and lungs, are susceptible.
Professor Zou Yue used detailed content, authoritative data and data, and clearly stated the advantages and role of proton ** to the guests, and the leaders of the oncology departments of various local hospitals said that they benefited a lot, had a new understanding of proton radiotherapy, and were more confident in the prospects of tumor **.
Professor Zou Yue also conducted further discussions with the guests on the spot through specific cases and in the MDT discussion session, and further analyzed the specific situation of proton ** in clinical application according to the actual situation of different patients. The guests at the meeting made in-depth comments on the diagnosis and treatment of the disease, radiotherapy plan, dose calculation, radiation angle, and post-diagnosis.
The meeting was held in a friendly group, and the detailed content of the meeting played a positive role in effectively promoting the improvement of the level of cancer prevention and treatment at the grassroots level, promoting rural revitalization, promoting the construction of healthy cities and healthy villages, and carrying out training activities for grassroots medical personnel.