Today, the editor of the cancer-free home is talking about abdominal tumors. When it comes to this type of cancer, surgical treatment is still the main treatment method for most patients. Although radiotherapy technology has made significant progress and randomized trials have shown that multidisciplinary treatment can improve patient survival, the toxic effects of chemoradiotherapy for abdominal tumors are still very strong.
In order to prove the significant efficacy of protons in the treatment of abdominal tumors, the editor has consulted relevant literature published by many foreign researchers to demonstrate the therapeutic advantages of proton therapy!
gastric cancer
Surgery resection is the standard treatment plan for radical gastric cancer treatment, but most patients still need to receive multidisciplinary treatment, including postoperative chemotherapy and perioperative chemotherapy. Dosimetry studies have shown that 3D conformal RT (3DCRT) and intensity-modulated radiation therapy (IMRT) can significantly improve the coverage of tumor targets and better protect organs when compared with 2D radiotherapy.
dosage advantages of proton therapy
Compared with intensity-modulated radiation therapy, proton therapy can further protect normal organs from irradiation, significantly reduce the total radiation dose, and reduce the risk of advanced toxic reactions and secondary malignant tumors.
A retrospective analysis of the APSS Proton Center in Italy included 13 patients with gastric cancer. Intensity-modulated radiation therapy (6 irradiation fields per day) and double passive scattering/uniform scanning proton therapy (2 to 3 irradiation fields per day) were compared, and all patients received adjuvant treatment doses of 45 to 54 Gy.
Results showed that proton therapy significantly reduced the low-medium dose zones of the small intestine, liver, left/right kidneys and heart, and the total irradiation dose outside the target zone was also significantly reduced. Four of the 13 patients received proton therapy, and the scan results showed that the stable target volume coverage of the proton therapy scan was within ±2%.
clinical effect of proton therapy
Although proton therapy can reduce the toxic response in patients with gastric cancer, improve local control of the lesions, and is used for dose-escalation treatment, the current clinical data is still very limited, and strict follow-up data is needed to prove its advantages.
hepatoma
The essence of proton therapy is radiotherapy, but the difference is that the tumor is accurately irradiated. Its inherent Prague peak principle allows the ray to release less energy before it reaches the tumor, just like setting off fireworks. All the energy is released when the tumor is finally released, achieving the best tumor killing effect.
Liver cancer is not very sensitive to radiation therapy, and when the liver tissue is irradiated with a dose of killing liver cancer cells, normal liver cells are also quite killed. "Rolls-Royce" in radiotherapy - proton therapy breaks the situation of radiotherapy tolerance in liver cancer, and we turn proton therapy into a high-end version of radiotherapy.
Dosimetric advantages of proton therapy
Proton therapy is better than ordinary radiotherapy. First of all, the radiation is different. Ordinary radiotherapy is X-ray , which belongs to photon lines, with greater side effects and surrounding healthy tissues are susceptible to damage; protons use proton lines, which are less harmful to the human body's radiation. Secondly, when proton rays irradiate the tumor, a Bragg peak will form. Simply put, the energy of the ray is released after reaching the tumor site, and the healthy tissues before, after and around the tumor will not be affected.
Proton treatment (left) and IMRT (right) treatment plan for hepatocellular carcinoma treatment
X-ray releases energy when it reaches the human skin. dermatitis is the most common side effect. Most of the energy consumption reaches the tumor site, the effective dose is insufficient, and there will be energy ejection behind the tumor, so healthy tissue cannot avoid damage. The proton treatment time is short, and the treatment can be completed in a few minutes. After general outpatient treatment, you can go home. The advantage of
proton therapy is that compared with other treatment methods, a higher treatment response rate and a tumor control rate of more than 90%, while liver function does not decrease and side effects with the stomach and intestines do not increase.Compared with X-ray therapy, proton therapy has been shown to have higher tumor control and overall survival, and has lower side effects. For example, there are important organs around the liver, such as lungs, heart, esophagus, spine, etc. X-ray therapy cannot guarantee the degree of damage to these organs, and serious complications may occur and cause death.
clinical effect of proton treatment
005, a report from researchers from Chiba Prefecture, Japan pointed out that after the patients received proton treatment with a median dose of 76 GyE/20 f, 80% of the 30 patients achieved complete radiological remission, and the 2-year local control rate (LC) was 96% . A retrospective analysis of 242 patients receiving 8 proton treatment regimens (52.8~84 GyE/4~38 f) at Hyogo Prefecture Ion Medicine Center showed that the 15-year local control rate (LC) of html was 90% and the 5-year overall survival rate (OS) was 38%.
MD Anderson Cancer Center researchers recently reported retrospective analysis of proton therapy in 46 patients using different segmentation regimens, including treatment regimens with irradiation doses of 58 GyE/15 f and 67.5 GyE/15 f (56%). They pointed out that in patients with bioequivalent dose (BED) ≥90 GyE, the median overall survival of increased from 15.8 months to 49.9 months , indicating a dose-response effect.
If patients intend to use proton therapy, they can submit pathological report, treatment experience and hospitalization summary through cancer-free home medicine department for preliminary evaluation of whether this therapy can be used.
esophageal cancer
The treatment methods for esophageal cancer mainly include surgery, radiotherapy and chemotherapy, among which radiotherapy is one of the most important methods. However, because the esophagus is too close to the heart and lungs, traditional X-ray radiation can increase short-term and long-term side effects, and subsequent studies have shown that these excess radiation doses will seriously affect the patient's prognosis, thereby increasing the risk of heart disease or lung disease. Therefore, proton therapy may be an excellent choice for patients with advanced esophageal cancer.
Because proton rays have a unique Bragg effect, it can ensure that the radiation treatment dose is as concentrated as possible in the tumor lesion area. At the same time, minimize risk to the heart and lungs. Proton therapy provides unparalleled accuracy: it reaches the tumor site and stops, targets the tumor at a higher dose and increases the likelihood of treatment success.
Dosimetric Advantages of Proton Therapy
According to an article published in the journal Gastrointestinal Oncology on the dosage advantages of various radiotherapy techniques in the treatment of esophageal cancer patients, IMRT improves the dose distribution of the organs compared with 3D conformal radiotherapy (3DCRT). Comparative studies on treatment planning and dosage further show that proton therapy can significantly reduce the irradiation dose of the heart and lungs compared with 3DCRT and IMRT. proton therapy can protect the anterior tissue of the heart to the greatest extent and reduce the irradiation dose of the heart, which has obvious clinical advantages. (If you want to know about proton therapy, please consult the Cancer-Free Home Medical Department 400-626-9916)
The dosage comparison of proton therapy and IMRT in the treatment of esophageal cancer, the left is proton therapy, and the right is intensity-modulated radiotherapy
(Note: Dmax, maximum point dose; Vx, volume multiplied by the x dose of Gy; M LD, mean lung dose; MHD, mean heart dose; MLivD, mean liver dose; MKD, mean kidney dose)
clinical effect of proton treatment
In addition, there are several clinical trials showing that patients with esophageal cancer who receive proton therapy can obtain more clinical benefits, postoperative complications are significantly reduced, and hospital stays are significantly shortened.
998, Swedish scholars had a comparative study on common X-ray and proton treatment of esophageal cancer patients, which compared proton therapy, X-ray therapy and mixed proton and X-ray therapy respectively. The results show that proton therapy can significantly improve the dose distribution.That is to say, proton therapy can increase tumor dose and improve local tumor control rate without increasing side effects. A study by
MD Anderson Cancer Center included 62 patients with esophageal cancer, of which 47 were adenocarcinoma. After three years of receiving proton therapy and chemotherapy, more than half of the patients were stable, had no recurrence, and the incidence of serious side effects was less than 10%.
locally advanced cervical cancer
According to many published studies, proton therapy has many potential advantages in localized advanced cervical cancer. When using proton therapy to treat locally advanced cervical cancer, target movements caused by cervical movement can be overcome by combining information obtained from weekly changes during treatment. Proton therapy can reduce the accumulated dose that endangers the organs and significantly reduce the radiation dose of the intestine and bone marrow. Proton therapy is a viable option for patients who cannot accept or refuse close treatment.
pancreatic cancer and extrahepatic bile duct tumors
Although advanced X-ray radiation therapy technologies such as IMRT and stereotactic body radiotherapy (SBRT) are highly conformable, the physical characteristics of X-ray still limit their ability to reduce the dose of radiation exposure to normal tissues around them. Therefore, the gastrointestinal toxic reactions produced by traditional radiotherapy combined with chemotherapy have also greatly reduced the treatment effect.
Dosimetric Advantages of Proton Therapy
Multiple dosimetric studies have confirmed that compared with IMRT, proton therapy can reduce the irradiation dose of normal tissue in pancreatic cancer patients after inoperative resection or resection.
University of Pennsylvania researchers found that for patients with pancreatic tumors that cannot be surgically removed, double scattering and penis-beam proton therapy can reduce the irradiation dose of the stomach, duodenum and small intestine, while only slightly increasing the medium to high dose zones of the duodenum and stomach. The researchers also analyzed patients with pancreatic tumors after resection, proton therapy plans significantly reduce clinically relevant doses in the left kidney, stomach and spine compared to X-ray radiation; pendant beam scanning proton therapy can reduce the radiation dose in the right kidney, liver and small intestine compared with X-ray radiation and double-scattered proton therapy.
proton therapy (right) and X-ray radiation therapy (left) for the treatment of pancreatic cancer
proton therapy clinical effect
pancreatic cancer
pancreatic cancer
University of Florida reported routine segmentation proton therapy in patients with surgical resection (n=5), possible resection (n=5), and locally advanced (n=12) pancreatic cancer (50.4-59.4Gy, 1.8Gy/f) Clinical data on synchronous chemotherapy. No patients had grade 3 acute or advanced toxic reactions, and the patients had better tolerate synchronous chemotherapy, and could tolerate 99% of the prescribed chemotherapy dose; patients who did not receive the anterior or left lateral beam irradiation did not have grade 2 toxic reactions.
extrahepatic cholangiocarcinoma
The only published study is a retrospective series of studies conducted by the Proton Treatment Center in Koriyama, Japan. However, the study included patients with extrahepatic and intrahepatic cholangiocarcinoma, including 12 patients with intrahepatic cholangiocarcinoma, 3 patients with extrahepatic cholangiocarcinoma, 3 patients with gallbladder cancer, and 10 patients with local or lymph node recurrence after surgery. The median irradiation dose of proton therapy received by patients with
was 68.2Gy (50.6-80Gy, 2-3Gy/f), and 15 patients received adjuvant chemotherapy. The local control rate, progression-free survival rate and overall survival rate were 67.7%, 29.5% and 49.0% , respectively.
Rationally view proton heavy ion therapy
Although the cost of proton therapy is high at present, with the popularization of technology, the editor of believes that this new technology will gradually be reduced and benefit the public. Especially in some parts of my country, the process of incorporating proton therapy into medical insurance is accelerating the . I believe that in the near future, more cancer friends will use this advanced new anti-cancer technology.
In the field of proton heavy ion therapy, the relatively developed countries around the world are Germany, Japan, the United States and other countries.It is worth mentioning here that the proton treatment level of in Japan is comparable to that of the United States and Germany. It has many treatment cases and rich experience. However, the cost is the lowest among these top treatment centers, far lower than that of the United States and Germany, and even lower than that of the country, about 150,000 to 250,000 yuan, while the domestic proton cost is about 300,000 yuan. Therefore, Japan's medical expenses are the lowest in the four countries and are more cost-effective. If the patient wants to consult proton therapy, the cancer-free home proton expert consultation center can also conduct an authoritative proton program evaluation for patients.
This article is an original cancer-free home
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