PDF(Pubmed)
Abstract：
The growing interest in proton therapy (PT) in recent decades is justified by the evidence that protons dose distribution allows maximal dose release at the tumor depth followed by sharp distal dose fall-off. But, in the holistic management of head and neck cancer (HNC), limiting the potential of PT to a mere dosimetric advantage appears reductive. Indeed, the precise targeting of PT may help evaluate the effectiveness of de-escalation strategies, especially for patients with human papillomavirus associated-oropharyngeal cancer (OPC) and nasopharyngeal cancer (NPC). Furthermore, PT could have potentially greater immunogenic effects than conventional photon therapy, possibly enhancing both the radiotherapy (RT) capability to activate anti-tumor immune response and the effectiveness of immunotherapy drugs. Based on these premises, the aim of the present paper is to conduct a narrative review reporting the safety and efficacy of PT compared to photon RT focusing on NPC and OPC. We also provide a snapshot of ongoing clinical trials comparing PT with photon RT for these two clinical scenarios. Finally, we discuss new insights that may further develop clinical research on PT for HNC.
摘要：
近几十年来，质子治疗（PT）的兴趣与日俱增，有证据表明质子剂量分布允许在肿瘤深度最大剂量释放，然后急剧的远端剂量下降。但是,在头颈癌（HNC）的整体管理中，将PT的潜力限制为仅仅是剂量学优势似乎是减少的。的确,PT的精确目标可能有助于评估降级策略的有效性，尤其是人乳头瘤病毒相关口咽癌（OPC）和鼻咽癌（NPC）患者。此外，PT可能比常规光子疗法具有更大的免疫原性作用，可能增强放疗（RT）激活抗肿瘤免疫反应的能力和免疫治疗药物的有效性。基于这些前提,本文的目的是进行叙述性综述,报告PT与光子RT相比的安全性和有效性,重点关注NPC和OPC.我们还提供了正在进行的临床试验的快照，比较了这两种临床情况下的PT与光子RT。最后,我们讨论了可能进一步发展HNCPT临床研究的新见解。
