目的:质子束治疗(PBT)在原发性脊柱肿瘤的治疗中起着重要作用。该共识声明的目的是总结脊柱肿瘤的PBT的安全和最佳递送。
方法:粒子治疗合作组(PTCOG)颅底/中枢神经系统(CNS)/肉瘤小组委员会由放射肿瘤学家和具有脊柱照射专业知识的医学物理学家组成,制定了专家建议,讨论了治疗计划考虑因素和当前治疗原发性脊柱肿瘤的方法。
结果:CT模拟:需要重大考虑的因素包括:1)患者舒适度,2)设置的重现性和稳定性,和3)适当的光束角度的可接近性。
■如果存在,硬件应放置在原发肿瘤水平的上方/下方,以减少肿瘤床水平的金属负担。可以减少不确定性的新材料包括聚醚醚酮(PEEK)和复合PEEK-碳纤维植入物。
■需要适当的波束选择以确保稳健的目标覆盖和OAR节省。通常,2-4个治疗场,通常从后部和/或后部倾斜方向,被利用。
■建议对所有笔形波束扫描计划(首选治疗方式)进行稳健优化,并且应考虑设置不确定性(3-7mm之间)和范围不确定性(3-3.5%)。在金属硬件存在的情况下,建议使用范围不确定度增加至5%.
结论:PTCOG颅骨基地/中枢神经系统/肉瘤小组委员会已提出建议,使中心能够安全有效地提供PBT,以治疗原发性脊柱肿瘤。
OBJECTIVE: Proton beam therapy (PBT) plays an important role in the management of primary spine tumors. The purpose of this consensus statement was to summarize safe and optimal delivery of PBT for spinal tumors.
METHODS: The Particle Therapy Cooperative Group Skull Base/Central nervous system/Sarcoma Subcommittee consisting of radiation oncologists and medical physicists with specific expertise in spinal irradiation developed expert recommendations discussing treatment planning considerations and current approaches in the treatment of primary spinal tumors.
RESULTS: Computed tomography simulation: factors that require significant consideration include (1) patient comfort, (2) setup reproducibility and stability, and (3) accessibility of appropriate beam angles.
UNASSIGNED: If present, hardware should be placed with cross-links well above/below the level of the primary tumor to reduce the metal burden at the level of the tumor bed. New materials that can reduce uncertainties include polyether-ether-ketone and composite polyether-ether-ketone-carbon fiber implants.
UNASSIGNED: Appropriate beam selection is required to ensure robust target coverage and organ at risk sparing. Commonly, 2 to 4 treatment fields, typically from posterior and/or posterior-oblique directions, are used.
UNASSIGNED: Robust optimization is recommended for all pencil beam scanning plans (the preferred treatment modality) and should consider setup uncertainty (between 3 and 7 mm) and range uncertainty (3%-3.5%). In the presence of metal hardware, use of an increased range uncertainty up to 5% is recommended.
CONCLUSIONS: The Particle Therapy Cooperative Group Skull Base/Central nervous system/Sarcoma Subcommittee has developed recommendations to enable centers to deliver PBT safely and effectively for the management of primary spinal tumors.