Indications and clinical effects of proton therapy, once explained
Radiation therapy is one of the main methods of tumor treatment.
According to data released on the official website of the International Commission on Particle Therapy (PTCOG), as of 2022, over 31.2w patients worldwide have received proton therapy.
Improving the physical dose distribution, increasing the irradiation dose of tumor tissue, while reducing the dose of normal tissue, in order to control the occurrence of adverse reactions and complications while effectively treating tumors, is an important development direction in current radiation oncology.
Proton beams, which differ significantly in physical dosimetry from conventional X-rays, are used for radiation therapy.
By accurately locating the Bragg peak of the proton beam at the tumor target area, a high therapeutic gain ratio can be achieved.
With the development and gradual maturity of proton therapy technology, the indications for proton therapy are becoming increasingly widespread.
As a high-tech radiotherapy technology, many people have many doubts about proton therapy, and many friends leave messages asking: What cancers can proton therapy treat? What is the clinical effect of proton therapy?
Below, we will summarize the indications and clinical results of proton therapy together.
n theory, anyone who needs radiation therapy can receive proton therapy.
The indications for proton therapy are as follows:
In addition to the indications for proton therapy, the clinical efficacy of proton therapy is the most concerning issue for everyone. Next, let's take a look at the clinical efficacy of proton therapy for different tumors.
1
Head and Neck Cancer
(1)ocular tumors
The Paul Schell Institute (PSI) in Switzerland treated 7900 patients with eye tumors with proton therapy in 2022.
In reality, the prognosis of proton therapy for eye tumors is very good, with 98% of patients experiencing tumor growth cessation or even disappearance, and over 90% of eye tumor patients being able to preserve their eyeballs.
The study released by PSI in 2014 also showed a 10-year survival rate of 93% in 43 patients with eye tumors who received proton therapy.
(2) Oropharyngeal cancer
A study by Loma Linda University Medical Center reported that the 2-year local control rate of proton therapy for oropharyngeal cancer was 92%; The 2-year tumor free survival rate is 81%, and the 5-year tumor free survival rate is 65%.
2
Thoracic Tumors
1. Lung cancer
A study released by the University of Tsukuba in Japan in 2007 evaluated the efficacy and safety of proton therapy for non-small cell lung cancer.
The research results show that the 2-year local progression free survival rate of proton therapy for lung cancer is 96%, disease-free survival rate is 79%, 2-year overall survival rate is 74%, 2-year etiology specific survival rate is 86%, and no toxic side effects above grade 3 have been observed.
2. Esophageal cancer
A 2017 study by the Radiation Oncology Department of MD Anderson Cancer Center compared the results of proton therapy and intensity modulated radiation therapy for esophageal cancer.
The results showed that the overall 5-year survival rate of proton therapy for stage III esophageal cancer was 34.6%, while the survival rate of the intensity modulated radiation therapy group was only 25%.
The progression free survival rate of proton therapy is 33.5%, which is double the 13.2% increase compared to intensity modulated radiation therapy!
3. breast cancer
According to a study published on Radiotherapy&Oncology in 2018, 42 patients with breast cancer received proton therapy after surgery.
The results showed that the 3-year disease-free survival rate was as high as 96.3%, and the overall survival rate was 97.2%.
And there have been no acute skin toxicity levels 3 or 4.
3
Abdominal and pelvic tumors
1. Liver cancer
The National Cancer Comprehensive Network Guidelines in the United States include proton therapy as a recommended option for liver cancer treatment.
Canda et al. retrospectively analyzed the results of 46 liver cancer patients receiving proton therapy at MD Anderson Cancer Center.
The results showed that the one-year overall survival rate of proton therapy for liver cancer was 73%, and the one-year local control rate was 95%.
2. pancreatic cancer
In 2017, a Japanese study evaluated the results of proton therapy for locally advanced pancreatic cancer.
The results showed that the 1-year local control rate of proton therapy for pancreatic cancer was 100%, and the 1-year overall survival rate was 80%.
3. Renal cancer
In 2020, the Radiation Oncology Department in Japan conducted a nationwide retrospective study on proton therapy for primary renal cell carcinoma.
The results showed that the 3-year overall survival rate of proton therapy for renal cell carcinoma was 95%, and the 3-year disease specific survival rate was 100%.
4
Central nervous system tumors
1. Meningioma
A study published by the Paul Schell Institute in Switzerland in 2020 systematically evaluated the results of proton therapy for meningioma.
The results showed that the 5-year overall survival rate of proton therapy for WHO grade I meningiomas was 96.2%, and the 5-year progression free survival rate was 96.6%.
The 5-year local control rate for WHO grade II - III meningioma patients receiving proton therapy with over 60 GyRBE was 87.5%, while the 5-year local control rate for those receiving proton therapy with less than 60 GyRBE was 50%.
The 1-year and 2-year overall survival rates of proton therapy and re irradiation for recurrent meningiomas after radiotherapy were 89.6% and 71.4%, respectively.
2. Pituitary adenoma
A 2014 study in the International Journal of Radiation Oncology showed that the 3-year local control rate of proton therapy for pituitary tumors was as high as 100%, and the 3-year progression free survival rate was also 100%.
3. Ependymoma
A study published in Neuro Oncology in 2022 evaluated the results of proton therapy for ependymoma.
Research shows that the 3-year overall survival rate of proton therapy for ependymoma is 93.7%, and the 3-year local control rate is 74.1%.
4. Medulloblastoma
A study in Germany in 2022 analyzed the results of proton therapy for children with brain tumors.
Among them, the 3-year overall survival rate of 58 children with medulloblastoma was 83.8%, the 3-year progression free survival rate was 80%, and the 3-year local control rate was as high as 92.2%.
5
Bone and soft tissue tumors
Ewing's sarcoma
A research team from the Radiation Oncology Department of Harvard Medical School published a study in 2012 that evaluated the results of proton therapy for Ewing's sarcoma in children.
The results showed that the 3-year overall survival rate was 89%, and the 3-year local control rate was 86%。
6
skin tumors
Melanoma
In 2022, the Department of Radiology and Oncology at the Proton Center in New York, New York, USA, published the largest multi institution study in North America on the results of proton therapy for head and neck skin melanoma.
Research has shown that the 1-year overall survival rate of proton therapy for melanoma is 100%, the 3-year overall survival rate is 83.3%, and the 1-year progression free survival rate is 85.7%.
7
Hematology and lymphatic system tumors
Hodgkin's lymphoma
A study published in the journal Pediatric Blood&Cancer in 2016 analyzed the results of proton therapy for Hodgkin's lymphoma in children.
Research shows that the overall survival rates at 2 and 3 years are 94%, and the progression free survival rate is 86%.
No acute or late complications of grade 3 or above were observed in this study.
8
Child Tumor
The Belgian Cancer Registry stated in its published study that proton therapy is the preferred tumor irradiation technique for treating childhood tumors.
The MD Anderson Cancer Center in the United States also believes that proton therapy is the first choice for children with diencephalic tumors.
For children who are still in growth and development, proton therapy has great advantages.
In 2017, Lanzhou University evaluated the efficacy and safety of proton therapy for common intracranial tumors.
Research shows that the 2-year overall survival rate of proton therapy is 94%, the 3-year overall survival rate is 90%, and the 5-year overall survival rate is also 87%.
The University of Florida evaluated the results of proton therapy in 29 children with low-grade gliomas.
In this study, the 5-year overall survival rate of proton therapy for low-grade gliomas was 89%, and the 5-year local control rate was 82%; The 10-year overall survival rate is 85%, and the 10-year local control rate is 74%.
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