肿瘤质子治疗原及临床应用.docVIP

肿瘤质子治疗原理及临床应用 穆向魁 山东淄博万杰质子治疗中心 山东，淄博，255213 论文摘要： 放射治疗的目的是给予肿瘤致死放射剂量，而同时给予肿瘤周围正常组织最小的放射剂量以避免放射损伤。然而，通常使用的体外射线源，电子线和X-线，都有一定的限制：电子线限于治疗表浅肿瘤；X-线治疗可用于深部肿瘤，但是由于光子随穿透深度指数衰减，使肿瘤周围正常组织受到大量照射，引起早期或晚期并发症。质子射束由于其特殊的深度剂量分布，博拉格峰，使肿瘤内剂量分布均一，肿瘤后方剂量为零，肿瘤前方剂量低于光子；而且，博拉格峰的位置是能量依赖的，能够精确的调整到需要的位置。因此，使用质子治疗可以提高肿瘤剂量来提高肿瘤局部控制率，而且由于正常组织没有或少照射而避免的并发症的发生。文中简单探讨了质子治疗计划技术，使用几个病例来说明质子束剂量分布的特点。回顾分析了近年来的临床资料，并探讨了质子治疗的适应症和未来技术发展的方向等问题。 关键词：肿瘤 放射治疗 质子 Principle and clinical application of proton therapy in radiation oncology Mu Xiangkui Wanjie Proton Therapy Center, Zibo, Shandong. 255213 Abstract: The aim of radiotherapy is to delivery a lethal radiation dose to tumour without exceed the dose limit of surrounding normal tissues. However, the commonly used external radiation sources, such as electrons and photons, have certain limitations. Electrons are limited to treat superficial tumour, and photons are used for deep-sited target. Because the depth dose curve of photons follow the exponential law, which means that a considerable amount radiation dose delivered to surrounding normal tissue and cause early or late side effects. Protons have a special depth dose curve, so called bragg peak. It has a finite range, and is energy depended. This makes the radiation dose uniform across the target volume, a zero dose beyond tumour and a lower dose proximal tumour than photons. Therefore, the clinical benefits are very obvious. Tumour control probability can be improved by increasing radiation dose in tumour, while without increasing side effect. Several clinical cases were used for illustration of dose distribution of proton therapy, and the principles of proton treatment planning were discussed. The clinical results were reviewed briefly. The clinical indication and potential technical development were also discussed. Key words: oncology, radiotherapy, proton 一、 质子治疗原理 光子（X-射线）和电子线是最常用的对肿瘤实施体外照射的放射源。电子线由于穿透能力有限，只能用于治疗表浅部位肿瘤。光子可以治疗深部肿瘤，但是当使用单个射束照射时，肿瘤周围的正常组织也受到了与肿瘤内部相近的照射剂量（图1）。三维适形治疗（3D-C