文章：

质子治疗中线性能量传递引导治疗计划优化的系统综述：现状与未来需求分析

A Systematic Review of LET-Guided Treatment Plan Optimisation in Proton Therapy: Identifying the Current State and Future Needs

原文发布日期：25 August 2023

DOI: 10.3390/cancers15174268

类型: Article

开放获取: 是

英文摘要：

The well-known clinical benefits of proton therapy are achieved through higher target-conformality and normal tissue sparing than conventional radiotherapy. However, there is an increased sensitivity to uncertainties in patient motion/setup, proton range and radiobiological effect. Although recent efforts have mitigated some uncertainties, radiobiological effect remains unresolved due to a lack of clinical data for relevant endpoints. Therefore, RBE optimisations may be currently unsuitable for clinical treatment planning. LET optimisation is a novel method that substitutes RBE with LET, shifting LET hotspots outside critical structures. This review outlines the current status of LET optimisation in proton therapy, highlighting knowledge gaps and possible future research. Following the PRISMA 2020 guidelines, a search of the MEDLINE®and Scopus databases was performed in July 2023, identifying 70 relevant articles. Generally, LET optimisation methods achieved their treatment objectives; however, clinical benefit is patient-dependent. Inconsistencies in the reported data suggest further testing is required to identify therapeutically favourable methods. We discuss the methods which are suitable for near-future clinical deployment, with fast computation times and compatibility with existing treatment protocols. Although there is some clinical evidence of a correlation between high LET and adverse effects, further developments are needed to inform future patient selection protocols for widespread application of LET optimisation in proton therapy.

摘要翻译： 

质子治疗相较于传统放疗，因其更高的靶区适形性和正常组织保护能力而获得显著的临床效益。然而，该技术对患者位移/摆位、质子射程及放射生物学效应等方面的不确定性更为敏感。尽管近期研究已在一定程度上降低了部分不确定性，但由于缺乏相关临床终点数据，放射生物学效应问题仍未得到解决。因此，基于相对生物效应（RBE）的优化方案目前可能尚不适用于临床治疗计划制定。线性能量传递（LET）优化作为一种新兴方法，通过以LET替代RBE进行优化，将LET热点区域转移至关键结构之外。本综述系统阐述了质子治疗中LET优化的研究现状，指出当前知识空白及未来潜在研究方向。依据PRISMA 2020指南，我们于2023年7月对MEDLINE®和Scopus数据库进行检索，共纳入70篇相关文献。总体而言，LET优化方法基本实现了治疗目标，但其临床效益存在患者个体差异性。现有数据的不一致性表明，仍需进一步验证以筛选出更具治疗优势的优化方法。我们重点探讨了适用于近期临床部署的优化方案，这些方法具有计算速度快、与现有治疗协议兼容性强的特点。尽管已有临床证据表明高LET与不良反应存在关联，但仍需深入研究以建立患者筛选标准，为LET优化在质子治疗中的广泛应用提供依据。

原文链接：

A Systematic Review of LET-Guided Treatment Plan Optimisation in Proton Therapy: Identifying the Current State and Future Needs