Purpose: To provide the first report on proton radiotherapy (PRT) in the management of advanced nasopharyngeal angiofibroma (JNA) and evaluate potential benefits compared to conformal photon therapy (XRT). Methods: We retrospectively reviewed 10 consecutive patients undergoing PRT for advanced JNA in a definitive or postoperative setting with a relative biological effectiveness weighted dose of 45 Gy in 25 fractions between 2012 and 2022 at the Heidelberg Ion Beam Therapy Center. Furthermore, dosimetric comparisons and risk estimations for short- and long-term radiation-induced complications between PRT plans and helical XRT plans were conducted. Results: PRT was well tolerated, with only low-grade acute toxicities (CTCAE I–II) being reported. The local control rate was 100% after a median follow-up of 27.0 (interquartile range 13.3–58.0) months. PRT resulted in considerable tumor shrinkage, leading to complete remission in five patients and bearing the potential to provide partial or complete symptom relief. Favorable dosimetric outcomes in critical brain substructures by the use of PRT translated into reduced estimated risks for neurocognitive impairment and radiation-induced CNS malignancies compared to XRT. Conclusions: PRT is an effective treatment option for advanced JNA with minimal acute morbidity and the potential for reduced radiation-induced long-term complications.
目的：首次报告质子放射治疗（PRT）在晚期鼻咽血管纤维瘤（JNA）治疗中的应用，并评估其相较于适形光子治疗（XRT）的潜在优势。方法：回顾性分析2012年至2022年间在海德堡离子束治疗中心连续接受PRT治疗的10例晚期JNA患者（根治性或术后辅助治疗），处方剂量为相对生物效应加权剂量45 Gy/25次。同时，对PRT计划与螺旋XRT计划进行剂量学比较，并评估短期及长期放射性并发症的风险差异。结果：PRT耐受性良好，仅报告低级别急性毒性反应（CTCAE I–II级）。中位随访27.0个月（四分位距13.3–58.0个月）后局部控制率达100%。PRT可显著缩小肿瘤体积，其中5例患者达到完全缓解，并可能实现症状的部分或完全缓解。与XRT相比，PRT在关键脑亚结构中的剂量学优势转化为神经认知损伤和放射性中枢神经系统恶性肿瘤的预估风险降低。结论：PRT是治疗晚期JNA的有效方案，具有急性毒性轻微的特点，并可能减少放射性长期并发症的发生风险。
Proton Therapy for Advanced Juvenile Nasopharyngeal Angiofibroma
肿瘤(癌症)患者之家