Proton therapy has emerged as a crucial tool in the treatment of head and neck and skull-base cancers, offering advantages over photon therapy in terms of decreasing integral dose and reducing acute and late toxicities, such as dysgeusia, feeding tube dependence, xerostomia, secondary malignancies, and neurocognitive dysfunction. Despite its benefits in dose distribution and biological effectiveness, the application of proton therapy is challenged by uncertainties in its relative biological effectiveness (RBE). Overcoming the challenges related to RBE is key to fully realizing proton therapy’s potential, which extends beyond its physical dosimetric properties when compared with photon-based therapies. In this paper, we discuss the clinical significance of RBE within treatment volumes and adjacent serial organs at risk in the management of head and neck and skull-base tumors. We review proton RBE uncertainties and its modeling and explore clinical outcomes. Additionally, we highlight technological advancements and innovations in plan optimization and treatment delivery, including linear energy transfer/RBE optimizations and the development of spot-scanning proton arc therapy. These advancements show promise in harnessing the full capabilities of proton therapy from an academic standpoint, further technological innovations and clinical outcome studies, however, are needed for their integration into routine clinical practice.
质子治疗已成为头颈及颅底肿瘤治疗的关键手段，相较于光子治疗，其在降低积分剂量、减少急性和晚期毒性（如味觉障碍、饲管依赖、口干症、继发性恶性肿瘤及神经认知功能障碍）方面具有优势。尽管质子治疗在剂量分布和生物效应方面具有益处，但其相对生物有效性（RBE）的不确定性对其临床应用构成挑战。克服与RBE相关的挑战是实现质子治疗全部潜力的关键，这超越了其与光子治疗相比的物理剂量学特性。本文探讨了RBE在头颈及颅底肿瘤治疗中，对靶区及邻近串联危机器官临床意义的影响。我们综述了质子RBE的不确定性及其建模方法，并探讨了临床结果。此外，我们重点介绍了计划优化和治疗实施方面的技术进步与创新，包括线性能量传递/RBE优化以及点扫描质子弧治疗的发展。从学术角度看，这些进展有望充分发挥质子治疗的潜力，然而，要将其整合到常规临床实践中，仍需进一步的技术创新和临床结果研究。
肿瘤(癌症)患者之家