Background/Objectives:Adjuvant radiation for gynecologic malignancies often exposes organs at risk (OARs), such as the bone marrow, bowel, rectum, and bladder, to radiation, leading to toxicities that impact treatment tolerance and patient quality of life. Scanning proton beam therapy, particularly with Individual Field Simultaneous Optimization (IFSO), may offer dosimetric and biological advantages over volumetric modulated arc therapy (VMAT). This study evaluates the clinical impact of IFSO-based proton planning in post-operative gynecologic cancer patients.Materials and Methods:Fourteen patients receiving adjuvant proton therapy to 45 Gy in 25 fractions were retrospectively analyzed. Comparison VMAT plans were generated on the same datasets. Dose–volume metrics for key OARs and normal tissue complication probabilities (NTCPs) were compared using paired statistical tests. Robustness evaluations accounted for setup and range uncertainties.Results:Proton plans significantly reduced dose to bone marrow (V10Gy: 58% vs. 86%,p< 0.00001; V20Gy: 47% vs. 58%,p< 0.00001), small bowel (V20Gy: 21% vs. 56%,p< 0.00001), and femoral heads (left femoral head mean: 11Gy vs. 13Gy,p= 0.032; right femoral head mean: 11Gy vs. 13Gy,p= 0.022). NTCP modeling predicted significantly lower rates of bowel urgency (9.4% vs. 3.3%,p< 0.001) and hematologic toxicity (10.2% vs. 4.9%,p< 0.001) with proton therapy. Plans remained robust across uncertainty scenarios.Conclusions:IFSO-based scanning proton therapy provides clinically meaningful sparing of bone marrow and bowel, with the potential to reduce hematologic and gastrointestinal toxicities. These findings support its use in patients receiving adjuvant pelvic radiotherapy, particularly those undergoing extended field treatment or chemotherapy.
**背景/目的：** 妇科恶性肿瘤的辅助放疗常使骨髓、肠道、直肠和膀胱等危及器官受到照射，导致毒性反应，影响治疗耐受性和患者生活质量。扫描质子束治疗，特别是采用个体化野同步优化技术，相较于容积旋转调强放疗，可能具有剂量学和生物学优势。本研究评估了基于IFSO的质子计划在术后妇科癌症患者中的临床影响。 **材料与方法：** 本研究回顾性分析了14例接受辅助质子治疗的患者，处方剂量为45 Gy/25次。使用相同数据集生成对照的VMAT计划。采用配对统计检验比较关键危及器官的剂量-体积参数和正常组织并发症概率。稳健性评估考虑了摆位和射程不确定性。 **结果：** 质子计划显著降低了骨髓（V10Gy：58% vs. 86%，p < 0.00001；V20Gy：47% vs. 58%，p < 0.00001）、小肠（V20Gy：21% vs. 56%，p < 0.00001）和股骨头（左股骨头平均剂量：11Gy vs. 13Gy，p = 0.032；右股骨头平均剂量：11Gy vs. 13Gy，p = 0.022）的受照剂量。NTCP模型预测质子治疗可显著降低肠道急迫症（9.4% vs. 3.3%，p < 0.001）和血液学毒性（10.2% vs. 4.9%，p < 0.001）的发生率。计划在各种不确定性场景下均保持稳健。 **结论：** 基于IFSO的扫描质子治疗能对骨髓和肠道提供具有临床意义的剂量保护，并可能降低血液学和胃肠道毒性。这些发现支持其在接受辅助盆腔放疗的患者中的应用，特别是那些接受扩大野照射或化疗的患者。
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