Evolving role of hadron irradiation: Potential and risks of hadrons heavier than protons

摘要

Proton irradiation has been developed to achieve the clinical benefit of improved 3D-dose distribution, with biological properties similar to X-rays. Neutron irradiation, though much less 3D-conformal than proton treatment, has been developed to take advantage of increased relative biologic effectiveness (RBE). Irradiation with hadrons heavier than protons (e.g. carbon and neon ions) exhibits the unique combination of improved 3D-dose distribution and increased RBE. The synchrotron technology is rapidly developing to improve the efficiency of delivering these heavier hadrons clinically, but important issues remain regarding optimization of dose and fractionation parameters in the treatment of various histopathologies located in different portions of the anatomy. Many laboratory animal and in vitro cellular studies, and some clinical studies, have been performed to enable better understanding of how to adjust dose-fraction-ation selection to improve the therapeutic ratio of tumor-cell kill to normal-tissue injury. This paper highlights the enhanced therapeutic potential and associated risks of treatment with these heavier hadrons.