质子放疗在儿童髓母细胞瘤治疗中的应用进展OA

Craniospinal irradiation(CSI)following surgical resection remains the standard treatment strategy for medulloblastoma(MB)in children.However,conventional photon-based radiotherapy inevitably results in radiation deposition in normal tissues,leading to multisystem long-term toxicities.Proton beam therapy(PBT),owing to its unique physical dose distribution characteristics,has emerged as a key approach for improving long-term quality of life in MB pediatric patients.Studies have demonstrated that PBT and photon-based CSI provide comparable efficacy in tumor control and overall survival outcomes,while PBT offers significant advantages in normal tissue sparing.By substantially reducing radiation exposure to organs at risk,PBT effectively decreases acute toxicities such as myelosuppression and gastrointestinal adverse effects,prevents irreversible decline in long-term neurocognitive function,and provides clear benefits in maintaining endocrine homeostasis of the hypothalamic-pituitary axis.Nevertheless,the clinical implementation of PBT remains limited by several challenges,including the lack of standardized protocols for target volume expansion beyond the gross tumor volume,variations in relative biological effectiveness associated with linear energy transfer,and uncertainties in proton range estimation.Overall,PBT not only maintains the curative potential of radiotherapy for MB but also profoundly reshapes the landscape of radiation toxicity prevention and management,representing a promising strategy toward precision radiotherapy for pediatric patients with MB.