Release date: 2017-04-10 Radiation therapy has been reported to play a very important role as one of the three basic means of cancer treatment. In the large family of radiotherapy, in addition to the familiar X-rays, gamma rays, etc., there has been a "new star" in recent years, which has received much attention and enthusiasm. Despite the high cost, people still spend a lot of money to build, and many places in China The stock construction boom, it is proton therapy. As a newcomer to the radiotherapy world, what is proton therapy, is it really so god? "Life Times" interviewed Professor Gao Xianshu, director of the Department of Radiotherapy, Peking University First Hospital . Gold mine to be developed Professor Gao Xianshu told the Life Times reporter: "In the mid-1990s, I studied and studied in Japan, and I was exposed to proton and heavy ion therapy technology. At that time, the technology was just applied to the clinic, and the academic community also had two opinions on it. More pessimistic, it is believed that proton therapy may be just a scientist's toy; another group believes that it will become a breakthrough technology for the treatment of cancer. After more than 20 years, it seems that proton therapy is indeed promising and full of potential ." "The essence of radiotherapy is to use radiation to break the DNA of tumor cells, not to replicate, and to lose the ability to permanently divide, whether it uses X-rays, gamma rays, protons or heavy ions. Generally speaking, it is a sterilization operation for tumor cells. Tumor cells do not necessarily die immediately, but they cannot regenerate children." Gao Xianshu explained, "In theory, as long as the intensity of the irradiation is sufficient, there is no cell that cannot be killed. The problem is that the surrounding normal tissue limits the dose increase of the radiation. ." What we usually call "radiation therapy" refers to photon therapy. Proton therapy can avoid normal tissue, release energy accurately to the tumor site, and achieve "fixed-point blasting" to reduce damage to surrounding normal tissue. But this advantage also needs to be confirmed by large clinical Phase III studies . "Although this physical advantage makes it bring a halo as soon as it is born, but at present, proton therapy has yet to be developed, its physical advantage is far from being exerted, and it is still a gold mine to be developed." Gao Xianshu said. The treatment effect is not so real. The current five constraints If proton therapy is to become a real "cancer for cancer", there is still a way to go in the future. At present, there are several aspects that restrict its development. 1. Good horse is not equipped with a good saddle. In recent years, radiation therapy has been pursuing two goals. One is the high conformity of the tumor target area, that is, the tumor tissue is wrapped more accurately, the corners and corners can be irradiated, and the normal tissue is incorporated less; The second is the high degree of accuracy of the position, the target can not be old. Protons are like missiles. If you want to aim at the target, you have to rely on image-guided equipment. Some existing proton therapy centers in China have not equipped these auxiliary equipment, which restricts the development of proton therapy technology. 2. The price is not high. In some cases, the effect of proton therapy is not necessarily much better than ordinary radiation therapy, but the price is much more expensive, which is unbearable for ordinary families. The main reason is the high construction cost. 3. The tumor and normal tissue are too close. In the case of prostate cancer, the prostate and the rectum are too close. In order to completely eliminate the tumor, it is necessary to sacrifice a part of the normal tissue, which is bound to bring about side effects. In the future, by inserting some absorbable bio-gel between the tumor and normal tissue, separating the tumor tissue from the normal tissue will enhance the therapeutic advantage of protons. 4. Lack of experienced radiologists. The quality of proton therapy is largely limited by the skill level and experience of the doctor. The scope and dose of the radiation are determined by people rather than machines. Although proton therapy centers are currently under construction, there is a lack of experienced physicians, and the treatment effect is also worrying. 5. The biological dose of treatment needs to be improved. At present, the proton therapy program is not mature enough, especially in the absence of image guidance, it can only be divided according to the routine, resulting in insufficient single dose, and the biological dose is not improved. With the advancement of illumination precision technology, changing the radiation dose mode will improve the treatment effect. Promising prospects for the next decade Gao Xianshu said that at present, if the indications and timing are selected, proton therapy can reduce the side effects of some tumors and reduce the chance of cancer recurrence compared with ordinary photon therapy, but these benefits are at the cost of high prices. "Although it seems that the therapeutic effect of protons is not so popular, but its future is still bright." Gao Xianshu said that there is no technology to treat cancer without cure, but if you choose indications, proton therapy will Become an "artifact." With the continuous advancement of radiology technology and the accumulation of experience, the physical advantages of proton therapy can be better exerted. "I believe that in the next decade, the results of proton therapy should be better than photon therapy, and it is bound to shine. 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