Article record

调强质子治疗（IMPT）与调强放射治疗（IMRT）治疗口咽癌的比较：疗效与毒性的差异取决于结局指标

Comparison of intensity-modulated proton therapy (IMPT) and intensity-modulated radiotherapy (IMRT) for oropharyngeal cancer: efficacy and toxicity differ by outcome measure.

综述 Meta咽喉科IF 8.8Q1

文献信息

PMID	42901049
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	J You 查看其他 3 位作者 J You；B Xu；Z Zhou
作者单位	Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China. 查看其他 3 条单位信息 Department of Gynecology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China.；Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China; Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors, Fujian Medical University, Fuzhou, China; Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, China. Electronic address: benhuaxu123@126.com.；Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China; Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors, Fujian Medical University, Fuzhou, China; Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, China. Electronic address: zihanzhou123@163.com.
期刊	ESMO open
SCI 分区	Q1
IF	8.8
研究类型	综述 Meta · 临床
所属专科	咽喉科

中文摘要

目的： 调强质子治疗（IMPT）相较调强放射治疗（IMRT）在口咽癌中是否具有可测量的临床获益仍存争议。
方法： 我们汇总了两项III期随机试验和一项匹配队列研究的数据，这些研究比较了IMPT与IMRT，并分析了疾病控制、生存、急性毒性及营养结局。
结果： 局部区域复发的风险比为1.37［95%置信区间（CI）0.56-3.36，I2=0%］；无进展生存为0.90（95%CI 0.61-1.33，I2=0%）；总生存为0.79（95%CI 0.32-1.98，I2=47%）。接受IMPT的患者中急性3级吞咽困难发生率为24%，而接受IMRT者为40.9%［风险比（RR）0.65，95%CI 0.51-0.84，I2=0%］。3级口干症或口腔/咽部干燥分别发生于19.9%和32.5%（RR 0.72，95%CI 0.54-0.95，I2=0%）。探索性营养结局未显示明确获益，包括12个月胃造瘘依赖（RR 0.32，95%CI 0.08-1.28，I2=0%）、体重下降≥20%（RR 1.05，95%CI 0.12-9.38，I2=85.7%）以及复合营养终点（RR 0.92，95%CI 0.12-7.07，I2=87.7%）。
结论： IMPT的主要优势在于减少急性毒性，而非改善疗效。

英文摘要

AIM: Whether intensity-modulated proton therapy (IMPT) offers measurable clinical benefits over intensity-modulated radiotherapy (IMRT) for oropharyngeal cancer remains debated.
METHODS: We pooled data from two phase III randomized trials and one matched cohort study comparing IMPT with IMRT and analyzed disease-control, survival, acute toxicity, and nutritional outcomes.
RESULTS: The hazard ratio for locoregional recurrence was 1.37 [95% confidence interval (CI) 0.56-3.36, I2 = 0%]; for progression-free survival, 0.90 (95% CI 0.61-1.33, I2 = 0%); and for overall survival, 0.79 (95% CI 0.32-1.98, I2 = 47%). Acute grade 3 dysphagia occurred in 24% of patients receiving IMPT, compared with 40.9% receiving IMRT [risk ratio (RR) 0.65, 95% CI 0.51-0.84, I2 = 0%]. Grade 3 xerostomia or oral/pharyngeal dryness occurred in 19.9% and 32.5%, respectively (RR 0.72, 95% CI 0.54-0.95, I2 = 0%). Exploratory nutritional outcomes showed no definitive benefit, including 12-month gastrostomy dependence (RR 0.32, 95% CI 0.08-1.28, I2 = 0%), weight loss ≥20% (RR 1.05, 95% CI 0.12-9.38, I2 = 85.7%), and composite nutritional endpoints (RR 0.92, 95% CI 0.12-7.07, I2 = 87.7%).
CONCLUSIONS: IMPT's primary advantage is reducing acute toxicity, not improving efficacy.