質子治療在頭頸癌之發展與應用

Advances and Applications of Proton Beam Therapy in Head and Neck Cancer

放射治療在頭頸癌的角色日趨重要，相較於傳統手術方式，放射治療在許多原發性頭頸腫瘤能帶來更好的功能保存性，並改善臨床療效。雖然現今的光子放射治療技術已有大幅進步，但仍會帶來如口乾、吞嚥困難、頸部纖維化、聽力受損及其它相關副作用。相較於光子射束，質子具有重要的「布拉格峰」物理優勢，能進一步降低正常組織之傷害。過去因為建置成本昂貴而一直無法普及，台灣自2017年開始引進質子設備，未來幾年內北、中、南各區將會陸續成立數間質子治療中心。本文章整理過去發表文獻資料，回顧質子治療在頭頸癌的治療成效，亦作為未來台灣質子治療臨床應用之參考。

The role of radiation therapy in head and neck cancer is becoming increasingly important. Radiotherapy, in comparison to surgery, has been shown to be associated with better functional preservation and improved outcomes in many primary head and neck cancers. Though great progress has been made with photon radiotherapy technology, side-effects such as xerostomia, dysphagia, fibrosis in the neck, hearing loss, and many other related toxicities are continuously reported with radiotherapy. Compared with traditional photon beams, proton therapy offers an advantage of the ''Bragg peak,'' thus, allowing precise localization of the radiation, eliminating the exit dose, and sparing normal cells| however, the high cost of construction has prevented the popularization of proton therapy. The first proton therapy equipment was installed in Taiwan in 2017, and several proton centers are proposed to be established in the North, Central, and South of Taiwan in the next few years. This article summarizes the available literature on proton therapy, reviews the therapeutic effectiveness in head and neck cancer, and serves as a reference for the future applications of proton therapy in Taiwan.