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肺癌治療新趨勢：質子治療在精準控癌上的角色

質子治療癌症治療精準醫療肺癌放射線治療

文／放射腫瘤部醫師簡君儒

肺癌放射治療是運用高能量射線照射腫瘤及周邊高風險區域，可單獨使用，或與藥物、手術搭配作為根治性、緩和性或(新)輔助性治療，提高局部控制率或改善症狀。

進行胸腔放射時因鄰近多個重要器官，如肺臟、心臟、食道及骨髓，傳統光子治療（Photon Therapy）在通過腫瘤前後仍會持續釋放能量，導致周邊正常組織接受不必要輻射劑量(圖一)，可能引起肺炎、食道炎、心臟機能受損、免疫功能抑制，或神經功能障礙等情況。

質子治療（Proton Therapy）運用質子束，將能量集中於腫瘤位置，射線通過腫瘤前劑量較光子少，通過後幾乎不再釋放。研究顯示，質子治療可降低約1/3心臟、食道及正常肺臟輻射劑量(圖二)，減少相關副作用，有助於維持治療期間身體狀態與生活品質。此外亦適用於需再度照射的復發患者，可在兼顧治療劑量同時，提供新的治療契機。

近年臨床上發展之立體定位消融放射治療(stereotactic ablative radiotherapy，SABR)通常僅需6次以內照射，結合質子技術運用於適合個案，在維持相同腫瘤控制率時，進一步提升治療便利性與整體生活品質，可與胸腔內、外科或血腫科配合進行。

綜合而言，質子治療在精準控制腫瘤劑量同時，能有效降低輻射劑量於正常器官曝露，減少短期與長期副作用風險，是肺癌患者追求治療效果與生活品質時，值得考慮的放射治療選項。

照射劑量分佈圖

腦部質子治療選項

文獻佐證

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