头颈部(head and neck,HN)癌是台湾地区的一种地方性疾病。全量照射后局部复发的HN癌是一个治疗挑战,而硼中子俘获疗法(boron neutron capture therapy,BNCT)是一种能够提供持久局部控制且毒性可耐受的解决方案。位于新竹清华大学的清...头颈部(head and neck,HN)癌是台湾地区的一种地方性疾病。全量照射后局部复发的HN癌是一个治疗挑战,而硼中子俘获疗法(boron neutron capture therapy,BNCT)是一种能够提供持久局部控制且毒性可耐受的解决方案。位于新竹清华大学的清华开放池反应堆(Tsing-Hua Open Pool Reactor,THOR)为基础和临床BNCT研究提供了一个高质量的超热中子源。我们于2010年至2013年间开展了名为"在THOR应用硼中子俘获疗法治疗复发性头颈癌的I/II期临床试验"的首项临床试验。17例患者被招募至该研究,共有23个复发性HN肿瘤接受了高剂量光子照射。以L-硼苯丙氨酸的果糖复合物为硼载体,每例患者进行了间隔28天的2次分割BNCT治疗。结果其毒性可以耐受,虽然反应率高(12/17),但常见放射部位或附近区再次复发。为了获得更好的局部控制,2014年启动了另一项临床试验,名为"硼中子俘获疗法联合影像引导的调强放疗(image-guided intensity-modulated radiotherapy,IG-IMRT)治疗局部复发性HN癌的I/II期临床试验"。按照我们之前的方案首先进行BNCT,在BNCT后28天开始进行IG-IMRT。截至2017年5月,已有7例患者接受了这种联合治疗。治疗相关毒性与之前两次使用BNCT时观察到的毒性相似。3例患者实现完全缓解,但尽管初期反应良好,局部复发仍是治疗失败的主要原因。未来将在THOR开展局部或全身治疗与BNCT联合应用来治疗复发性HN癌患者的其他临床试验。展开更多
Head and neck(HN)cancer is an endemic disease in Taiwan,China.Locally recurrent HN cancer after full-dose irradia-tion poses a therapeutic challenge,and boron neutron capture therapy(BNCT)may be a solution that could ...Head and neck(HN)cancer is an endemic disease in Taiwan,China.Locally recurrent HN cancer after full-dose irradia-tion poses a therapeutic challenge,and boron neutron capture therapy(BNCT)may be a solution that could provide durable local control with tolerable toxicity.The Tsing-Hua Open Pool Reactor(THOR)at National Tsing-Hua University in Hsin-Chu,provides a high-quality epithermal neutron source for basic and clinical BNCT research.Our first clinical trial,entitled“A phase I/II trial of boron neutron capture therapy for recurrent head and neck cancer at THOR”,was carried out between 2010 and 2013.A total of 17 patients with 23 recurrent HN tumors who had received high-dose photon irradiation were enrolled in the study.The fructose complex of l-boronophenylalanine was used as a boron carrier,and a two-fraction BNCT treatment regimen at 28-day intervals was used for each patient.Toxicity was acceptable,and although the response rate was high(12/17),re-recurrence within or near the radiation site was common.To obtain better local control,another clinical trial entitled“A phase I/II trial of boron neutron capture therapy combined with image-guided intensity-modulated radiotherapy(IG-IMRT)for locally recurrent HN cancer”was initiated in 2014.The first administration of BNCT was performed according to our previous protocol,and IG-IMRT was initiated 28 days after BNCT.As of May 2017,seven patients have been treated with this combination.The treatment-related toxicity was similar to that previously observed with two BNCT applications.Three patients had a complete response,but locoregional recurrence was the major cause of failure despite initially good responses.Future clinical trials combining BNCT with other local or systemic treatments will be carried out for recurrent HN cancer patients at THOR.展开更多
文摘头颈部(head and neck,HN)癌是台湾地区的一种地方性疾病。全量照射后局部复发的HN癌是一个治疗挑战,而硼中子俘获疗法(boron neutron capture therapy,BNCT)是一种能够提供持久局部控制且毒性可耐受的解决方案。位于新竹清华大学的清华开放池反应堆(Tsing-Hua Open Pool Reactor,THOR)为基础和临床BNCT研究提供了一个高质量的超热中子源。我们于2010年至2013年间开展了名为"在THOR应用硼中子俘获疗法治疗复发性头颈癌的I/II期临床试验"的首项临床试验。17例患者被招募至该研究,共有23个复发性HN肿瘤接受了高剂量光子照射。以L-硼苯丙氨酸的果糖复合物为硼载体,每例患者进行了间隔28天的2次分割BNCT治疗。结果其毒性可以耐受,虽然反应率高(12/17),但常见放射部位或附近区再次复发。为了获得更好的局部控制,2014年启动了另一项临床试验,名为"硼中子俘获疗法联合影像引导的调强放疗(image-guided intensity-modulated radiotherapy,IG-IMRT)治疗局部复发性HN癌的I/II期临床试验"。按照我们之前的方案首先进行BNCT,在BNCT后28天开始进行IG-IMRT。截至2017年5月,已有7例患者接受了这种联合治疗。治疗相关毒性与之前两次使用BNCT时观察到的毒性相似。3例患者实现完全缓解,但尽管初期反应良好,局部复发仍是治疗失败的主要原因。未来将在THOR开展局部或全身治疗与BNCT联合应用来治疗复发性HN癌患者的其他临床试验。
基金supported by“Ministry of science and technology of Taiwan”,China.
文摘Head and neck(HN)cancer is an endemic disease in Taiwan,China.Locally recurrent HN cancer after full-dose irradia-tion poses a therapeutic challenge,and boron neutron capture therapy(BNCT)may be a solution that could provide durable local control with tolerable toxicity.The Tsing-Hua Open Pool Reactor(THOR)at National Tsing-Hua University in Hsin-Chu,provides a high-quality epithermal neutron source for basic and clinical BNCT research.Our first clinical trial,entitled“A phase I/II trial of boron neutron capture therapy for recurrent head and neck cancer at THOR”,was carried out between 2010 and 2013.A total of 17 patients with 23 recurrent HN tumors who had received high-dose photon irradiation were enrolled in the study.The fructose complex of l-boronophenylalanine was used as a boron carrier,and a two-fraction BNCT treatment regimen at 28-day intervals was used for each patient.Toxicity was acceptable,and although the response rate was high(12/17),re-recurrence within or near the radiation site was common.To obtain better local control,another clinical trial entitled“A phase I/II trial of boron neutron capture therapy combined with image-guided intensity-modulated radiotherapy(IG-IMRT)for locally recurrent HN cancer”was initiated in 2014.The first administration of BNCT was performed according to our previous protocol,and IG-IMRT was initiated 28 days after BNCT.As of May 2017,seven patients have been treated with this combination.The treatment-related toxicity was similar to that previously observed with two BNCT applications.Three patients had a complete response,but locoregional recurrence was the major cause of failure despite initially good responses.Future clinical trials combining BNCT with other local or systemic treatments will be carried out for recurrent HN cancer patients at THOR.
