...

1895.
.
1896. .
1898.
.
1934. -
.

(,
-).
( , , , ,
-).

,
.
1 = 1/1

.
.

1. -

2. :
- :

- , ,
;

,
60, 226Ra, 137Cs, .

- :

(, , )

.

- :

,
60, 192Ir, 198u .

 ;
;
;


;

I. .

HDR.

-HDR,
192Ir

I. .

2.

.

A.

B.


, 125I,

= 160.

125I

125I

I-125 ,

,
,
, .
, ,


1.
2. :
-
-
3.
4.

;

, ,
;

,
.

. ( ,
,
,
);
(

.);
.;
;
(
, );
(
, );
(
, ,
);
(
);
,
, ;
( )

, ,

-



,
,

, ,
-
-


in vitro

. , , ,
, ,
. , ,
. , ,
,
D. ,
, ,
. , , , .

-
, ..
""
.
:
-

-

, ,

.
- .



50

1. 3 - d 4-d .
2. .
3. .
4. - 60
.
5. .
6. , , .
7. .
8.
.
9. .
10.
(IMRT).
11. .
12. .

.
, .
.

.
.

.
,
.

- .



1. (HF)
2. (AF)
3.
(CF)

1. < 1,8
2. 4 -6
3. 2
4. 10-15% ,

5.
(7 )

1.
2.
3.
4.
5.
6.
7.

Marchial et al, 1987

Cox et al, 1990
Pinto et al, 1991
EORTC 22791 1992
Lee et al, 1993
Hadded et al, 1997
RTOG 9003, 2000


356
1-3N0M0
( RTC 22791, 1992 .)

1. 1,15
2. 4-6
3. 2
4. 80,5
5. 7 .


( RTC 22791, 1992 .)

60
50

(5 )

59,0

40,0

40
% 30

20
10
0


( .
.. )

1
4 80 .
1,2
4 , 70- 74,4.
1
4 70 .
1,1
4 70 .
1,1
1,25
4 60 .

 -
( - 1
4 80 )
%

100

80
60

43,2

35,7

40

18

20

25,2

17,5

9,3

0
0

10



( - 1,2
4 , 70- 74,4)

16
14
12
10
%

8
6
4
2
0

C (16,0%)

(4,5%)

 -

( - 1 4
, 70 )

70
60
50
40
%

30
20
10
0

(62,9%)

(28,0%)

 III
( - 1,1
4 70 )

74
72
70
% 68

66
64
62

(74,0%)

(67,0%)



( 1,1 1,25
4 60 )

35
30
25
20
%

15
10
5
0

(32,0%)

(7,0%)

 -
,
( )
,
.

: ,
.

.

 -
-4

*<0,05

100
80

79,7
59

60

46,6*

58,7
40

44

20

29,1*

0
0

100
80
60
40

32,8

20

25,4

26,8
12,0

0
0

10

3-D RTP system

based on a new type of display, called beam's eyes view
(BEV)

 ?

20 MeV

8 MeV, SSD=1m

200 MeV
Modified Bragg
Peak Length =
5 cm

Bragg peak


-
:

;
;
;
;
,
;
;


( 10 , - 120 )

Shizuoka Gantry Treatment Area

Confidential

Proton Therapy Center in ITEP

Multi-Leaf Collimator

Respiration gating
4-d treatment


Respiration gating

Comparison to conventional
radiation therapy

Comparison Dose Distribution :

Medulloblastoma


Example (1)

54y Male Maxillary sinus CA T4pN1M0

Before

37.5GyE

65GyE/26fr/7w

5M

(Courtesy of Hyogo Ion Beam Medical Center)

Local control rate


1-3N0-1M0
( . .. )
11

89

Proton results
1. Ocular melanoma
96% at 10 years at HCL (70 CGE in 5 fractions)
98% at 5 years at PS I, Switzerland
89% at 5 years at Nice, France

2. Hepatocellular carcinoma
94% at 7 years, Tsukuba (72 CGE in 18 fractions)
3. Paranasal sinus (76.6 CGE in 48 fractions)

4. Lung cancer
87% local control
63% disease-free
31% survival

5. Skull Base Chordoma

115 patients (1978-1993)
49 females + 66 males
Prescribed dose 66.6 CGE - 79.2 CGE
Tumor volume 4.6 cm3 - 190 cm3
Median follow-up 61 months (5-174)
Actuarial control rates:
5 years - 59.2%
10 years - 44.4%

1.

.
2.
.
3. 50 .
4.
.


+
+ .

5-

10-

.
+

.
+

T1 N 0 M 0

427

93,3

91,8

85,2

79,9

T2 N 0 M 0

304

88,3

83,6

75,4

70,4

1.
,


.
2.
:
5 ,
, ,
, 4-
,
, - ,
(HER2/neu) .

 -

-

- %

Manchester

38

19

CRC

29

11

NSABP (B-04)

14

Oslo

16

Stockholm

26

. ..

30

5- %
+

Spangenberg et al

40

27
%

Fourquet A. et al

20

58


(Harvard Joint Center for
Radiation Therapy (JCRT), 2000.)

1.
12-16
.
2.



.

1.
-
-
.
2.



( . .. )

5-
.

32
100%

23
71,8%

6
18,7%

3
9,5%

11
34,3
%

17
53,1
%

4
12,6
%

32,7%

22
+ 100%

18
81,8%

3
13,6%

1
4,6%

9
40,9
%

10
45,4
%

3
13,7
%

44,5%

41
75,9%

9
16,7%

4
7,4%

20
37,0
%

27
50,0
%

7
13,0
%

38,3%

54
100%

( %)

80%

86%

39%

72%

1-3 N0-1 0

83%

1-3 N0-3 1

50%

:
( ,
,
)
( ,
,
)
( ,
)
( ,
)



.

.

Tolerance doses (TD5/5-TD50/5) to

whole-organ irradiation

Organ
Testes
Ovary
Eye (lens)
Lung
Kidney
Liver
Skin
Thyroid
Heart
Bone marrow
Gastrointestinal
Spinal cord
Brain
Bone and cartilage
Muscle

Total dose (Gy)

1-2
6-10
6-12
20-30
20-30
35-40
30-40
30-40
40-50
40-50
50-60
50-60
60-70
>70
>70 Muscle

,

3 (100 ) .

3
.


- :

0 -
1 - ,
, ( 5
), .
2 - - ,
5 ,

.
3 - ,
.
4 - .


III

., 66 , 96/11385
: 1N0M0- I
: .
,
.
.
22
, . .
.
25.07.05.
2,52 .
26.08 15.10.86.
62 , 10 40 .
.
9 .

1.
,
,

2.

3.
4. (3d RT)
5. .