Improving Radiation Conformality in the Treatment of Non-Small-Cell Lung Cancer
Improving Radiation Conformality in the Treatment of Non-Small-Cell Lung Cancer
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DOI：
10.1016/j.semradonc.2010.01.005
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发表时间：
2010-07-01
影响因子：
3.5
通讯作者：
Cox, James D.
中科院分区：
文献类型：
--
作者：
Chang, Joe Y.;Cox, James D.
肺癌放射治疗的许多挑战之一是由于肿瘤/器官运动以及需要保留周围关键结构而使辐射剂量符合靶。不断发展的放射治疗技术，如4维图像为基础的运动管理，每日机载成像，和自适应放射治疗，使我们能够提高肺癌放射治疗的治疗指数，允许设计个性化的治疗，提供足够的剂量符合目标，同时保留周围的关键正常组织。基于四维计算机断层扫描图像的运动管理提供了个体化目标运动裕度并降低地理目标错过的风险的机会。每日机载成像和自适应放疗减少了放疗过程中的设置和运动/解剖不确定性。影像引导的这些成就已经允许在肺癌患者中实施对器官运动和解剖变化非常敏感的高度适形治疗递送技术，例如调强放射治疗、立体定向体放射治疗和质子治疗。需要更多的临床研究来进一步优化适形放疗，使用基于放疗过程中解剖结构和肿瘤运动变化的个体化治疗适应性，并使用功能和生物成像来选择性地将剂量逐步增加到肿瘤内的抗辐射亚区域。Semin Radiat Oncol 20：171-177（C）2010 Elsevier Inc. All rights reserved.
One of the many challenges of lung cancer radiotherapy is conforming the radiation dose to the target because of tumor/organ motion and the need to spare surrounding critical structures. Evolving radiotherapy technologies, such as 4-dimensional image-based motion management, daily on-board imaging, and adaptive radiotherapy, have enabled us to improve the therapeutic index of radiation therapy for lung cancer by permitting the design of personalized treatments that deliver adequate doses conforming to the target while sparing the surrounding critical normal tissues. Four-dimensional computed tomography image-based motion management provides an opportunity to individualize target motion margins and reduce the risk of a geographic target miss. Daily on-board imaging and adaptive radiotherapy reduce setup and motion/anatomy uncertainties over the course of radiotherapy. These achievements in image guidance have permitted the implementation in lung cancer patients of highly conformal treatment delivery techniques that are exquisitely sensitive to organ motion and anatomic change, such as intensity-modulated radiation therapy, stereotactic body radiation therapy, and proton therapy. More clinical studies are needed to further optimize conformal radiotherapy using individualized treatment adaptations based on changes in anatomy and tumor motion during the course of radiotherapy and using functional and biological imaging to selectively escalate doses to radioresistant subregions within the tumor. Semin Radiat Oncol 20:171-177 (C) 2010 Elsevier Inc. All rights reserved.