Intensity modulated radiotherapy: advantages, limitations and future developments.
Intensity modulated radiotherapy: advantages, limitations and future developments.
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DOI：
10.2349/biij.2.1.e19
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发表时间：
2006-01-01
期刊：
影响因子：
--
通讯作者：
Cheung, Ky
中科院分区：
文献类型：
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作者：
Cheung, Ky
调强适形放射治疗(IMRT)在发达国家被广泛应用于临床，用于治疗恶性和非恶性疾病。该技术使用强度不均匀的多个辐射束。光束被调制到所需的强度图，以便向治疗目标提供高度共形剂量的辐射，同时避免邻近的正常组织结构。这种治疗技术比二维(2D)和传统的三维适形放射治疗(3DCRT)具有更好的剂量学优势。它可以在三个方面潜在地使患者受益。首先，通过提高与目标剂量的符合性，它可以降低野战复发的可能性。其次，通过减少对正常组织的照射，它可以将与治疗相关的发病率降至最低。第三，通过促进剂量的增加，它可以改善当地的控制。早期的临床结果是有希望的，特别是在鼻咽癌(NPC)的治疗上。然而，由于调强放射治疗是一项复杂的治疗，涉及高符合性和高精度，它有特定的要求。因此，与传统的2D和3D治疗相比，对随机和系统误差的严格容忍水平必须应用于所有治疗和前处理程序。出于这个原因，这种治疗方式的大规模常规临床实施需要大量资源，在某些情况下，是不切实际的。本文将对调强放射治疗的潜在优势、治疗输送方法以及目前可用于促进治疗模式的设备进行概述。它还将讨论设备的局限性和正在进行的开发工作，以提高设备的效率以及处理技术和程序。
Intensity modulated radiotherapy (IMRT) is widely used in clinical applications in developed countries, for the treatment of malignant and non-malignant diseases. This technique uses multiple radiation beams of non-uniform intensities. The beams are modulated to the required intensity maps for delivering highly conformal doses of radiation to the treatment targets, while sparing the adjacent normal tissue structures. This treatment technique has superior dosimetric advantages over 2-dimensional (2D) and conventional 3-dimensional conformal radiotherapy (3DCRT) treatments. It can potentially benefit the patient in three ways. First, by improving conformity with target dose it can reduce the probability of in-field recurrence. Second, by reducing irradiation of normal tissue it can minimise the degree of morbidity associated with treatment. Third, by facilitating escalation of dose it can improve local control. Early clinical results are promising, particularly in the treatment of nasopharyngeal carcinoma (NPC). However, as the IMRT is a sophisticated treatment involving high conformity and high precision, it has specific requirements. Therefore, tight tolerance levels for random and systematic errors, compared with conventional 2D and 3D treatments, must be applied in all treatment and pre-treatment procedures. For this reason, a large-scale routine clinical implementation of the treatment modality demands major resources and, in some cases, is impractical. This paper will provide an overview of the potential advantages of the IMRT, methods of treatment delivery, and equipment currently available for facilitating the treatment modality. It will also discuss the limitations of the equipment and the ongoing development work to improve the efficiency of the equipment and the treatment techniques and procedures.