Biology-guided radiotherapy: redefining the role of radiotherapy in metastatic cancer.
Biology-guided radiotherapy: redefining the role of radiotherapy in metastatic cancer.
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DOI：
10.1259/bjr.20200873
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发表时间：
2021-01-01
期刊：
影响因子：
--
通讯作者：
Mazin S
中科院分区：
文献类型：
--
作者：
Shirvani SM;Huntzinger CJ;Melcher T;Olcott PD;Voronenko Y;Bartlett-Roberto J;Mazin S
新出现的对转移性癌症的生物学理解和概念验证临床试验表明，揭开所有肉眼疾病的面纱对改善患者预后大有裨益。然而，传统的外照射系统消融多个靶点比较繁琐，这限制了大多数晚期疾病患者对完全转移消融的研究和利用。要克服这一物流障碍，技术创新是必要的。生物引导放射治疗是一种将正电子发射断层扫描-计算机断层扫描与6 MV直线加速器相结合的新型外照射方式。关键的创新是直线加速器对传出的肿瘤PET发射的持续反应，以及亚秒延迟的放射治疗光束。这使得沉积的剂量可以实时跟踪肿瘤。多种新的硬件和算法进步进一步促进了这种低延迟反馈过程。通过静脉注射放射性示踪剂后将肿瘤转化为自己的基准，BGRT有可能以一种对单个患者有效的方式实现完全转移性消融，并可扩展到所有转移性疾病患者。未来的趋势可能会进一步加强BGRT在临床上的应用，因为这项技术与放射治疗中的其他创新相吻合，包括新的剂量绘制和分割方案、放射组学和新的放射示踪剂。
The emerging biological understanding of metastatic cancer and proof-of-concept clinical trials suggest that debulking all gross disease holds great promise for improving patient outcomes. However, ablation of multiple targets with conventional external beam radiotherapy systems is burdensome, which limits investigation and utilization of complete metastatic ablation in the majority of patients with advanced disease. To overcome this logistical hurdle, technical innovation is necessary. Biology-guided radiotherapy (BgRT) is a new external beam radiotherapy delivery modality combining positron emission tomography-computed tomography (PET-CT) with a 6 MV linear accelerator. The key innovation is continuous response of the linear accelerator to outgoing tumor PET emissions with beamlets of radiotherapy at subsecond latency. This allows the deposited dose to track tumors in real time. Multiple new hardware and algorithmic advances further facilitate this low-latency feedback process. By transforming tumors into their own fiducials after intravenous injection of a radiotracer, BgRT has the potential to enable complete metastatic ablation in a manner efficient for a single patient and scalable to entire populations with metastatic disease. Future trends may further enhance the utility of BgRT in the clinic as this technology dovetails with other innovations in radiotherapy, including novel dose painting and fractionation schemes, radiomics, and new radiotracers.
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影响因子：
45.3
作者：
Gomez, Daniel R.;Tang, Chad;Heymach, John, V
通讯作者：
Heymach, John, V
影响因子：
51.1
作者：
Bentzen, SM
通讯作者：
Bentzen, SM
影响因子：
28.4
作者：
Bauml, Joshua M.;Mick, Rosemarie;Langer, Corey J.
通讯作者：
Langer, Corey J.
影响因子：
51.1
作者：
Gomez, Daniel R.;Blumenschein, George R., Jr.;Lee, J. Jack;Hernandez, Mike;Ye, Rong;Camidge, D. Ross;Doebele, Robert C.;Skoulidis, Ferdinandos;Gaspar, Laurie E.;Gibbons, Don L.;Karam, Jose A.;Kavanagh, Brian D.;Tang, Chad;Komaki, Ritsuko;Louie, Alexander V.;Palma, David A.;Tsao, Anne S.;Sepesi, Boris;William, William N.;Zhang, Jianjun;Shi, Qiuling;Wang, Xin Shelley;Swisher, Stephen G.;Heymach, John V.
通讯作者：
Heymach, John V.
影响因子：
5.7
作者：
Gronlund, Eric;Johansson, Silvia;Ahnesjo, Anders
通讯作者：
Ahnesjo, Anders