A Review of the Clinical Evidence for Intensity-modulated Radiotherapy
A Review of the Clinical Evidence for Intensity-modulated Radiotherapy
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DOI：
10.1016/j.clon.2010.06.013
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发表时间：
2010-10-01
影响因子：
3.4
通讯作者：
Board, Radiotherapy Dev
中科院分区：
文献类型：
--
作者：
Staffurth, J.;Board, Radiotherapy Dev
目标：调强放射治疗（IMRT）是三维适形放射治疗的发展，在许多临床场景中提供剂量学的改进。在这里，我们回顾了调强放射治疗的临床证据，并介绍了正在进行的或未发表的随机对照试验（RCT）。我们使用MEDLINE、手工检索放射治疗和肿瘤学以及国际放射肿瘤学杂志，生物学和物理学以及美国放射治疗和肿瘤学会和欧洲放射治疗和肿瘤学会年会的会议记录。检索对照试验荟萃登记册，以确定已完成的未发表的，正在进行的和计划的RCTs.Results：61项研究比较调强放疗和传统放疗被确定。其中包括3项头颈癌（205例患者）和3项乳腺癌（664例患者）的RCT，这些RCT报告了临床结局：这些都是毒性相关终点的把握度，在每项试验中，IMRT的疗效显著更好。另有27项非随机研究在头颈部（1119例患者）、26项在前列腺癌（>5000例患者）、4项在乳腺癌（875例患者）和9项在其他肿瘤部位。这些研究的结果支持了RCT的结果，并在急性和晚期毒性、健康相关生活质量和肿瘤控制终点方面报告了获益。确定了28项已完成-未发表、正在进行或计划进行的纳入IMRT的RCT，包括至少12，310名患者，其中15项在IMRT中比较常规放疗作为随机分组或预先计划分层。讨论：逆向计划调强放射治疗在局部晚期头颈癌放疗期间维持腮腺唾液分泌并减少急性和晚期口干，降低前列腺癌患者的晚期直肠毒性，允许安全剂量递增，并且似乎降低了几个其他肿瘤部位的毒性。与传统的切线乳腺放疗相比，前瞻性计划调强放疗减少了急性毒性，改善了后期临床医师评估的美容效果。(C)2010年皇家放射科医师学院。由爱思唯尔有限公司出版。保留所有权利。
Aims: Intensity-modulated radiotherapy (IMRT) is a development of three-dimensional conformal radiotherapy that offers improvements in dosimetry in many clinical scenarios. Here we review the clinical evidence for IMRT and present ongoing or unpublished randomised controlled trials (RCTs).Methods: We identified randomised and non-randomised comparative studies of IMRT and conventional radiotherapy using MEDLINE, hand-searching Radiotherapy and Oncology and the International Journal of Radiation Oncology, Biology and Physics and the proceedings of the American Society for Therapeutic Radiology and Oncology and the European Society for Therapeutic Radiology and Oncology annual meetings. The metaRegister of Controlled Trials was searched to identify completed-unpublished, ongoing and planned RCTs.Results: Sixty-one studies comparing IMRT and conventional radiotherapy were identified. These included three RCTs in head and neck cancer (205 patients) and three in breast cancer (664 patients) that had reported clinical outcomes: these were all powered for toxicity-related end points, which were significantly better with IMRT in each trial. There were 27 additional non-randomised studies in head and neck (1119 patients), 26 in prostate cancer (>5000 patients), four in breast cancer (875 patients) and nine in other tumour sites. The results of these studies supported those of the RCTs with benefits reported in acute and late toxicity, health-related quality of life and tumour control end points. Twenty-eight completed-unpublished, ongoing or planned RCTs incorporating IMRT were identified, including at least 12,310 patients, of which 15 compared conventional radiotherapy within IMRT as a randomisation or pre-planned stratification.Discussion: Inverse-planned IMRT maintains parotid saliva production and reduces acute and late xerostomia during radiotherapy for locally advanced head and neck cancer, reduces late rectal toxicity in prostate cancer patients allowing safe dose escalation and seems to reduce toxicity in several other tumour sites. Forward-planned IMRT reduces acute toxicity and improves late clinician-assessed cosmesis compared with conventional tangential breast radiotherapy. (C) 2010 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.