Departments of Human Oncology, Medical Physics, Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI 53792, USA.
Semin Radiat Oncol. 2011 Apr;21(2):101-10. doi: 10.1016/j.semradonc.2010.10.001.
Dose painting is the prescription of a nonuniform radiation dose distribution to the target volume based on functional or molecular images shown to indicate the local risk of relapse. Two prototypical strategies for implementing this novel paradigm in radiation oncology are reviewed: subvolume boosting and dose painting by numbers. Subvolume boosting involves the selection of a "target within the target," defined by image segmentation on the basis of the quantitative information in the image or morphologically, and this is related to image-based target volume selection and delineation. Dose painting by numbers is a voxel-level prescription of dose based on a mathematical transformation of the image intensity of individual pixels. The quantitative use of images to decide both where and how to delivery radiation therapy in an individual case is also called theragnostic imaging. Dose painting targets are imaging surrogates for cellular or microenvironmental phenotypes associated with poor radioresponsiveness. In this review, the focus is on the following positron emission tomography tracers: FDG and choline as surrogates for tumor burden, fluorothymidine as a surrogate for proliferation (or cellular growth fraction) and hypoxia-sensitive tracers, including [(18)F] fluoromisonidazole, EF3, EF5, and (64)Cu-labeled copper(II) diacetyl-di(N(4)-methylthiosemicarbazone) as surrogates of cellular hypoxia. Research advances supporting the clinicobiological rationale for dose painting are reviewed as are studies of the technical feasibility of optimizing and delivering realistic dose painted radiation therapy plans. Challenges and research priorities in this exciting research field are defined and a possible design for a randomized clinical trial of dose painting is presented.
剂量描绘是根据功能或分子图像显示的局部复发风险，为目标体积规定不均匀的辐射剂量分布。综述了在放射肿瘤学中实施这一新范例的两种典型策略：亚体积增强和按数字剂量描绘。亚体积增强涉及到“目标内的目标”的选择，这是基于图像中定量信息或形态学的图像分割来定义的，这与基于图像的目标体积选择和描绘有关。按数字剂量描绘是根据个体像素的图像强度的数学变换来规定剂量的体素级处方。定量使用图像来决定在个体病例中何处以及如何进行放射治疗，也称为治疗诊断成像。剂量描绘的目标是与不良放射反应性相关的细胞或微环境表型的成像替代物。在这篇综述中，重点介绍了以下正电子发射断层扫描示踪剂：FDG 和胆碱作为肿瘤负荷的替代物，氟脱氧胸苷作为增殖（或细胞生长分数）的替代物，以及缺氧敏感示踪剂，包括 [(18)F]氟米索硝唑、EF3、EF5 和 (64)Cu 标记的铜(II)二乙酰二 (N(4)-甲基硫代半卡巴腙)作为细胞缺氧的替代物。回顾了支持剂量描绘的临床生物学原理的研究进展，以及优化和提供现实剂量描绘放射治疗计划的技术可行性研究。定义了这一令人兴奋的研究领域中的挑战和研究重点，并提出了剂量描绘的随机临床试验的可能设计。
