Louvel G, Cazoulat G, Chajon E, Le Maître A, Simon A, Henry O, Bensadoun R J, de Crevoisier R
Département de radiothérapie, centre Eugène-Marquis, Rennes, France.
Cancer Radiother. 2012 Sep;16(5-6):423-9. doi: 10.1016/j.canrad.2012.07.177. Epub 2012 Aug 21.
Image-guided radiotherapy (IGRT) aims to take into account anatomical variations occurring during irradiation by visualization of anatomical structures. It may consist of a rigid registration of the tumour by moving the patient, in case of prostatic irradiation for example. IGRT associated with intensity-modulated radiotherapy (IMRT) is strongly recommended when high-dose is delivered in the prostate, where it seems to reduce rectal and bladder toxicity. In case of significant anatomical deformations, as in head and neck tumours (tumour shrinking and decrease in volume of the salivary glands), replanning appears to be necessary, corresponding to the adaptive radiotherapy. This should ideally be "monitored" and possibly triggered based on a calculation of cumulative dose, session after session, compared to the initial planning dose, corresponding to the concept of dose-guided adaptive radiotherapy. The creation of "planning libraries" based on predictable organ positions (as in cervical cancer) is another way of adaptive radiotherapy. All of these strategies still appear very complex and expensive and therefore require stringent validation before being routinely applied.
图像引导放射治疗（IGRT）旨在通过解剖结构可视化来考虑照射过程中出现的解剖变异。例如，在前列腺照射时，它可能包括通过移动患者对肿瘤进行刚性配准。当在前列腺中给予高剂量照射时，强烈推荐将IGRT与调强放射治疗（IMRT）联合使用，因为这样似乎可以降低直肠和膀胱毒性。在出现明显解剖变形的情况下，如头颈部肿瘤（肿瘤缩小和唾液腺体积减小），重新计划似乎是必要的，这相当于自适应放射治疗。理想情况下，这应该基于与初始计划剂量相比逐次累积剂量的计算进行“监测”并可能触发，这对应于剂量引导自适应放射治疗的概念。基于可预测器官位置（如宫颈癌）创建“计划库”是自适应放射治疗的另一种方式。所有这些策略仍然显得非常复杂且昂贵，因此在常规应用之前需要严格验证。
