Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario, Canada.
Nat Rev Clin Oncol. 2012 Dec;9(12):688-99. doi: 10.1038/nrclinonc.2012.194. Epub 2012 Nov 20.
Radiotherapy is a highly effective, targeted therapy for the management of cancer. Technological innovations have enabled the direct integration of imaging technology into the radiation treatment device to increase the precision and accuracy of radiation delivery. As well as addressing a clinical need to better control the placement of the dose within the body, image-guided radiotherapy has enabled innovators in the field to accelerate their exploration of a number of different paradigms of radiation delivery, including toxicity reduction, dose escalation, hypofractionation, voxelization, and adaptation. Although these approaches are already innovative trends in radiation oncology, it is anticipated that they will work synergistically with other innovations in cancer management (including biomarker strategies, novel systemic and local therapies) as part of the broader goal of personalized cancer medicine. This Review discusses the rationale for adopting image-guidance approaches in radiotherapy, and the technology for achieving precision and accuracy in the context of different paradigms within the evolving radiation oncology practice. It also examines exciting advances in radiotherapy technology that suggest a convergence of radiotherapy practice in which patient-specific radiotherapy treatment courses are one of the most personalized forms of intervention in cancer medicine.
放射治疗是一种高度有效的癌症治疗方法。技术创新使成像技术能够直接集成到放射治疗设备中，从而提高放射治疗的精度和准确性。图像引导放射治疗不仅满足了临床对更好地控制体内剂量分布的需求，还使该领域的创新者能够加速探索多种不同的放射治疗模式，包括降低毒性、提高剂量、缩短分割次数、体素化和自适应。虽然这些方法已经是放射肿瘤学的创新趋势，但预计它们将与癌症管理的其他创新（包括生物标志物策略、新型全身和局部治疗）协同作用，作为个性化癌症医学的更广泛目标的一部分。本文综述了在放射治疗中采用图像引导方法的基本原理，以及在不断发展的放射肿瘤学实践中，在不同模式下实现精度和准确性的技术。本文还探讨了放射治疗技术令人兴奋的进展，这些进展表明放射治疗实践正在趋同，其中个体化放射治疗方案是癌症治疗中最个性化的干预形式之一。
