Graff P, Huger S, Kirby N, Pouliot J
Service de radiothérapie, institut de cancérologie de Lorraine, 6, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France.
Cancer Radiother. 2013 Oct;17(5-6):513-22. doi: 10.1016/j.canrad.2013.06.040. Epub 2013 Aug 22.
Onboard volumetric imaging systems can provide accurate data of the patient's anatomy during a course of head and neck radiotherapy making it possible to assess the actual delivered dose and to evaluate the dosimetric impact of complex daily positioning variations and gradual anatomic changes such as geometric variations of tumors and normal tissues or shrinkage of external contours. Adaptive radiotherapy is defined as the correction of a patient's treatment planning to adapt for individual variations observed during treatment. Strategies are developed to selectively identify patients that require replanning because of an intolerable dosimetric drift. Automated tools are designed to limit time consumption. Deformable image registration algorithms are the cornerstones of these strategies, but a better understanding of their limits of validity is required before adaptive radiotherapy can be safely introduced to daily practice. Moreover, strict evaluation of the clinical benefits is yet to be proven.
机载容积成像系统能够在头颈部放射治疗过程中提供患者解剖结构的准确数据，从而有可能评估实际给予的剂量，并评估复杂的每日定位变化以及诸如肿瘤和正常组织的几何变化或外部轮廓收缩等渐进性解剖变化的剂量学影响。自适应放射治疗的定义是对患者的治疗计划进行校正，以适应治疗期间观察到的个体差异。已制定策略以选择性地识别因剂量学漂移无法耐受而需要重新规划的患者。设计自动化工具以限制时间消耗。可变形图像配准算法是这些策略的基石，但在将自适应放射治疗安全引入日常实践之前，需要更好地了解其有效性的局限性。此外，对临床益处的严格评估尚未得到证实。
