Thörnqvist Sara, Hysing Liv B, Tuomikoski Laura, Vestergaard Anne, Tanderup Kari, Muren Ludvig P, Heijmen Ben J M
a Department of Oncology and Medical Physics , Haukeland University Hospital , Bergen , Norway ;
b Department of Oncology , Helsinki University Central Hospital , Helsinki , Finland ;
Acta Oncol. 2016 Aug;55(8):943-58. doi: 10.3109/0284186X.2016.1156738. Epub 2016 Apr 8.
Introdution: Variation in shape, position and treatment response of both tumor and organs at risk are major challenges for accurate dose delivery in radiotherapy. Adaptive radiotherapy (ART) has been proposed to customize the treatment to these motion/response patterns of the individual patients, but increases workload and thereby challenges clinical implementation. This paper reviews strategies and workflows for clinical and in silico implemented ART for prostate, bladder, gynecological (gyne) and ano-rectal cancers.
Initial identification of papers was based on searches in PubMed. For each tumor site, the identified papers were screened independently by two researches for selection of studies describing all processes of an ART workflow: treatment monitoring and evaluation, decision and execution of adaptations. Both brachytherapy and external beam studies were eligible for review.
The review consisted of 43 clinical studies and 51 in silico studies. For prostate, 1219 patients were treated with offline re-planning, mainly to adapt prostate motion relative to bony anatomy. For gyne 1155 patients were treated with online brachytherapy re-planning while 25 ano-rectal cancer patients were treated with offline re-planning, all to account for tumor regression detected by magnetic resonance imaging (MRI)/computed tomography (CT). For bladder and gyne, 161 and 64 patients, respectively, were treated with library-based online plan selection to account for target volume and shape variations. The studies reported sparing of rectum (prostate and bladder cancer), bladder (ano-rectal cancer) and bowel cavity (gyne and bladder cancer) as compared to non-ART.
Implementations of ART were dominated by offline re-planning and online brachytherapy re-planning strategies, although recently online plan selection workflows have increased with the availability of cone-beam CT. Advantageous dosimetric and outcome patterns using ART was documented by the studies of this review. Despite this, clinical implementations were scarce due to challenges in target/organ re-contouring and suboptimal patient selection in the ART workflows.
引言：肿瘤和危及器官的形状、位置及治疗反应的变化是放射治疗中精确剂量输送的主要挑战。自适应放射治疗（ART）已被提出，以根据个体患者的这些运动/反应模式定制治疗，但这增加了工作量，从而给临床实施带来挑战。本文综述了临床和计算机模拟实施的针对前列腺癌、膀胱癌、妇科（gyne）癌和肛管直肠癌的ART策略及工作流程。
论文的初步识别基于在PubMed中的搜索。对于每个肿瘤部位，由两名研究人员独立筛选已识别的论文，以选择描述ART工作流程所有过程的研究：治疗监测与评估、调整的决策与执行。近距离放射治疗和外照射研究均符合综述要求。
该综述包括43项临床研究和51项计算机模拟研究。对于前列腺癌，1219例患者接受了离线重新计划治疗，主要是为了适应前列腺相对于骨骼解剖结构的运动。对于妇科癌，1155例患者接受了在线近距离放射治疗重新计划，而25例肛管直肠癌患者接受了离线重新计划，所有这些都是为了考虑通过磁共振成像（MRI）/计算机断层扫描（CT）检测到的肿瘤退缩。对于膀胱癌和妇科癌，分别有161例和64例患者接受了基于库的在线计划选择，以考虑靶体积和形状变化。研究报告称，与非ART相比，直肠（前列腺癌和膀胱癌）、膀胱（肛管直肠癌）和肠腔（妇科癌和膀胱癌）得到了保护。
ART的实施主要采用离线重新计划和在线近距离放射治疗重新计划策略，尽管最近随着锥形束CT的出现，在线计划选择工作流程有所增加。本综述的研究记录了使用ART的有利剂量学和结果模式。尽管如此，由于ART工作流程中靶区/器官重新轮廓勾画的挑战和患者选择不理想，临床实施仍然很少。
