The Christie NHS Foundation Trust and Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, UK.
Medical College of Wisconsin, USA.
Radiother Oncol. 2016 Jun;119(3):371-80. doi: 10.1016/j.radonc.2016.04.014. Epub 2016 May 6.
Dose escalated radiotherapy improves outcomes for men with prostate cancer. A plateau for benefit from dose escalation using EBRT may not have been reached for some patients with higher risk disease. The use of increasingly conformal techniques, such as step and shoot IMRT or more recently VMAT, has allowed treatment intensification to be achieved whilst minimising associated increases in toxicity to surrounding normal structures. To support further safe dose escalation, the uncertainties in the treatment target position will need be minimised using optimal planning and image-guided radiotherapy (IGRT). In particular the increasing usage of profoundly hypo-fractionated stereotactic therapy is predicated on the ability to confidently direct treatment precisely to the intended target for the duration of each treatment. This article reviews published studies on the influences of varies types of motion on daily prostate position and how these may be mitigated to improve IGRT in future. In particular the role that MRI has played in the generation of data is discussed and the potential role of the MR-Linac in next-generation IGRT is discussed.
提高放疗剂量可改善前列腺癌患者的预后。对于某些高危疾病患者，EBRT 剂量递增的获益可能尚未达到平台期。越来越多的适形技术（如步进和射击 IMRT 或最近的 VMAT）的使用允许在最小化周围正常结构相关毒性增加的同时实现治疗强化。为了支持进一步的安全剂量递增，需要使用最佳计划和图像引导放疗（IGRT）最小化治疗靶区位置的不确定性。特别是，深度低分割立体定向治疗的使用越来越多，这取决于在每次治疗期间能够将治疗精确引导到预期靶区的能力。本文综述了关于各种类型运动对每日前列腺位置影响的已发表研究，并讨论了如何减轻这些影响以改善未来的 IGRT。特别是讨论了 MRI 在数据生成中的作用，以及 MR-Linac 在下一代 IGRT 中的潜在作用。
