Macchia Gabriella, Deodato Francesco, Cilla Savino, Cammelli Silvia, Guido Alessandra, Ferioli Martina, Siepe Giambattista, Valentini Vincenzo, Morganti Alessio Giuseppe, Ferrandina Gabriella
Radiation Oncology Unit.
Medical Physics Unit, "Giovanni Paolo II" Foundation, Catholic University of the Sacred Heart, Campobasso.
Onco Targets Ther. 2017 Jul 26;10:3755-3772. doi: 10.2147/OTT.S113119. eCollection 2017.
This article discusses the current use of volumetric modulated arc therapy (VMAT) techniques in clinical practice and reviews the available data from clinical outcome studies in different clinical settings. An overview of available literature about clinical outcomes with VMAT stereotactic/radiosurgical treatment is also reported.
All published manuscripts reporting the use of VMAT in a clinical setting from 2009 to November 2016 were identified. The search was carried out in December 2016 using the National Library of Medicine (PubMed/Medline). The following words were searched: "volumetric arc therapy"[All Fields] OR "vmat"[All Fields] OR "rapidarc"[All Fields], AND "radiotherapy"[All Fields] AND "Clinical Trial"[All Fields].
Overall, 37 studies (21 prospective and 16 retrospective) fulfilling inclusion criteria and thus included in the review evaluated 2,029 patients treated with VMAT; of these patients, ~30.8% had genitourinary (GU) tumors (81% prostate, 19% endometrial), 26.2% head-and-neck cancer (H&NC), 13.9% oligometastases, 11.2% had anorectal cancer, 10.6% thoracic neoplasms (81% breast, 19% lung), and 7.0% brain metastases (BMs). Six different clinical scenarios for VMAT use were identified: 1) BMs, 2) H&NC, 3) thoracic neoplasms, 4) GU cancer, 5) anorectal tumor, and 6) stereotactic body radiation therapy (SBRT) performed by VMAT technique in the oligometastatic patient setting.
The literature addressing the clinical appropriateness of VMAT is scarce. Current literature suggests that VMAT, especially when used as simultaneous integrated boost or SBRT strategy, is an effective safe modality for all cancer types.
本文探讨容积调强弧形放疗（VMAT）技术在临床实践中的当前应用，并回顾不同临床环境下临床疗效研究的现有数据。还报告了有关VMAT立体定向/放射外科治疗临床疗效的可用文献综述。
确定了2009年至2016年11月期间所有报道在临床环境中使用VMAT的已发表手稿。2016年12月使用美国国立医学图书馆（PubMed/Medline）进行检索。检索词如下：“容积弧形放疗”[所有字段]或“VMAT”[所有字段]或“快速弧形放疗”[所有字段]，以及“放射治疗”[所有字段]和“临床试验”[所有字段]。
总体而言，37项符合纳入标准并因此纳入综述的研究（21项前瞻性研究和16项回顾性研究）评估了2029例接受VMAT治疗的患者；在这些患者中，约30.8%患有泌尿生殖系统（GU）肿瘤（81%为前列腺癌，19%为子宫内膜癌），26.2%患有头颈癌（H&NC），13.9%为寡转移，11.2%患有肛管直肠癌，10.6%患有胸部肿瘤（81%为乳腺癌，19%为肺癌），7.0%患有脑转移瘤（BMs）。确定了VMAT使用的六种不同临床情况：1）BMs，2）H&NC，3）胸部肿瘤，4）GU癌，5）肛管直肠肿瘤，6）在寡转移患者环境中通过VMAT技术进行的立体定向体部放射治疗（SBRT）。
关于VMAT临床适用性的文献稀缺。当前文献表明，VMAT，尤其是当用作同步整合增量放疗或SBRT策略时，对所有癌症类型都是一种有效且安全的方式。
