Garibaldi Cristina, Jereczek-Fossa Barbara Alicja, Marvaso Giulia, Dicuonzo Samantha, Rojas Damaris Patricia, Cattani Federica, Starzyńska Anna, Ciardo Delia, Surgo Alessia, Leonardi Maria Cristina, Ricotti Rosalinda
Unit of Medical Physics, European Institute of Oncology, 20141 Milan, Italy.
Department of Radiation Oncology, European Institute of Oncology, 20141 Milan, Italy.
Ecancermedicalscience. 2017 Nov 30;11:785. doi: 10.3332/ecancer.2017.785. eCollection 2017.
Radiotherapy (RT) is very much a technology-driven treatment modality in the management of cancer. RT techniques have changed significantly over the past few decades, thanks to improvements in engineering and computing. We aim to highlight the recent developments in radiation oncology, focusing on the technological and biological advances. We will present state-of-the-art treatment techniques, employing photon beams, such as intensity-modulated RT, volumetric-modulated arc therapy, stereotactic body RT and adaptive RT, which make possible a highly tailored dose distribution with maximum normal tissue sparing. We will analyse all the steps involved in the treatment: imaging, delineation of the tumour and organs at risk, treatment planning and finally image-guidance for accurate tumour localisation before and during treatment delivery. Particular attention will be given to the crucial role that imaging plays throughout the entire process. In the case of adaptive RT, the precise identification of target volumes as well as the monitoring of tumour response/modification during the course of treatment is mainly based on multimodality imaging that integrates morphological, functional and metabolic information. Moreover, real-time imaging of the tumour is essential in breathing adaptive techniques to compensate for tumour motion due to respiration. Brief reference will be made to the recent spread of particle beam therapy, in particular to the use of protons, but also to the yet limited experience of using heavy particles such as carbon ions. Finally, we will analyse the latest biological advances in tumour targeting. Indeed, the effectiveness of RT has been improved not only by technological developments but also through the integration of radiobiological knowledge to produce more efficient and personalised treatment strategies.
放射治疗（RT）在癌症治疗中是一种非常依赖技术驱动的治疗方式。由于工程学和计算机技术的进步，放射治疗技术在过去几十年中发生了显著变化。我们旨在突出放射肿瘤学的最新进展，重点关注技术和生物学方面的进步。我们将介绍采用光子束的先进治疗技术，如调强放射治疗、容积调强弧形治疗、立体定向体部放射治疗和自适应放射治疗，这些技术能够实现高度个性化的剂量分布，同时最大程度地减少对正常组织的照射。我们将分析治疗过程中涉及的所有步骤：成像、肿瘤和危及器官的勾画、治疗计划，以及在治疗实施前和过程中进行精确肿瘤定位的影像引导。我们将特别关注成像在整个过程中所起的关键作用。在自适应放射治疗中，准确识别靶区体积以及在治疗过程中监测肿瘤反应/变化主要基于整合了形态学、功能和代谢信息的多模态成像。此外，在呼吸自适应技术中，肿瘤的实时成像对于补偿由于呼吸引起的肿瘤运动至关重要。我们还将简要提及粒子束治疗的最新进展，特别是质子的应用，以及使用碳离子等重粒子的经验仍较为有限的情况。最后，我们将分析肿瘤靶向方面的最新生物学进展。事实上，放射治疗的有效性不仅通过技术发展得到了提高，还通过整合放射生物学知识以制定更有效和个性化的治疗策略得以提升。
