Li Y Q, Tan J S H, Wee J T S, Chua M L K
Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore.
Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore; Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
Cancer Radiother. 2018 May;22(3):287-295. doi: 10.1016/j.canrad.2018.01.003. Epub 2018 Apr 23.
Modern standards of precision radiotherapy, primarily driven by the technological advances of intensity modulation and image guidance, have led to increased versatility in radiotherapy planning and delivery. The ability to shape doses around critical normal organs, while simultaneously "painting" boost doses to the tumor have translated to substantial therapeutic gains in head and neck cancer patients. Recently, dose adaptation (or adaptive radiotherapy) has been proposed as a novel concept to enhance the therapeutic ratio of head and neck radiotherapy, facilitated in part by the onset of molecular and functional imaging. These contemporary imaging techniques have enabled visualisation of the spatial molecular architecture of the tumor. Daily cone-beam imaging, besides improving treatment accuracy, offers another unique angle to explore radiomics - a novel high throughput feature extraction and selection workflow, for adapting radiotherapy based on real-time tumor changes. Here, we review the existing evidence of molecular and functional imaging in head and neck cancers, as well as the current application of adaptive radiotherapy in the treatment of this tumor type. We propose that adaptive radiotherapy can be further exploited through a systematic application of molecular and functional imaging, including radiomics, at the different phases of planning and treatment.
现代精确放疗标准主要由调强放疗和图像引导技术的进步推动，这使得放疗计划制定和实施的灵活性有所提高。在关键正常器官周围塑造剂量，同时对肿瘤“涂抹”增敏剂量的能力，已为头颈癌患者带来了显著的治疗收益。最近，剂量适应性放疗（或自适应放疗）作为一种提高头颈放疗治疗比的新概念被提出，分子成像和功能成像的出现为此提供了部分助力。这些当代成像技术能够显示肿瘤的空间分子结构。每日锥形束成像除了提高治疗准确性外，还为探索放射组学提供了另一个独特视角，放射组学是一种新颖的高通量特征提取和选择流程，可根据肿瘤实时变化调整放疗方案。在此，我们综述了头颈癌分子成像和功能成像的现有证据，以及自适应放疗在该肿瘤类型治疗中的当前应用。我们认为，通过在放疗计划和治疗的不同阶段系统应用包括放射组学在内的分子成像和功能成像，可以进一步挖掘自适应放疗的潜力。
