Hamming-Vrieze Olga, Navran Arash, Al-Mamgani Abrahim, Vogel Wouter V
Department of Radiation Oncology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands -
Department of Radiation Oncology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands.
Q J Nucl Med Mol Imaging. 2018 Dec;62(4):349-368. doi: 10.23736/S1824-4785.18.03087-X. Epub 2018 Jun 4.
In recent years, the possibility of adapting radiotherapy to changes in biological tissue parameters has emerged. It is hypothesized that early identification of radio-resistant parts of the tumor during treatment provides the possibility to adjust the radiotherapy plan to improve outcome. The aim of this systematic literature review was to evaluate the current state of the art of biological PET-guided adaptive radiotherapy, focusing on dose escalation to radio-resistant tumor.
A structured literature search was done to select clinical trials including patients with head and neck cancer of the oral cavity, oropharynx, hypopharynx or larynx, with a PET performed during treatment used to develop biological adaptive radiotherapy by: 1) delineation of sub-volumes suitable for adaptive re-planning; 2) in-silico adaptive treatment planning; or 3) treatment of patients with PET based dose escalated adaptive radiotherapy.
Nineteen articles were selected, 12 articles analyzing molecular imaging signal during treatment and 7 articles focused on biological adaptive treatment planning, of which two were clinical trials. Studied biological pathways include metabolism (FDG), hypoxia (MISO, FAZA and HX4) and proliferation (FLT).
In the development of biological dose adaptation in radiotherapy for head-neck tumors, many aspects of the procedure remain ambiguous. Patient selection, tracer selection for detection of the radio-resistant sub-volumes, timing of adaptive radiotherapy, workflow and treatment planning aspects are discussed in a clinical context.
近年来，出现了使放射治疗适应生物组织参数变化的可能性。据推测，在治疗过程中早期识别肿瘤的抗辐射部分为调整放射治疗计划以改善治疗结果提供了可能。本系统文献综述的目的是评估生物正电子发射断层扫描（PET）引导的自适应放射治疗的当前技术水平，重点是对抗辐射肿瘤进行剂量递增。
进行了结构化文献检索，以选择包括口腔、口咽、下咽或喉的头颈癌患者的临床试验，这些试验在治疗期间进行PET检查，用于通过以下方式制定生物自适应放射治疗：1）勾勒适合自适应重新规划的子体积；2）计算机模拟自适应治疗计划；或3）对基于PET剂量递增的自适应放射治疗患者进行治疗。
共筛选出19篇文章，其中12篇分析治疗期间的分子成像信号，7篇关注生物自适应治疗计划，其中2篇为临床试验。研究的生物途径包括代谢（氟代脱氧葡萄糖[FDG]）、缺氧（18F-氟代吗啉代硝唑[MISO]、18F-氟阿扎胞苷[FAZA]和HX4）和增殖（18F-氟代胸苷[FLT]）。
在头颈肿瘤放射治疗的生物剂量适应发展中，该过程的许多方面仍不明确。在临床背景下讨论了患者选择、用于检测抗辐射子体积的示踪剂选择、自适应放射治疗的时机、工作流程和治疗计划等方面。
