Burnet N G, Noble D J, Paul A, Whitfield G A, Delorme S
Division of Cancer Sciences, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, and The Christie NHS Foundation Trust, University of Manchester, M20 4GJ, Manchester, Großbritannien.
Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, University of Cambridge, Hills Road, CB2 0QQ, Cambridge, Großbritannien.
Radiologe. 2018 Aug;58(8):708-721. doi: 10.1007/s00117-018-0420-6.
Successful radiotherapy requires precise localization of the tumor and requires high-quality imaging for developing a treatment plan.
Irradiation of the tumor region, including a safety margin.
The target volume consists of the gross tumor volume (GTV) containing visible parts of the tumor, the clinical target volume (CTV) covering the GTV plus invisible tumor extensions, and the planning target volume (PTV) to account for uncertainties. The non-GTV parts of the CTV are based on historical patient data. The PTV margins are based on a calculation of possible uncertainties during planning, setup, or treatment. Normal tissue deserves the identical care in contouring, since its tolerance may limit the tumor dose, taking into account the contours of organs at risk. Serial risk organs benefit from defining a planning organ of risk volume (PRV) to better limit the dose delivered to them.
DIAGNOSTIC WORK-UP: The better the imaging, the more reliable the definition of the GTV and treatment success will be. Multiple imaging sequences are desirable to support the delineation of the tumor. They may result in different CTVs that, depending on their tumor burden, may require different doses.
The definition of standardized target volumes according to the ICRU reports 50, 62, and 83 forms the basis for an individualized radiation treatment planning according to unified criteria on a high-quality level.
Radio-oncology is by nature interdisciplinary, the diagnostic radiologist being an indispensable team partner. A regular dialogue between the disciplines is pivotal for target volume definition and treatment success.
Imaging for target volume definition requires highest quality imaging, the use of functional imaging methods and close cooperation with a diagnostic radiologist experienced in this field.
成功的放射治疗需要精确确定肿瘤位置，并需要高质量成像来制定治疗计划。
对肿瘤区域进行照射，包括安全边界。
靶区包括包含肿瘤可见部分的大体肿瘤体积（GTV）、覆盖GTV加上不可见肿瘤延伸部分的临床靶体积（CTV）以及考虑不确定性的计划靶体积（PTV）。CTV的非GTV部分基于既往患者数据。PTV边界基于计划、摆位或治疗期间可能不确定性的计算。正常组织在勾画轮廓时应给予同样的重视，因为其耐受性可能会限制肿瘤剂量，同时要考虑危及器官的轮廓。连续的危及器官通过定义计划危及器官体积（PRV）受益，以更好地限制给予它们的剂量。
成像质量越高，GTV的定义和治疗成功就越可靠。需要多个成像序列来支持肿瘤的勾画。它们可能会导致不同的CTV，根据其肿瘤负荷，可能需要不同的剂量。
根据ICRU报告50、62和83定义标准化靶区，为基于统一标准的高质量个体化放射治疗计划奠定基础。
放射肿瘤学本质上是跨学科的，诊断放射科医生是不可或缺的团队成员。各学科之间定期对话对于靶区定义和治疗成功至关重要。
用于靶区定义的成像需要最高质量的成像、功能成像方法的使用以及与该领域经验丰富的诊断放射科医生密切合作。
