The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK.
The Institute of Cancer Research, London, UK; Joint Department of Physics, The Royal Marsden NHS Foundation Trust, London, UK.
Clin Oncol (R Coll Radiol). 2018 Nov;30(11):711-719. doi: 10.1016/j.clon.2018.08.001. Epub 2018 Sep 7.
Adaptive radiotherapy (ART) strategies systematically monitor variations in target and neighbouring structures to inform treatment-plan modification during radiotherapy. This is necessary because a single plan designed before treatment is insufficient to capture the actual dose delivered to the target and adjacent critical structures during the course of radiotherapy. Magnetic resonance imaging (MRI) provides superior soft-tissue image contrast over current standard X-ray-based technologies without additional radiation exposure. With integrated MRI and radiotherapy platforms permitting motion monitoring during treatment delivery, it is possible that adaption can be informed by real-time anatomical imaging. This allows greater treatment accuracy in terms of dose delivered to target with smaller, individualised treatment margins. The use of functional MRI sequences would permit ART to be informed by imaging biomarkers, so allowing both personalised geometric and biological adaption. In this review, we discuss ART solutions enabled by MRI guidance and its potential gains for our patients across tumour types.
自适应放疗（ART）策略系统地监测靶区和邻近结构的变化，以便在放疗过程中告知治疗计划的修改。这是必要的，因为在治疗前设计的单一计划不足以捕捉到在放疗过程中实际给予靶区和相邻关键结构的剂量。与当前基于 X 射线的标准技术相比，磁共振成像（MRI）提供了优越的软组织图像对比度，而不会增加额外的辐射暴露。随着允许在治疗过程中进行运动监测的集成 MRI 和放疗平台的出现，实时解剖成像可以为自适应提供信息。这使得可以以更小的个体化治疗边界更精确地给予靶区剂量。使用功能 MRI 序列将允许 ART 通过成像生物标志物来获得信息，从而允许进行个体化的几何和生物学自适应。在这篇综述中，我们讨论了 MRI 引导的 ART 解决方案及其在各种肿瘤类型中对我们患者的潜在获益。
