Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK; Department of Clinical Oncology, The Christie NHS Foundation Trust Christie Hospital, Manchester Academic Health Science Centre, Manchester M20 4BX, UK.
Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester M20 4BX, UK.
Clin Oncol (R Coll Radiol). 2018 Nov;30(11):737-750. doi: 10.1016/j.clon.2018.08.002. Epub 2018 Sep 9.
The reference standard treatment for cervical cancer is concurrent chemoradiotherapy followed by magnetic resonance imaging (MRI)-guided brachytherapy. Improvements in brachytherapy have increased local control rates, but late toxicity remains high with rates of 11% grade ≥3. The primary clinical target volume (CTV) for external-beam radiotherapy includes the cervix and uterus, which can show significant inter-fraction motion. This means that generous margins are required to cover the primary CTV, increasing the radiation dose to organs at risk and, therefore, toxicity. A number of image-guided radiotherapy techniques (IGRT) have been developed, but motion can be random and difficult to predict prior to treatment. In light of the development of integrated MRI linear accelerators, this review discusses the potential value of MRI in external-beam radiotherapy. Current solutions for managing pelvic organ motion are reviewed, including the potential for online adaptive radiotherapy. The impacts of the use of MRI in tumour delineation and in the delivery of stereotactic ablative body radiotherapy (SABR) are highlighted. The potential role and challenges of using multi parametric MRI to guide radiotherapy are also discussed.
宫颈癌的标准治疗方法是同步放化疗后行磁共振成像（MRI）引导近距离放疗。近距离放疗的改进提高了局部控制率，但晚期毒性仍然很高，有 11%的≥3 级毒性。外照射放疗的主要临床靶区（CTV）包括宫颈和子宫，它们会出现明显的分次运动。这意味着需要给予CTV 较大的照射野以覆盖，从而增加了危及器官的照射剂量，进而导致毒性。已经开发出了许多图像引导放疗技术（IGRT），但在治疗前，运动可能是随机的且难以预测的。鉴于集成 MRI 线性加速器的发展，本综述讨论了 MRI 在体外放疗中的潜在价值。本文回顾了当前处理骨盆器官运动的解决方案，包括在线自适应放疗的潜力。强调了 MRI 在肿瘤勾画和立体定向消融体放疗（SABR）中的应用的影响。还讨论了使用多参数 MRI 引导放疗的潜在作用和挑战。
