Smyth Gregory, Evans Philip M, Bamber Jeffrey C, Bedford James L
1 Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust , London , UK.
2 Centre for Vision Speech and Signal Processing, University of Surrey , Guildford , UK.
Br J Radiol. 2019 May;92(1097):20180908. doi: 10.1259/bjr.20180908. Epub 2019 Feb 1.
This paper gives an overview of recent developments in non-coplanar intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT). Modern linear accelerators are capable of automating motion around multiple axes, allowing efficient delivery of highly non-coplanar radiotherapy techniques. Novel techniques developed for C-arm and non-standard linac geometries, methods of optimization, and clinical applications are reviewed. The additional degrees of freedom are shown to increase the therapeutic ratio, either through dose escalation to the target or dose reduction to functionally important organs at risk, by multiple research groups. Although significant work is still needed to translate these new non-coplanar radiotherapy techniques into the clinic, clinical implementation should be prioritized. Recent developments in non-coplanar radiotherapy demonstrate that it continues to have a place in modern cancer treatment.
本文概述了非共面调强放射治疗（IMRT）和容积调强弧形治疗（VMAT）的最新进展。现代直线加速器能够围绕多个轴自动运动，从而实现高效的非共面放射治疗技术的递送。本文回顾了为C形臂和非标准直线加速器几何结构开发的新技术、优化方法以及临床应用。多个研究小组表明，额外的自由度可通过提高靶区剂量或降低对功能重要的危险器官的剂量来提高治疗增益比。尽管将这些新的非共面放射治疗技术转化为临床应用仍需要大量工作，但临床实施应作为优先事项。非共面放射治疗的最新进展表明，它在现代癌症治疗中仍占有一席之地。
