Cancer Institute, University College London, London, UK.
NIHR University College London Hospitals Biomedical Research Centre, UCL Cancer Institute, University College London, London, UK.
Br J Cancer. 2019 Apr;120(8):779-790. doi: 10.1038/s41416-019-0412-y. Epub 2019 Mar 26.
Imaging has an essential role in the planning and delivery of radiotherapy. Recent advances in imaging have led to the development of advanced radiotherapy techniques-including image-guided radiotherapy, intensity-modulated radiotherapy, stereotactic body radiotherapy and proton beam therapy. The optimal use of imaging might enable higher doses of radiation to be delivered to the tumour, while sparing normal surrounding tissues. In this article, we review how the integration of existing and novel forms of computed tomography, magnetic resonance imaging and positron emission tomography have transformed tumour delineation in the radiotherapy planning process, and how these advances have the potential to allow a more individualised approach to the cancer therapy. Recent data suggest that imaging biomarkers that assess underlying tumour heterogeneity can identify areas within a tumour that are at higher risk of radio-resistance, and therefore potentially allow for biologically focussed dose escalation. The rapidly evolving concept of adaptive radiotherapy, including artificial intelligence, requires imaging during treatment to be used to modify radiotherapy on a daily basis. These advances have the potential to improve clinical outcomes and reduce radiation-related long-term toxicities. We outline how recent technological advances in both imaging and radiotherapy delivery can be combined to shape the future of precision radiation oncology.
影像在放疗的规划和实施中具有重要作用。影像技术的最新进展推动了先进放疗技术的发展，包括图像引导放疗、调强放疗、立体定向体部放疗和质子束疗法。优化影像的使用可以使肿瘤接受更高剂量的放疗，同时保护周围正常组织。本文综述了现有的和新型计算机断层扫描、磁共振成像和正电子发射断层扫描如何改变放疗计划过程中的肿瘤勾画，以及这些进展如何有可能使癌症治疗更个体化。最近的数据表明，评估肿瘤异质性的影像学生物标志物可以识别肿瘤内存在更高放射抵抗风险的区域，从而有可能实现有针对性的剂量升级。快速发展的自适应放疗概念（包括人工智能）需要在治疗期间使用影像学来每天修改放疗计划。这些进展有可能改善临床结果并降低与放疗相关的长期毒性。我们概述了影像和放疗实施方面的最新技术进展如何结合，以塑造精准放疗的未来。
