Pasquier D, Lacornerie T, Mirabel X, Brassart C, Vanquin L, Lartigau E
Département universitaire de radiothérapie, centre Oscar-Lambret, université de Lille, 3, rue Combemale, 59020 Lille cedex, France; Centre de recherche en informatique, signal et automatique de Lille UMR CNRS 9189, université de Lille, M3, avenue Carl-Gauss, 59650 Villeneuve-d'Ascq, France.
Service de physique médicale, centre Oscar-Lambret, 3, rue Combemale, 59020 Lille cedex, France.
Cancer Radiother. 2019 Oct;23(6-7):630-635. doi: 10.1016/j.canrad.2019.07.153. Epub 2019 Aug 22.
The use of stereotactic body radiotherapy (SBRT) has increased rapidly over the past decade. Optimal preservation of normal tissues is a major issue because of their high sensitivity to high doses per session. Extreme hypofractionation can convert random errors into systematic errors. Optimal preservation of organs at risk requires first of all a rigorous implementation of this technique according to published guidelines. The robustness of the imaging modalities used for planning, and training medical and paramedical staff are an integral part of these guidelines too. The choice of SBRT indications, dose fractionation, dose heterogeneity, ballistics, are also means of optimizing the protection of normal tissues. Non-coplanarity and tracking of moving targets allow dosimetric improvement in some clinical settings. Automatic planning could also improve normal tissue protection. Adaptive SBRT, with new image guided radiotherapy modalities such as MRI, could further reduce the risk of toxicity.
在过去十年中，立体定向体部放疗（SBRT）的应用迅速增加。由于正常组织对每次高剂量放疗的高敏感性，如何最佳地保护正常组织是一个主要问题。极度超分割放疗会将随机误差转化为系统误差。要最佳地保护危及器官，首先需要根据已发表的指南严格实施该技术。用于治疗计划的成像模态的稳健性以及对医疗和准医疗人员的培训也是这些指南的组成部分。SBRT适应症的选择、剂量分割、剂量不均匀性、射束弹道等，也是优化正常组织保护的方法。非共面照射和对移动靶区的追踪在某些临床情况下可改善剂量学效果。自动计划也可改善对正常组织的保护。采用如MRI等新的图像引导放疗模态的自适应SBRT，可进一步降低毒性风险。
