Badey A, Barateau A, Delaby N, Fau P, Garcia R, De Crevoisier R, Lisbona A
Service de physique médicale, Institut Sainte-Catherine, 84918 Avignon, France.
Inserm, LTSI - UMR 1099, Centre Eugène-Marquis, université de Rennes, 35000 Rennes, France.
Cancer Radiother. 2019 Oct;23(6-7):581-591. doi: 10.1016/j.canrad.2019.07.142. Epub 2019 Aug 28.
Intensity modulated radiotherapy combined with image guided radiotherapy has led to increase the precision of external beam radiotherapy. However, intra or inter-fraction anatomical variations are frequent during the treatment course and can cause under-dosing of the target volume and/or over-dosing of the organs at risk. Several adaptive radiotherapy (ART) strategies can be defined to compensate these anatomical variations. The purpose of this article is to provide an overview of available ART strategies: offline, online, hybrid (library of treatment plans) or in real-time, while considering the arrival of MR-Linac devices in radiotherapy departments. The tools required to these ART strategies such as auto-segmentation, deformable image registration, calculation of the daily dose or dose accumulation, are also described. Implementing an ART strategy requires a rigorous quality assurance process, at each stage and on the entire workflow, as well as prior organization and training from of all the trades. A strong multidisciplinary involvement is finally required in order to ensure ART treatments.
调强放疗联合图像引导放疗提高了外照射放疗的精度。然而,在治疗过程中,分次内或分次间的解剖结构变化很常见,可能导致靶区剂量不足和/或危及器官剂量过高。可以定义几种自适应放疗(ART)策略来补偿这些解剖结构变化。本文的目的是概述可用的ART策略:离线、在线、混合(治疗计划库)或实时,同时考虑磁共振直线加速器设备进入放疗科室的情况。还描述了这些ART策略所需的工具,如自动分割、可变形图像配准、每日剂量计算或剂量累积。实施ART策略需要在每个阶段和整个工作流程中进行严格的质量保证过程,以及所有相关人员的预先组织和培训。最后,为了确保ART治疗,需要多学科的大力参与。