Hend Daoud, Mnejja Wafa, Fourati Nejla, Kallel Mouna, Siala Wicem, Sahnoun Tarek, Farhat Leila, Daoud Jamel
CHU d'Habib-Bourguiba, service de radiothérapie carcinologique, Sfax, Tunisie; Université de Sfax, Sfax, Tunisie.
CHU d'Habib-Bourguiba, service de radiothérapie carcinologique, Sfax, Tunisie; Université de Sfax, Sfax, Tunisie.
Bull Cancer. 2020 May;107(5):565-573. doi: 10.1016/j.bulcan.2019.12.013. Epub 2020 Mar 31.
Modern high-precision radiotherapy techniques have recently incorporated the notion of anatomical variations of the patient during treatment and have tried to adapt the treatment planning to them. Adaptive radiotherapy for nasopharyngeal tumors is starting to prove its benefit nowadays. His interest is constantly being evaluated. The variations encountered during the treatment are both geometric and dosimetric. They are represented by a reduction in the macroscopic tumors volume, a change in its position and a consequent dosimetric impact. The changes also concern organs at risk with a reduction of glandular structure volumes, and a different position which increases their doses. Delivered doses to noble structures (brainstem and spinal cord) may also increase. However, difficulties are encountered in its realization. There is a problem to perfectly reproduce the patient position during the second acquisition, which impacts the fusion quality between the two CT scans. This generates an imprecision in the definition of the same treatment isocentre on the second scanner. Also, there is a difficulty in accumulated doses calculation. The indication of adaptive radiotherapy remains a subject of controversy. It should be proposed for a subgroup of patients who could benefit from this new strategy. We present here an update on the state of the art of adaptive radiotherapy for nasopharyngeal cancer.
现代高精度放射治疗技术最近纳入了患者在治疗期间解剖变异的概念，并试图使治疗计划与之相适应。如今，鼻咽癌的自适应放射治疗已开始证明其益处。其效果正在不断评估中。治疗期间遇到的变异包括几何变异和剂量学变异。它们表现为宏观肿瘤体积减小、位置改变以及随之而来的剂量学影响。这些变化还涉及危及器官，表现为腺体结构体积减小以及位置改变导致其剂量增加。给予重要结构（脑干和脊髓）的剂量也可能增加。然而，在实施过程中会遇到困难。在第二次扫描时难以完美重现患者体位，这会影响两次CT扫描之间的融合质量。这会导致在第二台扫描仪上同一治疗等中心的定义不准确。此外，在累积剂量计算方面也存在困难。自适应放射治疗的适应证仍然是一个有争议的话题。它应该针对可能从这种新策略中受益的患者亚组提出。我们在此介绍鼻咽癌自适应放射治疗的最新技术现状。
