Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; Institute of Cancer Research, London, UK.
Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; Institute of Cancer Research, London, UK.
Clin Oncol (R Coll Radiol). 2020 Dec;32(12):817-827. doi: 10.1016/j.clon.2020.10.009. Epub 2020 Oct 22.
Radiotherapy planning and delivery have dramatically improved in recent times. Imaging is key to a successful three-dimensional and increasingly four-dimensional based pathway with computed tomography embedded as the backbone modality. Computed tomography has significant limitations for many tumour sites where soft-tissue discrimination is suboptimal, and where magnetic resonance imaging (MRI) has largely superseded in the diagnostic arena. MRI is increasingly used together with computed tomography in the radiotherapy planning pathway and is now established as a prerequisite for several tumours. With the advent of combined MRI and linear accelerator (MR-linac) systems, a transition to MRI-based radiotherapy planning is becoming reality, with increasing experience and research involving these new platforms. In this overview, we aim to highlight how magnetic resonance-guided imaging has improved radiotherapy, using gynaecological malignancies to illustrate, in both external beam radiotherapy and image-guided brachytherapy, and will assess the early evidence for magnetic resonance-guided radiotherapy using combined MR-linac systems.
放射治疗计划和实施在近年来取得了显著的进步。影像学是成功实施三维甚至四维治疗的关键，其中计算机断层扫描（CT）作为主要的成像手段。然而，对于许多肿瘤部位，CT 存在明显的局限性，软组织分辨率欠佳，而磁共振成像（MRI）在诊断领域已基本取代 CT。MRI 越来越多地与 CT 联合应用于放射治疗计划中，目前已成为几种肿瘤的必备条件。随着磁共振成像和直线加速器（MR-linac）系统的出现，基于 MRI 的放射治疗计划正在成为现实，越来越多的经验和研究涉及这些新平台。在这篇综述中，我们旨在通过妇科恶性肿瘤的例子，强调磁共振引导成像如何改善放射治疗，包括外照射放疗和图像引导近距离放疗，并评估使用 MR-linac 系统的磁共振引导放疗的早期证据。
