Department of Radiation Oncology, Technical University of Munich, Munich, Germany; Institute of Radiation Medicine, Department of Radiation Sciences, Helmholtz Zentrum München, Munich, Germany; German Cancer Consortium (DKTK) Partner Site (DKTK), Munich, Germany.
Institute of Radiation Oncology, Cantonal Hospital Graubuenden, Chur, Switzerland.
Radiother Oncol. 2021 Mar;156:80-94. doi: 10.1016/j.radonc.2020.11.014. Epub 2020 Dec 10.
For skull base tumors, target definition is the key to safe high-dose treatments because surrounding normal tissues are very sensitive to radiation. In the present work we established a joint ESTRO ACROP guideline for the target volume definition of skull base tumors.
A comprehensive literature search was conducted in PubMed using various combinations of the following medical subjects headings (MeSH) and free-text words: "radiation therapy" or "stereotactic radiosurgery" or "proton therapy" or "particle beam therapy" and "skull base neoplasms" "pituitary neoplasms", "meningioma", "craniopharyngioma", "chordoma", "chondrosarcoma", "acoustic neuroma/vestibular schwannoma", "organs at risk", "gross tumor volume", "clinical tumor volume", "planning tumor volume", "target volume", "target delineation", "dose constraints". The ACROP committee identified sixteen European experts in close interaction with the ESTRO clinical committee who analyzed and discussed the body of evidence concerning target delineation.
All experts agree that magnetic resonance (MR) images with high three-dimensional spatial accuracy and tissue-contrast definition, both T2-weighted and volumetric T1-weighted sequences, are required to improve target delineation. In detail, several key issues were identified and discussed: i) radiation techniques and immobilization, ii) imaging techniques and target delineation, and iii) technical aspects of radiation treatments including planning techniques and dose-fractionation schedules. Specific target delineation issues with regard to different skull base tumors, including pituitary adenomas, meningiomas, craniopharyngiomas, acoustic neuromas, chordomas and chondrosarcomas are presented.
This ESTRO ACROP guideline achieved detailed recommendations on target volume definition for skull base tumors, as well as comprehensive advice about imaging modalities and radiation techniques.
对于颅底肿瘤，靶区定义是安全进行高剂量治疗的关键，因为周围的正常组织对辐射非常敏感。在本研究中，我们为颅底肿瘤的靶区定义制定了一份 ESTRO ACROP 联合指南。
我们在 PubMed 上进行了全面的文献检索，使用了各种组合的医学主题词（MeSH）和自由文本词：“放射治疗”或“立体定向放射外科”或“质子治疗”或“粒子束治疗”以及“颅底肿瘤”“垂体肿瘤”，“脑膜瘤”，“颅咽管瘤”，“脊索瘤”，“软骨肉瘤”，“听神经瘤/前庭神经鞘瘤”，“危险器官”，“大体肿瘤体积”，“临床肿瘤体积”，“计划肿瘤体积”，“靶区”，“靶区勾画”，“剂量限制”。ACROP 委员会确定了 16 位欧洲专家，他们与 ESTRO 临床委员会密切合作，分析和讨论了有关靶区勾画的证据。
所有专家都认为，需要具有高三维空间精度和组织对比度定义的磁共振（MR）图像，包括 T2 加权和容积 T1 加权序列，以改善靶区勾画。具体而言，确定并讨论了几个关键问题：i）放射技术和固定，ii）成像技术和靶区勾画，以及 iii）放射治疗的技术方面，包括计划技术和剂量分割方案。针对不同的颅底肿瘤，包括垂体腺瘤、脑膜瘤、颅咽管瘤、听神经瘤、脊索瘤和软骨肉瘤，提出了具体的靶区勾画问题。
本 ESTRO ACROP 指南针对颅底肿瘤的靶区定义提出了详细建议，并就成像方式和放射技术提供了全面建议。
