Cabaillé M, Khalifa J, Tessier A M, Belhomme S, Créhange G, Sargos P
Département de radiothérapie, Institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France.
Département de radiothérapie, Institut universitaire du Cancer de Toulouse-Oncopole, 1, avenue Irène-Joliot-Curie, 31100 Toulouse, France.
Cancer Radiother. 2021 May;25(3):271-278. doi: 10.1016/j.canrad.2020.08.046. Epub 2021 Jan 2.
Radiation therapy (RT) for muscle invasive bladder cancer (MIBC) is challenging, with observed variations in bladder shape and size resulting in inappropriate coverage of the target volumes (CTV). Large margins were historically applied around the CTV, increasing the dose delivered to organs at risk (OAR). With repositioning imaging and visualization of soft tissues during image guided RT, an opportunity to consider these movements and deformations appeared possible with an adaptive RT approach (ART).
A bibliographic search on the PubMed database has been done in January 2019. Studies focusing on patients with MIBC, treating on ART, with the objectives of feasibility, clinical and/or dosimetric evaluation and comparison with a standard irradiation technique were eligible. The purpose of this review was to define the different ART techniques used in clinical practice, to discuss their advantages compared to conventional RT in terms of target volume's coverage and OAR dose and to describe their feasibility in clinical practice.
A total of 30 studies were selected. The strategies known as "composite offline", "plan of the day" not individualized or individualized, and "re-optimization" have been identified. All the studies have shown a significant benefit of ART in target coverage and dose of OAR, especially the rectum and small bowel. All ART plans produced are not used during RT sessions. Inter-observer variability for the selection of these plans can be observed. The practical implementation within a department required staff education and training, and increases the duration of treatment preparation. The "A-POLO" approach seems to be the most suitable for practice.
ART is the technique of choice for bladder cancer RT. The "plan of the day" approach, individualized according to the A-POLO methodology, seems to be the most effective. The emergence of daily re-optimization, especially using MRI-Linac, is promising. The correlation between dosimetric benefits and clinical efficacy and safety results should be demonstrated into future trials.
肌肉浸润性膀胱癌（MIBC）的放射治疗（RT）具有挑战性，观察到膀胱形状和大小的变化会导致靶区体积（CTV）覆盖不当。历史上在CTV周围应用了较大的边界，增加了对危及器官（OAR）的剂量。随着图像引导放疗期间软组织的重新定位成像和可视化，采用自适应放疗方法（ART）考虑这些运动和变形成为可能。
2019年1月在PubMed数据库进行了文献检索。纳入的研究聚焦于MIBC患者，采用ART进行治疗，目标是评估其可行性、临床和/或剂量学，并与标准照射技术进行比较。本综述的目的是确定临床实践中使用的不同ART技术，讨论其与传统放疗相比在靶区覆盖和OAR剂量方面的优势，并描述其在临床实践中的可行性。
共筛选出30项研究。确定了“复合离线”“当日计划”（非个体化或个体化）以及“重新优化”等策略。所有研究均显示ART在靶区覆盖和OAR剂量方面有显著益处，尤其是直肠和小肠。生成的所有ART计划在放疗过程中并非都被使用。可以观察到观察者间在选择这些计划时的变异性。科室内部的实际实施需要工作人员的教育和培训，并增加了治疗准备时间。“A-POLO”方法似乎最适合实际应用。
ART是膀胱癌放疗的首选技术。根据A-POLO方法个体化的“当日计划”方法似乎最为有效。每日重新优化的出现，尤其是使用MRI直线加速器，前景广阔。剂量学益处与临床疗效及安全性结果之间的相关性应在未来试验中得到证实。
