Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USA.
Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USA; Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA.
Med Dosim. 2021;46(3):289-294. doi: 10.1016/j.meddos.2021.02.008. Epub 2021 Apr 2.
Stereotactic body radiotherapy (SBRT) has demonstrated promising outcomes for patients with early-stage, medically inoperable, primary renal cell carcinoma (RCC) in large multi-institutional studies and prospective clinical trials. The traditional approach used in these studies consisted of a CT-based planning approach for target and organ-at-risk (OAR) volume delineation, treatment planning, and daily treatment delivery. Alternatively, MRI-based approaches using daily online adaptive radiotherapy have multiple advantages to improve treatment outcomes: (1) more accurate delineation of the target volume and OAR volumes with improved soft tissue visualization; (2) gated beam delivery with biofeedback from the patient; and (3) potential for daily plan adaptation due to changes in anatomy to improve target coverage, reduce dose to OARs, or both. The workflow, treatment planning principles, and aspects of treatment delivery specific to this technology are outlined using a case example of a patient with an early-stage RCC of the right kidney treated with MRI-guided SBRT using daily adaptive treatment to a dose of 42 Gy in 3 fractions.
立体定向体部放射治疗（SBRT）在大型多机构研究和前瞻性临床试验中，为早期、无法手术的、原发性肾细胞癌（RCC）患者展示了良好的疗效。这些研究中传统的方法是基于 CT 的靶区和危及器官（OAR）勾画、治疗计划和日常治疗的方法。相反，基于 MRI 的每日在线自适应放疗方法具有多种优势，可以提高治疗效果：（1）更准确地勾画靶区和 OAR 体积，改善软组织可视化；（2）通过来自患者的生物反馈进行门控束输送；（3）由于解剖结构的变化，每天的计划适应潜力，可以提高靶区覆盖，降低 OAR 剂量，或两者兼而有之。使用一名右侧肾脏早期 RCC 患者的病例示例，概述了该技术的工作流程、治疗计划原则和特定于治疗的方面，该患者接受了基于 MRI 的 SBRT 治疗，每日自适应治疗剂量为 42 Gy，共 3 次。
