Radiation Medicine, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.
Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark.
Clin Oncol (R Coll Radiol). 2021 Jun;33(6):350-368. doi: 10.1016/j.clon.2021.03.023.
Technological advancement has facilitated patient-specific radiotherapy in bladder cancer. This has been made possible by developments in image-guided radiotherapy (IGRT). Particularly transformative has been the integration of volumetric imaging into the workflow. The ability to visualise the bladder target using cone beam computed tomography and magnetic resonance imaging initially assisted with determining the magnitude of inter- and intra-fraction target change. It has led to greater confidence in ascertaining true anatomy at each fraction. The increased certainty of dose delivered to the bladder has permitted the safe reduction of planning target volume margins. IGRT has therefore improved target coverage with a reduction in integral dose to the surrounding tissue. Use of IGRT to feed back into plan and dose delivery optimisation according to the anatomy of the day has enabled adaptive radiotherapy bladder solutions. Here we undertake a review of the stepwise developments underpinning IGRT and adaptive radiotherapy strategies for external beam bladder cancer radiotherapy. We present the evidence in accordance with the framework for systematic clinical evaluation of technical innovations in radiation oncology (R-IDEAL).
技术进步促进了膀胱癌的个体化放疗。这得益于图像引导放疗（IGRT）的发展。将容积成像整合到工作流程中尤其具有变革意义。使用锥形束计算机断层扫描和磁共振成像来可视化膀胱靶区，最初有助于确定靶区在分次间和分次内的变化幅度。这使得在每个分次中更有信心确定真正的解剖结构。膀胱的剂量确定性增加允许安全地减少计划靶区的边缘。因此，IGRT 通过减少周围组织的积分剂量，提高了靶区覆盖率。根据当天的解剖结构，使用 IGRT 反馈到计划和剂量输送优化中，实现了自适应放疗膀胱解决方案。在这里，我们根据放射肿瘤学中技术创新的系统临床评估框架（R-IDEAL），对 IGRT 和自适应放疗策略的逐步发展进行了综述。我们按照框架提供了证据。
