ACRF Image X Institute, The University of Sydney, Sydney, New South Wales, Australia.
Department of Human Oncology, University of Wisconsin, Madison, WI, USA.
Nat Rev Clin Oncol. 2022 Jul;19(7):458-470. doi: 10.1038/s41571-022-00631-3. Epub 2022 Apr 19.
MRI can help to categorize tissues as malignant or non-malignant both anatomically and functionally, with a high level of spatial and temporal resolution. This non-invasive imaging modality has been integrated with radiotherapy in devices that can differentially target the most aggressive and resistant regions of tumours. The past decade has seen the clinical deployment of treatment devices that combine imaging with targeted irradiation, making the aspiration of integrated MRI-guided radiotherapy (MRIgRT) a reality. The two main clinical drivers for the adoption of MRIgRT are the ability to image anatomical changes that occur before and during treatment in order to adapt the treatment approach, and to image and target the biological features of each tumour. Using motion management and biological targeting, the radiation dose delivered to the tumour can be adjusted during treatment to improve the probability of tumour control, while simultaneously reducing the radiation delivered to non-malignant tissues, thereby reducing the risk of treatment-related toxicities. The benefits of this approach are expected to increase survival and quality of life. In this Review, we describe the current state of MRIgRT, and the opportunities and challenges of this new radiotherapy approach.
MRI 可以在解剖学和功能上帮助对组织进行恶性或非恶性分类，具有较高的空间和时间分辨率。这种非侵入性成像方式已与放射治疗设备相结合，可以有区别地靶向肿瘤中最具侵袭性和耐药性的区域。在过去的十年中，已经出现了将成像与靶向照射相结合的治疗设备，使集成 MRI 引导放疗（MRIgRT）的实现成为可能。采用 MRIgRT 的两个主要临床驱动因素是能够在治疗前后成像以适应治疗方法，以及成像和靶向每个肿瘤的生物学特征的能力。通过运动管理和生物靶向，可以在治疗过程中调整肿瘤的辐射剂量，以提高肿瘤控制的概率，同时减少对非恶性组织的辐射，从而降低治疗相关毒性的风险。这种方法的好处预计将提高生存率和生活质量。在这篇综述中，我们描述了 MRIgRT 的现状，以及这种新的放射治疗方法的机遇和挑战。
