Cavedon Carlo, Mazzarotto Renzo
Medical Physics Unit, Azienda Ospedaliera Universitaria Integrata, 37124 Verona, Italy.
Radiation Oncology Unit, Azienda Ospedaliera Universitaria Integrata, 37124 Verona, Italy.
Cancers (Basel). 2022 Jul 20;14(14):3532. doi: 10.3390/cancers14143532.
As opposed to external beam radiation therapy (EBRT), treatment planning systems (TPS) dedicated to intraoperative radiation therapy (IORT) were not subject to radical modifications in the last two decades. However, new treatment regimens such as ultrahigh dose rates and combination with multiple treatment modalities, as well as the prospected availability of dedicated in-room imaging, call for important new features in the next generation of treatment planning systems in IORT. Dosimetric accuracy should be guaranteed by means of advanced dose calculation algorithms, capable of modelling complex scattering phenomena and accounting for the non-tissue equivalent materials used to shape and compensate electron beams. Kilovoltage X-ray based IORT also presents special needs, including the correct description of extremely steep dose gradients and the accurate simulation of applicators. TPSs dedicated to IORT should also allow real-time imaging to be used for treatment adaptation at the time of irradiation. Other features implemented in TPSs should include deformable registration and capability of radiobiological planning, especially if unconventional irradiation schemes are used. Finally, patient safety requires that the multiple features be integrated in a comprehensive system in order to facilitate control of the whole process.
与外照射放疗（EBRT）不同，过去二十年来，用于术中放疗（IORT）的治疗计划系统（TPS）并未经历彻底变革。然而，诸如超高剂量率以及与多种治疗方式联合等新的治疗方案，以及有望实现的专用室内成像，都对下一代IORT治疗计划系统提出了重要的新特性要求。剂量测定的准确性应通过先进的剂量计算算法来保证，这些算法能够模拟复杂的散射现象，并考虑用于塑形和补偿电子束的非组织等效材料。基于千伏X射线的IORT也有特殊需求，包括正确描述极其陡峭的剂量梯度以及精确模拟施源器。用于IORT的TPS还应允许在照射时将实时成像用于治疗调整。TPS中实现的其他特性应包括可变形配准和放射生物学计划能力，特别是在使用非常规照射方案时。最后，患者安全要求将多种特性集成到一个综合系统中，以便于对整个过程进行控制。
