International Atomic Energy Agency, Vienna International Centre, Vienna, Austria.
Radiation Therapy Services, Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
Clin Oncol (R Coll Radiol). 2023 Aug;35(8):e453-e468. doi: 10.1016/j.clon.2023.05.003. Epub 2023 May 10.
This review aims to showcase the brachytherapy tools and technologies that have emerged during the last 10 years. Soft-tissue contrast using magnetic resonance and ultrasound imaging has seen enormous growth in use to plan all forms of brachytherapy. The era of image-guided brachytherapy has encouraged the development of advanced applicators and given rise to the growth of individualised 3D printing to achieve reproducible and predictable implants. These advances increase the quality of implants to better direct radiation to target volumes while sparing normal tissue. Applicator reconstruction has moved beyond manual digitising, to drag and drop of three-dimensional applicator models with embedded pre-defined source pathways, ready for auto-recognition and automation. The simplified TG-43 dose calculation formalism directly linked to reference air kerma rate of high-energy sources in the medium water remains clinically robust. Model-based dose calculation algorithms accounting for tissue heterogeneity and applicator material will advance the field of brachytherapy dosimetry to become more clinically accurate. Improved dose-optimising toolkits contribute to the real-time and adaptive planning portfolio that harmonises and expedites the entire image-guided brachytherapy process. Traditional planning strategies remain relevant to validate emerging technologies and should continue to be incorporated in practice, particularly for cervical cancer. Overall, technological developments need commissioning and validation to make the best use of the advanced features by understanding their strengths and limitations. Brachytherapy has become high-tech and modern by respecting tradition and remaining accessible to all.
本文旨在展示过去 10 年来出现的近距离治疗工具和技术。磁共振和超声成像的软组织对比在各种近距离治疗计划中得到了广泛应用。图像引导近距离治疗的时代鼓励了先进施源器的发展，并促进了个体化 3D 打印的发展，以实现可重复和可预测的植入物。这些进展提高了植入物的质量，更好地将辐射引导至靶区，同时保护正常组织。施源器重建已经超越了手动数字化，发展为三维施源器模型的拖放，其中嵌入了预定义的源路径，可实现自动识别和自动化。与中能水中参考空气比释动能率直接相关的简化 TG-43 剂量计算形式仍然在临床上具有强大的稳健性。考虑组织异质性和施源器材料的基于模型的剂量计算算法将推动近距离治疗剂量学领域变得更加准确。改进的剂量优化工具包有助于实时和自适应规划组合，从而协调和加快整个图像引导近距离治疗过程。传统的计划策略仍然与验证新兴技术相关，并且应该继续在实践中使用，特别是对于宫颈癌。总的来说，技术发展需要经过调试和验证，以充分利用先进功能，了解其优缺点。近距离治疗通过尊重传统并保持对所有人的可及性，变得高科技和现代化。
