Beddok Arnaud, Lim Ruth, Thariat Juliette, Shih Helen A, El Fakhri Georges
Department of Radiation Oncology, Institut Godinot, 51100 Reims, France.
Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
Cancers (Basel). 2023 Oct 10;15(20):4906. doi: 10.3390/cancers15204906.
Multidisciplinary management is crucial in cancer diagnosis and treatment. Multidisciplinary teams include specialists in surgery, medical therapies, and radiation therapy (RT), each playing unique roles in oncology care. One significant aspect is RT, guided by radiation oncologists (ROs). This paper serves as a detailed primer for non-oncologists, medical students, or non-clinical investigators, educating them on contemporary RT practices. This report follows the process of RT planning and execution. Starting from the decision-making in multidisciplinary teams to the completion of RT and subsequent patient follow-up, it aims to offer non-oncologists an understanding of the RO's work in a comprehensive manner. The first step in RT is a planning session that includes obtaining a CT scan of the area to be treated, known as the CT simulation. The patients are imaged in the exact position in which they will receive treatment. The second step, which is the primary source of uncertainty, involves the delineation of treatment targets and organs at risk (OAR). The objective is to ensure precise irradiation of the target volume while sparing the OARs as much as possible. Various radiation modalities, such as external beam therapy with electrons, photons, or particles (including protons and carbon ions), as well as brachytherapy, are utilized. Within these modalities, several techniques, such as three-dimensional conformal RT, intensity-modulated RT, volumetric modulated arc therapy, scattering beam proton therapy, and intensity-modulated proton therapy, are employed to achieve optimal treatment outcomes. The RT plan development is an iterative process involving medical physicists, dosimetrists, and ROs. The complexity and time required vary, ranging from an hour to a week. Once approved, RT begins, with image-guided RT being standard practice for patient alignment. The RO manages acute toxicities during treatment and prepares a summary upon completion. There is a considerable variance in practices, with some ROs offering lifelong follow-up and managing potential late effects of treatment. Comprehension of RT clinical effects by non-oncologists providers significantly elevates long-term patient care quality. Hence, educating non-oncologists enhances care for RT patients, underlining this report's importance.
多学科管理在癌症诊断和治疗中至关重要。多学科团队包括外科、医学治疗和放射治疗（RT）方面的专家，他们在肿瘤护理中各自发挥着独特作用。一个重要方面是由放射肿瘤学家（ROs）指导的RT。本文为非肿瘤学家、医学生或非临床研究人员提供了一份详细的入门指南，让他们了解当代RT实践。本报告遵循RT计划制定和实施的过程。从多学科团队的决策到RT完成及后续患者随访，旨在全面地让非肿瘤学家了解RO的工作。RT的第一步是一个计划会议，包括获取待治疗区域的CT扫描，即CT模拟。患者在接受治疗的精确位置成像。第二步，这也是不确定性的主要来源，涉及确定治疗靶区和危及器官（OAR）。目的是确保对靶区进行精确照射，同时尽可能保护OAR。使用了各种放射治疗方式，如电子、光子或粒子（包括质子和碳离子）的外照射治疗以及近距离放射治疗。在这些方式中，采用了几种技术，如三维适形RT、调强RT、容积调强弧形治疗、散射束质子治疗和调强质子治疗，以实现最佳治疗效果。RT计划制定是一个涉及医学物理学家、剂量师和RO的迭代过程。其复杂性和所需时间各不相同，从一小时到一周不等。一旦获得批准，RT就开始，图像引导RT是患者定位的标准做法。RO在治疗期间管理急性毒性反应，并在完成后准备一份总结。实践中存在很大差异，一些RO提供终身随访并管理治疗的潜在晚期效应。非肿瘤学医护人员对RT临床效果的理解显著提高长期患者护理质量。因此，对非肿瘤学家进行教育可加强对RT患者的护理，凸显了本报告的重要性。
