Department of Radiation Oncology, Institut du cancer de Montpellier, Montpellier, France; Fédération universitaire d'oncologie radiothérapie de Méditerranée Occitanie, université de Montpellier, Montpellier, France; U1194, Inserm, Montpellier, France.
Department of Radiation Oncology, Institut du cancer de Montpellier, Montpellier, France; Fédération universitaire d'oncologie radiothérapie de Méditerranée Occitanie, université de Montpellier, Montpellier, France; U1194, Inserm, Montpellier, France.
Cancer Radiother. 2024 Nov;28(6-7):603-609. doi: 10.1016/j.canrad.2024.07.007. Epub 2024 Sep 30.
Adaptive radiotherapy (ART) is a recent development in radiotherapy technology and treatment personalization that allows treatment to be tailored to the daily anatomical changes of patients. While it was until recently only performed "offline", i.e. between two radiotherapy sessions, it is now possible during ART to perform a daily online adaptive process for a given patient. Therefore, ART allows a daily customization to ensure optimal coverage of the treatment target volumes with minimized margins, taking into account only the uncertainties related to the adaptive process itself. This optimization appears particularly relevant in case of daily variations in the positioning of the target volume or of the organs at risk (OAR) associated with a proximity of these volumes and a tenuous therapeutic index. ART aims to minimize severe acute and late toxicity and allows tumor dose escalation. These new achievements have been possible thanks to technological development, the contribution of new multimodal and onboard imaging modalities and the integration of artificial intelligence tools for the contouring, planning and delivery of radiation therapy. Online ART is currently available on two types of radiotherapy machines: MR-linear accelerators and recently CBCT-linear accelerators. We will first describe the benefits, advantages, constraints and limitations of each of these two modalities, as well as the online adaptive process itself. We will then evaluate the clinical situations for which online adaptive radiotherapy is particularly indicated on MR- and CBCT-linear accelerators. Finally, we will detail some challenges and possible solutions in the development of online ART in the coming years.
自适应放疗（ART）是放疗技术和治疗个体化的最新发展，可根据患者的日常解剖变化调整治疗方案。虽然直到最近它还只能在两次放疗之间进行“离线”操作，但现在在 ART 中可以为特定患者进行每日在线自适应处理。因此，ART 允许进行日常定制，以确保以最小的边缘最佳覆盖治疗靶区，仅考虑自适应过程本身相关的不确定性。在靶区或与这些体积接近且治疗指数微弱的危险器官（OAR）的位置每天发生变化的情况下，这种优化显得尤为重要。ART 的目的是最大限度地减少严重的急性和迟发性毒性，并允许肿瘤剂量升级。这些新成就得益于技术发展、新的多模态和在线成像方式的贡献以及人工智能工具在轮廓勾画、计划和放射治疗中的应用。在线 ART 目前可用于两种类型的放疗机：MR-直线加速器和最近的 CBCT-直线加速器。我们将首先描述这两种方式各自的优势、优点、限制和局限性，以及在线自适应处理本身。然后，我们将评估在线自适应放疗在 MR-和 CBCT-直线加速器上特别适用的临床情况。最后，我们将详细介绍在线 ART 在未来几年发展中面临的挑战和可能的解决方案。
