Alshamrani A, Aznar M, Hoskin P, Chuter R, Eccles C L
Division of Cancer Sciences, The University of Manchester, Manchester, M13 9PL, UK; Princess Nourah Bint Abdulrahman University, Department of Radiological Sciences, College of Health and Rehabilitation Sciences, P.O. Box 84428, Riyadh 11671, Saudi Arabia.
Division of Cancer Sciences, The University of Manchester, Manchester, M13 9PL, UK.
Clin Oncol (R Coll Radiol). 2024 Dec;36(12):e483-e493. doi: 10.1016/j.clon.2024.09.005. Epub 2024 Sep 17.
Variability in the target and organs at risk (OARs) in cervical cancer treatment presents challenges for precise radiotherapy. Adaptive radiotherapy (ART) offers the potential to enhance treatment precision and outcomes. However, the increased workload and a lack of consensus on the most suitable ART approach hinder its clinical adoption. This systematic review aims to assess the current use of adaptive strategies for cervical cancer and define the optimal approach.
A systematic review of current literature published between January 2012 and May 2023 was conducted. Searches used PubMed/Medline, Cochrane Library, and Web of Science databases, supplemented with the University of Manchester, Google Scholar, and papers retrieved from reference lists. The review assessed workflows, compared dosimetric benefits, and examined resources for each identified strategy. Excluded were abstracts, conference abstracts, reviews, articles unrelated to ART management, proton therapy, brachytherapy, or qualitative studies. A narrative synthesis involved data tabulation, summarizing selected studies detailing workflow for cervical cancer and dosimetric outcomes for targets and OARs.
Sixteen articles met the inclusion criteria; these were mostly retrospective simulation planning studies, except four studies that had been clinically implemented. We identified five approaches for ART radiotherapy for cervical cancer: reactive and scheduled adaptation, internal target volume (ITV)-based approach using library of plans (LOP), fixed-margin approach using LOP, and real-time adaptation, with each approach reducing irradiated volumes without compromising target coverage compared to the non-ART approach. The LOP-based ITV approach is the most used and clinically assessed.
Identifying the optimal strategy is challenging due to dosimetric assessment limitations. Implementing cervical cancer ART necessitates strategic optimization of clinical benefits and resources through research, including studies to identify the optimal frequency, and prospective evaluations of toxicity.
宫颈癌治疗中靶区和危及器官（OARs）的变异性给精确放疗带来了挑战。自适应放疗（ART）有提高治疗精度和疗效的潜力。然而，工作量的增加以及对于最合适的ART方法缺乏共识阻碍了其临床应用。本系统评价旨在评估目前宫颈癌自适应策略的应用情况并确定最佳方法。
对2012年1月至2023年5月发表的当前文献进行系统评价。检索使用了PubMed/Medline、Cochrane图书馆和Web of Science数据库，并补充了曼彻斯特大学、谷歌学术搜索以及从参考文献列表中检索到的论文。该评价评估了工作流程，比较了剂量学益处，并检查了每种确定策略所需的资源。排除的文献包括摘要、会议摘要、综述、与ART管理、质子治疗、近距离放疗无关的文章或定性研究。叙述性综合分析包括数据制表，总结选定的研究，详细说明宫颈癌的工作流程以及靶区和OARs的剂量学结果。
16篇文章符合纳入标准；除了4篇已临床实施的研究外，其余大多为回顾性模拟计划研究。我们确定了五种宫颈癌ART放疗方法：反应性和计划性适应、基于内部靶区体积（ITV）使用计划库（LOP）的方法、使用LOP的固定边界方法以及实时适应，与非ART方法相比，每种方法在不影响靶区覆盖的情况下减少了照射体积。基于LOP的ITV方法是使用最多且经过临床评估的。
由于剂量学评估的局限性，确定最佳策略具有挑战性。实施宫颈癌ART需要通过研究对临床益处和资源进行战略优化，包括确定最佳频率的研究以及毒性的前瞻性评估。
