在线放疗：向实时自适应放疗的范式转变。
Online Radiotherapy: The Paradigm Shift to Real-Time Adaptive Radiotherapy.
作者信息
Kalinauskaite Goda, Nikolaou Konstantin, Wittig Andrea, Zips Daniel, Zöphel Klaus, Senger Carolin
机构信息
Department of Radiation Oncology and Radiotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Academy, Digital Clinician Scientist Program; Department of Diagnostic and Interventional Radiology, University Hospital Tübingen; Department of Radiotherapy and Radiooncology, University Hospital Würzburg; Department of Nuclear Medicine, Klinikum Chemnitz gGmbH.
出版信息
Dtsch Arztebl Int. 2025 Feb 7;122(3):59-64. doi: 10.3238/arztebl.m2024.0242.
BACKGROUND
Adaptive radiotherapy (ART) involves the continuous adaptation of the radiation plan according to patient- and tumorspecific feedback. In online ART, the plan is optimized in real time during the treatment; in offline ART, the plan is recalculated between treatment sessions. Hybrid linear accelerators with integrated CT, MRI, or PET are required to perform online ART.
METHODS
This review is based on clinically relevant studies on online ART (January 2019 - May 2024) that were retrieved by a selective search in PubMed.
RESULTS
Online ART is a new technique for which no phase 3 trials have been published; in contrast, multiple randomized trials are already available for offline ART. The initial findings of a random - ized phase 2 trial of online ART for head and neck cancer showed lower rates of G2 or higher radiation-induced dermatitis (8% vs. 31%, p = 0.05) and a lower dose to the parotid gland (mean dose: 11.5 Gy vs. 16.0 Gy, p = 0.02) with online ART compared to standard radiochemotherapy. Moreover, observational studies show that online ART is feasible and spares organs at risk in patients with esophageal, pancreatic, rectal, and prostatic cancer. Additionally, online ART can enable simulation-free treatment planning and faster initiation of radiotherapy. It is, however, more demanding of time and resources and more costly than standard radiotherapy, and no studies with long-term clinical endpoints are available to date.
CONCLUSION
Initial studies confirm the feasibility of online ART and arouse the hope that it will enable more precise radiotherapy with less damage to surrounding structures. Phase 3 trials are needed so that the patient groups who stand to benefit most from online ART can be identified.
背景
自适应放射治疗（ART）涉及根据患者和肿瘤的特定反馈对放射治疗计划进行持续调整。在在线ART中，计划在治疗过程中实时优化；在离线ART中，计划在治疗疗程之间重新计算。需要集成CT、MRI或PET的混合直线加速器来进行在线ART。
方法
本综述基于2019年1月至2024年5月在PubMed上通过选择性检索获得的关于在线ART的临床相关研究。
结果
在线ART是一项尚未发表3期试验的新技术；相比之下，离线ART已经有多项随机试验。一项针对头颈癌的在线ART随机2期试验的初步结果显示，与标准放化疗相比，在线ART导致2级或更高级别放射性皮炎的发生率更低（8%对31%，p = 0.05），腮腺所受剂量更低（平均剂量：11.5 Gy对16.0 Gy，p = 0.02）。此外，观察性研究表明，在线ART在食管癌、胰腺癌、直肠癌和前列腺癌患者中是可行的，并且能使危及器官得到保护。此外，在线ART可以实现无需模拟的治疗计划并更快地开始放射治疗。然而，它比标准放射治疗对时间和资源的要求更高，成本也更高，而且迄今为止尚无具有长期临床终点的研究。
结论
初步研究证实了在线ART的可行性，并让人希望它能够实现更精确的放射治疗，同时对周围结构的损伤更小。需要进行3期试验，以便确定能从在线ART中获益最大的患者群体。
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