在线放射治疗:范式转变为实时自适应性放射治疗
Goda Kalinauskaite1, Konstantin Nikolaou, Andrea Wittig
1Department 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.
Deutsches Arzteblatt international
|December 20, 2024
概括
在线适应性放射治疗 (ART) 提供精确的辐射输送,并减少副作用,特别是在头癌. 进一步的第三阶段试验至关重要,以确定这种先进技术的最佳患者群体.
科学领域:
- 在瘤学瘤学.
- 辐射瘤学 辐射瘤学
- 医学物理 医学物理
背景情况:
- 适应性放射治疗 (ART) 涉及基于患者特定反的辐射计划的实时 (在线) 或会话间 (离线) 调整.
- 在线ART需要先进的混合线性加速器与集成成像 (CT,MRI,PET) 实时计划优化.
- 虽然线下ART有众多试验,但在线ART是一种新兴技术,发布的第3阶段数据有限.
研究的目的:
- 审查2019年1月至2024年5月期间发表的关于在线适应性放射治疗 (ART) 的临床相关研究.
- 总结有关在线ART可行性,有效性和挑战的当前证据.
- 突出进一步研究的需要,特别是第三期试验,以确定在线ART的全部临床益处.
主要方法:
- 对在线ART的临床相关研究进行了PubMed的选择性搜索.
- 从2019年1月到2024年5月发表的研究被纳入了审查.
- 该审查综合了随机试验和观察性研究的发现.
主要成果:
- 对头癌的初步第二阶段试验显示,与标准放射化疗相比,ART显著降低了辐射皮炎和腺剂量.
- 观察性研究表明在线ART在各种癌症中的可行性,包括食道癌,胰腺癌,直肠癌和前列腺癌,有效地节省有风险的器官.
- 在线ART可以促进无模拟规划和更快的治疗启动,但比传统放射治疗更资源密集,更昂贵;长期结果数据正在等待.
结论:
- 目前的证据表明,在线ART是可行的,并且有望实现更精确的放射治疗,降低毒性.
- 进一步的第三阶段临床试验至关重要,以验证这些发现,并确定哪些患者群体将从在线ART中获益最多.
- 建立长期临床终点是必要的,以充分理解在线ART对患者结果的影响.
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