Integrated MRI-guided radiotherapy - opportunities and challenges

被引:92
作者
Keall, Paul J. [1 ]
Brighi, Caterina [1 ]
Glide-Hurst, Carri [2 ]
Liney, Gary [3 ]
Liu, Paul Z. Y. [1 ]
Lydiard, Suzanne [1 ]
Paganelli, Chiara [4 ]
Trang Pham [5 ]
Shan, Shanshan [1 ]
Tree, Alison C. [6 ,7 ]
van der Heide, Uulke A. [8 ]
Waddington, David E. J. [1 ]
Whelan, Brendan [1 ]
机构
[1] Univ Sydney, ACRF Image X Inst, Sydney, NSW, Australia
[2] Univ Wisconsin, Dept Human Oncol, Madison, WI USA
[3] Ingham Inst Appl Med Res, Sydney, NSW, Australia
[4] Politecn Milan, Dipartimento Elettron Informaz & Bioingn, Milan, Italy
[5] Univ New South Wales, Fac Med & Hlth, Sydney, NSW, Australia
[6] Royal Marsden NHS Fdn Trust, London, England
[7] Inst Canc Res, London, England
[8] Netherlands Canc Inst, Dept Radiat Oncol, Amsterdam, Netherlands
基金
英国医学研究理事会; 澳大利亚国家健康与医学研究理事会;
关键词
ADAPTIVE RADIATION-THERAPY; CELL LUNG-CANCER; PROSTATE-CANCER; CLINICAL IMPLEMENTATION; TARGET COVERAGE; DOSE-ESCALATION; NON-INFERIORITY; LINAC SYSTEMS; TIME; TRACKING;
D O I
10.1038/s41571-022-00631-3
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
MRI can help to categorize tissues as malignant or non-malignant both anatomically and functionally, with a high level of spatial and temporal resolution. This non-invasive imaging modality has been integrated with radiotherapy in devices that can differentially target the most aggressive and resistant regions of tumours. The past decade has seen the clinical deployment of treatment devices that combine imaging with targeted irradiation, making the aspiration of integrated MRI-guided radiotherapy (MRIgRT) a reality. The two main clinical drivers for the adoption of MRIgRT are the ability to image anatomical changes that occur before and during treatment in order to adapt the treatment approach, and to image and target the biological features of each tumour. Using motion management and biological targeting, the radiation dose delivered to the tumour can be adjusted during treatment to improve the probability of tumour control, while simultaneously reducing the radiation delivered to non-malignant tissues, thereby reducing the risk of treatment-related toxicities. The benefits of this approach are expected to increase survival and quality of life. In this Review, we describe the current state of MRIgRT, and the opportunities and challenges of this new radiotherapy approach. In the past decade, treatment devices that combine imaging with targeted irradiation have been developed to deliver MRI-guided radiotherapy (MRIgRT). This treatment modality uses motion management and biological targeting to improve local control rates whilst reducing the radiation delivered to non-malignant tissues. The authors of this Review describe the current state of MRIgRT, and the opportunities and challenges of this radiotherapy approach.
引用
收藏
页码:458 / 470
页数:13
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