A Alshamrani, M Aznar, P Hoskin, R Chuter, C L Eccles
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引用次数: 0
Abstract
Aims: 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.
Materials and methods: 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.
Results: 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.
Conclusion: 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.
目的：宫颈癌治疗中靶点和危险器官（OAR）的可变性给精确放疗带来了挑战。自适应放疗（ART）具有提高治疗精确度和疗效的潜力。然而，工作量的增加和对最合适的 ART 方法缺乏共识阻碍了它在临床上的应用。本系统性综述旨在评估目前宫颈癌适应性策略的使用情况，并确定最佳方法：对 2012 年 1 月至 2023 年 5 月间发表的最新文献进行了系统性回顾。检索使用了 PubMed/Medline、Cochrane 图书馆和 Web of Science 数据库，并辅以曼彻斯特大学、谷歌学术和从参考文献列表中检索到的论文。审查评估了工作流程，比较了剂量效益，并检查了每种已确定策略的资源。不包括摘要、会议摘要、综述、与 ART 管理、质子治疗、近距离放射治疗无关的文章或定性研究。叙述性综述包括数据制表，对所选研究进行总结，详细说明宫颈癌的工作流程以及靶点和OAR的剂量测定结果：有 16 篇文章符合纳入标准；这些文章大多是回顾性模拟规划研究，但有 4 项研究已在临床上实施。我们确定了宫颈癌 ART 放射治疗的五种方法：反应性适应和计划性适应、使用计划库（LOP）的基于内部靶体积（ITV）的方法、使用 LOP 的固定边缘方法以及实时适应，与非 ART 方法相比，每种方法都能在不影响靶区覆盖的情况下减少照射体积。基于 LOP 的 ITV 方法使用最多，临床评估也最多：结论：由于剂量评估的局限性，确定最佳策略具有挑战性。宫颈癌 ART 的实施需要通过研究（包括确定最佳频率的研究和毒性的前瞻性评估）对临床效益和资源进行战略性优化。
期刊介绍：
Clinical Oncology is an International cancer journal covering all aspects of the clinical management of cancer patients, reflecting a multidisciplinary approach to therapy. Papers, editorials and reviews are published on all types of malignant disease embracing, pathology, diagnosis and treatment, including radiotherapy, chemotherapy, surgery, combined modality treatment and palliative care. Research and review papers covering epidemiology, radiobiology, radiation physics, tumour biology, and immunology are also published, together with letters to the editor, case reports and book reviews.
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