Image-guided brachytherapy sets benchmarks in advanced radiotherapy.

摘要

During the last two decades remarkable progress has been made in radiotherapy, not taking into account the important developments through the introduction of drug-radiation treatment strategies. This progress was much driven first by improvements in morphologic imaging (US, CT, and MRI) and information technology (computer and software) [1] and more recently also by improvements in hardware technology ("treatment machines") [2]. External beam radiotherapy was the first to incorporate many of these changes with important benefits through these different technologies resulting in promising new treatment strategies for a number of tumour sites, such as IMRT for head and neck cancer [3-6], IGRT for prostate cancer [7,8] and stereotactic radiotherapy for limited volume brain or lung malignancies [9,10]. Even non-photon radiotherapy could speed up enormously and hadron therapy seems to become enormously attractive [11,12]. These developments are at present advancing rapidly, driven to a large extent by a market which seems to offer unlimited technological possibilities which are inherently assumed to result in enlarging the therapeutic window meaning more local control and cure and/or less side effects. The paradigm is to develop advanced dose planning and delivery tools such as "shaping", "painting", "stereo-tacting", "knife-ing" and "tomo-ing" with as much direct link to imaging as possible (4D) [1 ]. The integration of molecular technology seems to become then the ultimate tool, as the design of a "PET MRS MRI MSCT stereotactic hadron robotic knife". However, progress in clinical outcome due to most of this technology progress is not (yet) much visible and evident and not at all overwhelming which has been discussed recently, thoroughly and controversially for hadrons [12-18].