文章：

精准医学时代的放射肿瘤学

Radiation oncology in the era of precision medicine

原文发布日期：2016-03-18

DOI: 10.1038/nrc.2016.18

类型: Review Article

开放获取: 否

要点：

1. Radiotherapy has proven potential to cure tumours by eradicating cancer stem cells.
2. Current state-of-the-art techniques of photon-based radiotherapy are approaching the physical limits of shaping high doses to the target volume.
3. Particle therapy reduces the volume of normal tissues irradiated with low or intermediate radiation doses and has the potential to reduce side effects in normal tissue as well as to escalate doses to radioresistant tumours.
4. Photon and especially particle radiotherapy will benefit from further improvements to image guidance with full adaptation of dose delivery to motion and anatomical changes of tumours and normal tissues during treatment.
5. Treatment planning algorithms that enable much faster planning and replanning, include uncertainties to improve robustness and enable optimization of multi-objective planning or plan comparison are on the verge of widespread clinical implementation.
6. The basic biological mechanisms of radiosensitivity and radioresistance are known and part of today's population-based treatment strategies.
7. Biomarkers and bio-imaging that enable mechanisms of radioresistance to be assessed in individual tumours and normal tissues are rapidly emerging.
8. Biomarkers have unexplored potential for predicting the extent of subclinical spread of tumour cells to help define the clinical target volume.
9. Biomarkers, when integrated into treatment planning, may potentiate the degree of personalization of radiotherapy that is already achieved today on a technological basis.
10. Radiation oncology has high potential to showcase the efficacy of precision medicine in oncology.

要点翻译：

1. 放疗已被证实具有通过根除癌症干细胞来治愈肿瘤的潜力。
2. 目前最先进的光子放疗技术在将高剂量剂量精准投射至靶区的技术已接近物理极限。
3. 粒子治疗可减少受到低、中剂量照射的正常组织范围，不仅有望降低正常组织副作用，还能对放射抵抗性肿瘤实施剂量递增。
4. 光子放疗（尤其是粒子放疗）将通过图像引导技术的进一步完善而受益——实现剂量投照全程适应肿瘤运动及正常组织的解剖变化。
5. 支持快速计划与重新规划的放疗计划算法即将迎来广泛临床实施，这些算法通过纳入不确定性参数提升稳健性，并能实现多目标计划优化与方案比对。
6. 放射敏感性与放射抵抗性的基本生物学机制已被阐明，并已应用于当前基于人群数据的治疗策略。
7. 能够评估个体肿瘤及正常组织放射抵抗机制的生物标志物与生物成像技术正在快速涌现。
8. 生物标志物在预测肿瘤细胞亚临床播散范围方面具有尚未开发的潜力，这有助于界定临床靶区范围。
9. 将生物标志物整合至治疗计划，可能强化目前已基于技术实现的放疗个性化程度。
10. 放射肿瘤学极有可能彰显精准医学在肿瘤治疗领域的实效性。

英文摘要：

Technological advances and clinical research over the past few decades have given radiation oncologists the capability to personalize treatments for accurate delivery of radiation dose based on clinical parameters and anatomical information. Eradication of gross and microscopic tumours with preservation of health-related quality of life can be achieved in many patients. Two major strategies, acting synergistically, will enable further widening of the therapeutic window of radiation oncology in the era of precision medicine: technology-driven improvement of treatment conformity, including advanced image guidance and particle therapy, and novel biological concepts for personalized treatment, including biomarker-guided prescription, combined treatment modalities and adaptation of treatment during its course.

摘要翻译： 

过去几十年间的技术进步与临床研究，使放射肿瘤学家能够依据临床参数和解剖信息个性化治疗，实现辐射剂量的精准递送。许多患者可在保持与健康相关生活质量的同时，根除大体和显微镜下肿瘤。在精准医学时代，两大协同策略将进一步拓宽放射肿瘤学的治疗窗：一是以技术驱动的治疗适形性提升，包括先进影像引导与粒子治疗；二是基于新生物学理念的个体化治疗，包括生物标志物引导的处方、联合治疗模式以及在疗程中动态调整方案。

原文链接：

Radiation oncology in the era of precision medicine