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kV Cone-Beam CT-Based IGRT

A Clinical Review

kV-Cone-beam-CT-basierte bildgeführte Strahlentherapie – ein klinischer Überblick

  • Review Article
  • Published:
Strahlentherapie und Onkologie Aims and scope Submit manuscript

Abstract

Aims and Methods:

Delivery of high radiation doses while simultaneously sparing organs at risk requires advanced imaging for target volume definition, highly conformal dose distributions of intensity modulated radiotherapy (IMRT), and narrow planning target volume (PTV) margins. Three-dimensional image-guided radiotherapy (IGRT) with cone-beam computer tomography (CBCT), which results in more precise target localization, is quickly replacing two-dimensional (2D) IGRT. An overview on the clinical applications of kilovoltage gantry-mounted CBCT systems with emphasis on the most frequently targeted body sites (prostate, lung, head and neck) is provided based on a review of the relevant literature. Alternative imaging methods and their advantages/disadvantages are discussed.

Results:

IGRT with soft tissue detection improves set-up accuracy and is currently replacing 2D verification and frame-based stereotactic treatments; safety margins are significantly reduced by this IGRT technology. In addition, systematic changes of tumor volume and shape and of the normal tissue can be monitored allowing for adaptation of radiotherapy. IGRT in combination with conformal treatment planning allows for hypofractionated dose escalation, which results in improved rates of local tumor control with low rates of toxicity.

Conclusion:

CBCT allows for daily pretreatment position verification and online correction of set-up errors which improves the precision of patient repositioning with the possibility of shrinking safety margins, sparing organs at risk, and escalating radiation doses. A trend for better clinical outcome can be observed.

Zusammenfassung

Hintergrund und Methodik:

Die Verwendung von eskalierten Bestrahlungsdosen bei gleichzeitiger Schonung der Risikoorgane setzt multimodale Bildgebung zur Zielvolumendefinition, hochkonformale Bestrahlungsplanung mittels intensitätsmodulierter Radiotherapie und enge Sicherheitssäume voraus. Bildgeführte Strahlentherapie (IGRT) dient der präzisen Lokalisation des Zielvolumens, und konventionelle 2D Techniken wie Feldkontrollaufnahmen werden aktuell insbesondere durch dreidimensionale Cone-beam-(CBCT-)Technik ersetzt. Dieser Artikel gibt einen Literaturüberblick über den aktuellen Stand der IGRT mittels CBCT. Schwerpunkte sind die praktische Anwendung und klinischen Resultate bei Prostatakarzinom, Bronchialkarzinom und Kopf-Hals-Tumoren. Ergebnisse: Schlussfolgerungen: Schlüsselwörter:

Ergebnisse:

IGRT mittels CBCT ist hocheffektiv zur Verifikation der Patientenpositionierung und insbesondere zur Verifikation der Tumorposition. Rahmenbasierte Stereotaxie kann durch IGRT ersetzt werden, sowohl kraniell als auch extrakraniell. Bei Verwendung von IGRT-Techniken ohne ausreichenden Weichteilkontrast müssen größere Sicherheitssäume verwendet werden, um ein Verfehlen des Zielvolumens zu vermeiden. Zusätzlich sind mittels 3D IGRT systematische Veränderungen von Tumorvolumen, Tumorform und Lagebeziehung zu Risikoorganen darstellbar, was zur Adaption des Bestrahlungsplanes genutzt werden kann. Mittels konformaler IMRT-Bestrahlungstechniken und präziser IGRT konnten hypofraktionierte, eskalierte Bestrahlungsdosen sicher appliziert werden, was in verbesserter lokaler Tumorkontrolle ohne erhöhte Toxizität resultierte.

Schlussfolgerungen:

CBCT ermöglicht die Verifikation der Tumorposition zur Online-Korrektur von Positionsfehlern vor der Behandlung, was die Anwendung von kleinen Sicherheitssäumen, Normalgewebsschonung und Dosiseskalation ermöglicht. Die Verbesserung klinischer Ergebnisse wird durch diese Techniken erwartet und ist z.T. bereits in der Literatur dokumentiert.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany

    Judit Boda-Heggemann, Frank Lohr & Frederik Wenz

  2. Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany

    Michael Flentje & Matthias Guckenberger

  3. Department of Radiation Oncology, University Medical Center Mannheim University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Germany

    Judit Boda-Heggemann

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  1. Judit Boda-Heggemann
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Correspondence to Judit Boda-Heggemann.

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Boda-Heggemann, J., Lohr, F., Wenz, F. et al. kV Cone-Beam CT-Based IGRT. Strahlenther Onkol 187, 284–291 (2011). https://doi.org/10.1007/s00066-011-2236-4

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