对于颅底肿瘤,目标定义是安全的高剂量治疗的关键,因为周围的正常组织对辐射非常敏感。在目前的工作中,我们为颅底肿瘤的目标体积定义建立了联合ESTROACROP指南。
在PubMed中使用以下医学主题标题(MeSH)和自由文本单词的各种组合进行了全面的文献检索:“放射疗法”或“立体定向放射外科”或“质子疗法”或“粒子束疗法”和“颅底肿瘤”,“脑膜瘤”,“颅咽管瘤”,\"脊索瘤\",“软骨肉瘤”,“听神经瘤/前庭神经鞘瘤”,“危险器官”,“肿瘤总体积”,“临床肿瘤体积”,“计划肿瘤体积”,\"目标卷\",“目标划定”,“剂量限制”。ACROP委员会确定了16位与ESTRO临床委员会密切互动的欧洲专家,他们分析并讨论了有关目标描绘的证据。
所有专家都同意磁共振(MR)图像具有高三维空间精度和组织对比度清晰度,T2加权和体积T1加权序列,需要改进目标划定。详细来说,确定并讨论了几个关键问题:i)辐射技术和固定化,ii)成像技术和目标描绘,和iii)放射治疗的技术方面,包括计划技术和剂量分割时间表。关于不同颅底肿瘤的特定目标描绘问题,包括垂体腺瘤,脑膜瘤,颅咽管瘤,听神经瘤,提出了脊索瘤和软骨肉瘤。
ESTROACROP指南对颅底肿瘤的目标体积定义提出了详细的建议,以及有关成像方式和辐射技术的全面建议。
For skull base tumors, target definition is the key to safe high-dose treatments because surrounding normal tissues are very sensitive to radiation. In the present work we established a joint ESTRO ACROP
guideline for the target volume definition of skull base tumors.
A comprehensive literature search was conducted in PubMed using various combinations of the following medical subjects headings (MeSH) and free-text words: \"radiation therapy\" or \"stereotactic radiosurgery\" or \"proton therapy\" or \"particle beam therapy\" and \"skull base neoplasms\" \"pituitary neoplasms\", \"meningioma\", \"craniopharyngioma\", \"chordoma\", \"chondrosarcoma\", \"acoustic neuroma/vestibular schwannoma\", \"organs at risk\", \"gross tumor volume\", \"clinical tumor volume\", \"planning tumor volume\", \"target volume\", \"target delineation\", \"dose constraints\". The ACROP committee identified sixteen European experts in close interaction with the ESTRO clinical committee who analyzed and discussed the body of evidence concerning target delineation.
All experts agree that magnetic resonance (MR) images with high three-dimensional spatial accuracy and tissue-contrast definition, both T2-weighted and volumetric T1-weighted sequences, are required to improve target delineation. In detail, several key issues were identified and discussed: i) radiation techniques and immobilization, ii) imaging techniques and target delineation, and iii) technical aspects of radiation treatments including planning techniques and dose-fractionation schedules. Specific target delineation issues with regard to different skull base tumors, including pituitary adenomas, meningiomas, craniopharyngiomas, acoustic neuromas, chordomas and chondrosarcomas are presented.
This ESTRO ACROP
guideline achieved detailed recommendations on target volume definition for skull base tumors, as well as comprehensive advice about imaging modalities and radiation techniques.