目的:空间分割放射治疗(SFRT)的高度异质性剂量传递与标准放射计划和报告方法有很大的不同。早期的SFRT研究显示了良好的临床结果。然而,SFRT的前瞻性多机构临床试验仍然缺乏。NRG肿瘤学/美国医学物理学家协会(AAPM)工作组共识旨在制定剂量测定计划的建议,delivery,和SFRT剂量报告,以解决目前SFRT临床试验设计的障碍。
方法:由放射肿瘤学家组成的工作组,放射生物学家,NRG肿瘤学和AAPM成立了具有SFRT专业知识的医学物理学家,以调查SFRT临床试验的需求和障碍。
结果:在回顾SFRT技术和方法时,该小组确定了几个领域的挑战,包括SFRT的可用性,缺乏对SFRT的TPS支持,在SFRT的物理和剂量学方面缺乏指导,SFRT的近似放射生物学模型,和处方以及SFRT与常规放疗的结合。
结论:认识到这些挑战,该小组进一步推荐了SFRT在癌症治疗中应用的几个方面的改进,包括创建临床实践指导文件,TPS支持的改进,治疗计划和剂量测定指数报告模板的生成,通过临床前研究开发更好的放射生物学模型,并通过进行多机构临床试验。
OBJECTIVE: The highly heterogeneous dose delivery of spatially fractionated radiation therapy (SFRT) is a profound departure from standard radiation planning and reporting approaches. Early
SFRT studies have shown excellent clinical outcomes. However, prospective multi-institutional clinical trials of
SFRT are still lacking. This NRG Oncology/American Association of Physicists in Medicine working group consensus aimed to develop recommendations on dosimetric planning, delivery, and SFRT dose reporting to address this current obstacle toward the design of
SFRT clinical trials.
METHODS: Working groups consisting of radiation oncologists, radiobiologists, and medical physicists with expertise in SFRT were formed in NRG Oncology and the American Association of Physicists in Medicine to investigate the needs and barriers in SFRT clinical trials.
RESULTS: Upon reviewing the SFRT technologies and methods, this group identified challenges in several areas, including the availability of SFRT, the lack of treatment planning system support for
SFRT, the lack of guidance in the physics and dosimetry of
SFRT, the approximated radiobiological modeling of
SFRT, and the prescription and combination of
SFRT with conventional radiation therapy.
CONCLUSIONS: Recognizing these challenges, the group further recommended several areas of improvement for the application of SFRT in cancer treatment, including the creation of clinical practice guidance documents, the improvement of treatment planning system support, the generation of treatment planning and dosimetric index reporting templates, and the development of better radiobiological models through preclinical studies and through conducting multi-institution clinical trials.