Advances in research on organ-at-risk protection in pelvic tumor external beam radiotherapy_Journal of Biomedical Engineering

Authors：

ZENG Fubin ^1,2 , ZHAO Wenjuan ^1,2 , HE Jie ^1,2 , CHEN Di ¹ ,  ZHANG Huojun ¹

1. Department of Radiation Therapy, The First Affiliated Hospital of Naval Medical University, Shanghai 200433, P. R. China;
2. School of Health Sciences and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, P. R. China;

Corresponding?author：

Keywords：

Pelvic tumor; Radiotherapy; External beam radiation; Organ-at-risk protection

DOI：

10.7507/1001-5515.202312073

Video：

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The simultaneous objectives of destroying tumor cells while protecting normal pelvic organs present a dual clinical and technical challenge within the realm of pelvic tumor radiotherapy. This article reviews the latest literatures, focusing on technological innovations in key aspects of radiotherapy such as positioning, planning, and delivery. These include positioning fixation techniques, organ-at-risk avoidance irradiation, non-coplanar irradiation techniques, as well as organ displacement protection and image-guided adaptive techniques. It summarizes and discusses the research progress made in the protection of critical organs during pelvic tumor radiotherapy. The paper emphasizes technological advancements in the protection of critical organs throughout the processes of radiotherapy positioning, planning, and implementation, aiming to provide references for further research on the protection of critical organs in the external irradiation treatment of pelvic tumors.

Citation： ZENG Fubin, ZHAO Wenjuan, HE Jie, CHEN Di, ZHANG Huojun. Advances in research on organ-at-risk protection in pelvic tumor external beam radiotherapy. Journal of Biomedical Engineering, 2024, 41(3): 627-634. doi: 10.7507/1001-5515.202312073 Copy

1.	Al-Hallaq H, Batista V, Kügele M, et al. The role of surface-guided radiation therapy for improving patient safety. Radiother Oncol, 2021, 163: 229-236.
2.	林志悅, 許晨迪, 李宗泰, 等. 基于一體化CT直線加速器圖像引導放療的宮頸癌不同體位固定方式的對比研究. 中華腫瘤防治雜志, 2023, 30(15): 932-936.
3.	王宇留, 方涌文, 林曉生, 等. 基于CBCT分析三種體位固定技術在盆腔腫瘤放療中的應用比較. 現代腫瘤醫學, 2023, 31(17): 3237-3242.
4.	邱騰, 于大海, 趙迪, 等. 真空墊聯合CIVCO俯臥位托架在直腸癌放療擺位中的應用. 現代腫瘤醫學, 2024, 32(2): 316-322.
5.	鐘嘉健, 丘敏敏, 林澤煌, 等. 宮頸癌放療腰圍變化與兩種體位的相關性研究. 中國當代醫藥, 2021, 28(10): 159-162.
6.	王新新, 劉桂芝, 梁廣立. 基于錐形束CT直腸癌調強放療固定方式的臨床效果分析. 吉林醫學, 2021, 42(5): 1082-1084.
7.	郭雨軍, 李婷, 楊鑫, 等. 放療計劃定量評估在宮頸癌外照射精準放療流程管理中的應用. 南方醫科大學學報, 2023, 43(6): 1035-1040.
8.	Yan H, Wu M, Wang W, et al. Dosimetry and acute radiation enteritis comparison between prone and supine position in IMRT for gynecological cancers. J Appl Clin Med Phys, 2023, 24(12): e14135.
9.	許晨迪, 姜曉勃, 王亞娟, 等. 基于扇形束CT研究不同固定體位下宮頸癌術后放療中膀胱體積改變對膀胱和小腸受照劑量的影響. 中國醫學物理學雜志, 2023, 40(5): 529-535.
10.	羅丹, 孔為民, 陳姝寧. 宮頸癌放療后放射性直腸炎發生情況及其相關因素分析. 醫學綜述, 2021, 27(2): 400-403, 408.
11.	Brennan V S, Curran B, Skourou C, et al. A novel dynamic arc treatment planning solution to reduce dose to small bowel in preoperative radiotherapy for rectal cancer. Med Dosim, 2019, 44(3): 258-265.
12.	鄭蓮容, 黎桂華, 朱志鵬. 宮頸癌患者四種容積旋轉調強計劃小腸的劑量學比較. 影像研究與醫學應用, 2022, 6(15): 34-37.
13.	郝金龍, 曾靜, 宋明永, 等. 射野回避區域的設置對于宮頸癌容積旋轉調強計劃劑量學的影響. 現代腫瘤醫學, 2023, 31(12): 2298-2303.
14.	Yoshihiro U, Shingo O, Masaru I, et al. Strategies for reducing ovarian dose in volumetric modulated arc therapy (VMAT) for postoperative uterine cervical cancer. Br J Radiol, 2018, 91(1081): 20160777.
15.	馬敏, 戴建榮. 非共面放療技術的實現方式. 中華放射腫瘤學雜志, 2022, 31(1): 108-111.
16.	王東, 龐亞, 吳哲. 床轉角對宮頸癌非共面調強放療計劃的影響. 醫療衛生裝備, 2022, 43(7): 47-50, 59.
17.	董勝楠, 黃洋洋, 楊軍, 等. 非共面IMRT在宮頸癌放療計劃中保護卵巢的可行性探討. 現代腫瘤醫學, 2023, 31(1): 140-143.
18.	陳旭明, 陳穎, 許奕. 非共面容積旋轉調強在宮頸癌術后放射治療中的劑量學研究. 中國醫療設備, 2019, 34(1): 22-24, 33.
19.	Sharfo A W M, Rossi L, Dirkx M L P, et al. Complementing prostate SBRT VMAT with a two-beam non-coplanar IMRT class solution to enhance rectum and bladder sparing with minimum increase in treatment time. Front Oncol, 2021, 11: 620978.
20.	Liang B, Wei R, Zhang J, et al. Applying pytorch toolkit to plan optimization for circular cone based robotic radiotherapy. Radiat Oncol, 2022, 17: 82.
21.	馬建萍, 夏新舍, 潘聞燕, 等. 膀胱充盈狀態對宮頸癌調強放療子宮及危及器官的影響. 中華放射醫學與防護雜志, 2019, 39(9): 652-657.
22.	Jin F, Liu Q, Luo H, et al. Dynamic changes in bladder morphology over time in cervical cancer patients. Cancer Control, 2021, 28: 10732748211021082.
23.	鐘嘉健, 丘敏敏, 鄧永錦, 等. 兩種膀胱充盈方式在宮頸癌術后調強放療中的對比. 中華腫瘤防治雜志, 2021, 28(12): 944-948.
24.	黃家文, 張梅芳, 傅萬凱, 等. 膀胱不同充盈狀態在宮頸癌調強放療中的應用分析. 現代腫瘤醫學, 2023, 31(17): 3242-3247.
25.	Babar M, Katz A, Ciatto M. Dosimetric and clinical outcomes of SpaceOAR in men undergoing external beam radiation therapy for localized prostate cancer: a systematic review. J Med Imag Radiat On, 2021, 65(3): 384-397.
26.	Payne H A, Jain S, Peedell C, et al. Delphi study to identify consensus on patient selection for hydrogel rectal spacer use during radiation therapy for prostate cancer in the UK. BMJ Open, 2022, 12(7): e060506.
27.	Achard V, Ris F, Rouzaud M, et al. Sexual organ-sparing with hydrogel spacer injections for rectal cancer radiotherapy: a feasibility pilot study. Br J Radiol, 2021, 94(1120): 20200931.
28.	Grewal H, Kedar R, Dhillon G, et al. SpaceOAR hydrogel complications in prostate cancer. Br J Radiol, 2023, 96(1152): 20230717.
29.	Latorzeff I, Bruguière E, Bogart E, et al. Use of a biodegradable, contrast-filled rectal spacer balloon in intensity-modulated radiotherapy for intermediate-risk prostate cancer patients: dosimetric gains in the BioPro-RCMI-1505 study. Front Oncol, 2021, 11: 701998.
30.	Ahmad Khalil D, Wulff J, Jazmati D, et al. Is an endorectal balloon beneficial for rectal sparing after spacer implantation in prostate cancer patients treated with hypofractionated intensity-modulated proton beam therapy? A dosimetric and radiobiological comparison study. Curr Oncol, 2023, 30(1): 758-768.
31.	馬曉欣, 向陽, 狄文, 等. 盆腔惡性腫瘤放療前卵巢移位術中國專家共識(2023年版). 中國實用婦科與產科雜志, 2023, 39(11): 1114-1118.
32.	程曉龍, 呂曉娟, 劉吉平, 等. 子宮頸癌保留雙側卵巢功能的放療方法研究. 實用腫瘤雜志, 2019, 34(6): 540-549.
33.	Lv X J, Cheng X L, Tu Y Q, et al. Association between the location of transposed ovary and ovarian dose in patients with cervical cancer treated with postoperative pelvic radiotherapy. Radiat Oncol, 2019, 14(1): 230.
34.	Xu H, Guo C, Zhang X, et al. Significance of ovarian transposition in the preservation of ovarian function for young cervical cancer patients undergoing postoperative volumetric modulated radiotherapy. Ann Transl Med, 2021, 9(23): 1717.
35.	Jadon R, Pembroke C A, Hanna C L, et al. A systematic review of organ motion and image-guided strategies in external beam radiotherapy for cervical cancer. Clin Oncol (R Coll Radiol), 2014, 26(4): 185-196.
36.	Li Y, Gong Z, Liu M, et al. 3D-US and CBCT dual-guided radiotherapy for postoperative uterine malignancy: a primary workflow set-up. Technol Cancer Res Treat, 2023, 22: 15330338231212082.
37.	Avgousti R, Antypas C, Armpilia C, et al. Adaptive radiation therapy: when, how and what are the benefits that literature provides?. Cancer Radiother, 2022, 26(4): 622-636.
38.	許文哲, 王長建, 馬一鳴, 等. 核磁共振圖像引導的放療技術進展. 生物醫學工程學雜志, 2021, 38(1): 161-168.
39.	Shelley C E, Barraclough L H, Nelde C L, et al. Adaptive radiotherapy in the management of cervical cancer: review of strategies and clinical implementation. Clin Oncol (R Coll Radiol), 2021, 33(9): 579-590.
40.	Chuter R W, Whitehurst P, Choudhury A, et al. Technical note: investigating the impact of field size on patient selection for the 1. 5T MR-Linac. Med Phys, 2017, 44(11): 5667-5671.
41.	王光宇, 晏俊芳, 汪之群, 等. 基于iCBCT在線自適應放療在盆腔腫瘤中的臨床應用. 中華放射腫瘤學雜志, 2023, 32(6): 526-532.
42.	Peng H, Zhang J, Xu N, et al. Fan beam CT-guided online adaptive external radiotherapy of uterine cervical cancer: a dosimetric evaluation. BMC Cancer, 2023, 23(1): 588.
43.	楊波, 汪之群, 孟祥銀, 等. Ethos宮頸癌在線自動生成自適應放療計劃魯棒性研究. 中華放射腫瘤學雜志, 2024, 33(2): 145-151.
44.	Waters M, Price A, Laugeman E, et al. CT-based online adaptive radiotherapy improves target coverage and organ at risk (OAR) avoidance in stereotactic body radiation therapy (SBRT) for prostate cancer. Clin Transl Radiat Oncol, 2024, 44: 100693.
45.	Gan G, Gong W, Jia L, et al. Study of peripheral dose from low-dose CT to adaptive radiotherapy of postoperative prostate cancer. Front Oncol, 2023, 13: 1227946.
46.	許銀, 左宗超, 張顯梅, 等. 含硫輻射防護劑的研究進展. 現代腫瘤醫學, 2021, 29(10): 1801-1805.
47.	曾福斌, 張火俊. 高壓氧增強胰腺癌放射治療敏感性的研究進展. 中華胰腺病雜志, 2023, 23(5): 397-400.
48.	Ali Y F, Hong Z, Liu N A, et al. Clock in radiation oncology clinics: cost-free modality to alleviate treatment-related toxicity. Cancer Biol Ther, 2022, 23(1): 201-210.

1. Al-Hallaq H, Batista V, Kügele M, et al. The role of surface-guided radiation therapy for improving patient safety. Radiother Oncol, 2021, 163: 229-236.
2. 林志悅, 許晨迪, 李宗泰, 等. 基于一體化CT直線加速器圖像引導放療的宮頸癌不同體位固定方式的對比研究. 中華腫瘤防治雜志, 2023, 30(15): 932-936.
3. 王宇留, 方涌文, 林曉生, 等. 基于CBCT分析三種體位固定技術在盆腔腫瘤放療中的應用比較. 現代腫瘤醫學, 2023, 31(17): 3237-3242.
4. 邱騰, 于大海, 趙迪, 等. 真空墊聯合CIVCO俯臥位托架在直腸癌放療擺位中的應用. 現代腫瘤醫學, 2024, 32(2): 316-322.
5. 鐘嘉健, 丘敏敏, 林澤煌, 等. 宮頸癌放療腰圍變化與兩種體位的相關性研究. 中國當代醫藥, 2021, 28(10): 159-162.
6. 王新新, 劉桂芝, 梁廣立. 基于錐形束CT直腸癌調強放療固定方式的臨床效果分析. 吉林醫學, 2021, 42(5): 1082-1084.
7. 郭雨軍, 李婷, 楊鑫, 等. 放療計劃定量評估在宮頸癌外照射精準放療流程管理中的應用. 南方醫科大學學報, 2023, 43(6): 1035-1040.
8. Yan H, Wu M, Wang W, et al. Dosimetry and acute radiation enteritis comparison between prone and supine position in IMRT for gynecological cancers. J Appl Clin Med Phys, 2023, 24(12): e14135.
9. 許晨迪, 姜曉勃, 王亞娟, 等. 基于扇形束CT研究不同固定體位下宮頸癌術后放療中膀胱體積改變對膀胱和小腸受照劑量的影響. 中國醫學物理學雜志, 2023, 40(5): 529-535.
10. 羅丹, 孔為民, 陳姝寧. 宮頸癌放療后放射性直腸炎發生情況及其相關因素分析. 醫學綜述, 2021, 27(2): 400-403, 408.
11. Brennan V S, Curran B, Skourou C, et al. A novel dynamic arc treatment planning solution to reduce dose to small bowel in preoperative radiotherapy for rectal cancer. Med Dosim, 2019, 44(3): 258-265.
12. 鄭蓮容, 黎桂華, 朱志鵬. 宮頸癌患者四種容積旋轉調強計劃小腸的劑量學比較. 影像研究與醫學應用, 2022, 6(15): 34-37.
13. 郝金龍, 曾靜, 宋明永, 等. 射野回避區域的設置對于宮頸癌容積旋轉調強計劃劑量學的影響. 現代腫瘤醫學, 2023, 31(12): 2298-2303.
14. Yoshihiro U, Shingo O, Masaru I, et al. Strategies for reducing ovarian dose in volumetric modulated arc therapy (VMAT) for postoperative uterine cervical cancer. Br J Radiol, 2018, 91(1081): 20160777.
15. 馬敏, 戴建榮. 非共面放療技術的實現方式. 中華放射腫瘤學雜志, 2022, 31(1): 108-111.
16. 王東, 龐亞, 吳哲. 床轉角對宮頸癌非共面調強放療計劃的影響. 醫療衛生裝備, 2022, 43(7): 47-50, 59.
17. 董勝楠, 黃洋洋, 楊軍, 等. 非共面IMRT在宮頸癌放療計劃中保護卵巢的可行性探討. 現代腫瘤醫學, 2023, 31(1): 140-143.
18. 陳旭明, 陳穎, 許奕. 非共面容積旋轉調強在宮頸癌術后放射治療中的劑量學研究. 中國醫療設備, 2019, 34(1): 22-24, 33.
19. Sharfo A W M, Rossi L, Dirkx M L P, et al. Complementing prostate SBRT VMAT with a two-beam non-coplanar IMRT class solution to enhance rectum and bladder sparing with minimum increase in treatment time. Front Oncol, 2021, 11: 620978.
20. Liang B, Wei R, Zhang J, et al. Applying pytorch toolkit to plan optimization for circular cone based robotic radiotherapy. Radiat Oncol, 2022, 17: 82.
21. 馬建萍, 夏新舍, 潘聞燕, 等. 膀胱充盈狀態對宮頸癌調強放療子宮及危及器官的影響. 中華放射醫學與防護雜志, 2019, 39(9): 652-657.
22. Jin F, Liu Q, Luo H, et al. Dynamic changes in bladder morphology over time in cervical cancer patients. Cancer Control, 2021, 28: 10732748211021082.
23. 鐘嘉健, 丘敏敏, 鄧永錦, 等. 兩種膀胱充盈方式在宮頸癌術后調強放療中的對比. 中華腫瘤防治雜志, 2021, 28(12): 944-948.
24. 黃家文, 張梅芳, 傅萬凱, 等. 膀胱不同充盈狀態在宮頸癌調強放療中的應用分析. 現代腫瘤醫學, 2023, 31(17): 3242-3247.
25. Babar M, Katz A, Ciatto M. Dosimetric and clinical outcomes of SpaceOAR in men undergoing external beam radiation therapy for localized prostate cancer: a systematic review. J Med Imag Radiat On, 2021, 65(3): 384-397.
26. Payne H A, Jain S, Peedell C, et al. Delphi study to identify consensus on patient selection for hydrogel rectal spacer use during radiation therapy for prostate cancer in the UK. BMJ Open, 2022, 12(7): e060506.
27. Achard V, Ris F, Rouzaud M, et al. Sexual organ-sparing with hydrogel spacer injections for rectal cancer radiotherapy: a feasibility pilot study. Br J Radiol, 2021, 94(1120): 20200931.
28. Grewal H, Kedar R, Dhillon G, et al. SpaceOAR hydrogel complications in prostate cancer. Br J Radiol, 2023, 96(1152): 20230717.
29. Latorzeff I, Bruguière E, Bogart E, et al. Use of a biodegradable, contrast-filled rectal spacer balloon in intensity-modulated radiotherapy for intermediate-risk prostate cancer patients: dosimetric gains in the BioPro-RCMI-1505 study. Front Oncol, 2021, 11: 701998.
30. Ahmad Khalil D, Wulff J, Jazmati D, et al. Is an endorectal balloon beneficial for rectal sparing after spacer implantation in prostate cancer patients treated with hypofractionated intensity-modulated proton beam therapy? A dosimetric and radiobiological comparison study. Curr Oncol, 2023, 30(1): 758-768.
31. 馬曉欣, 向陽, 狄文, 等. 盆腔惡性腫瘤放療前卵巢移位術中國專家共識(2023年版). 中國實用婦科與產科雜志, 2023, 39(11): 1114-1118.
32. 程曉龍, 呂曉娟, 劉吉平, 等. 子宮頸癌保留雙側卵巢功能的放療方法研究. 實用腫瘤雜志, 2019, 34(6): 540-549.
33. Lv X J, Cheng X L, Tu Y Q, et al. Association between the location of transposed ovary and ovarian dose in patients with cervical cancer treated with postoperative pelvic radiotherapy. Radiat Oncol, 2019, 14(1): 230.
34. Xu H, Guo C, Zhang X, et al. Significance of ovarian transposition in the preservation of ovarian function for young cervical cancer patients undergoing postoperative volumetric modulated radiotherapy. Ann Transl Med, 2021, 9(23): 1717.
35. Jadon R, Pembroke C A, Hanna C L, et al. A systematic review of organ motion and image-guided strategies in external beam radiotherapy for cervical cancer. Clin Oncol (R Coll Radiol), 2014, 26(4): 185-196.
36. Li Y, Gong Z, Liu M, et al. 3D-US and CBCT dual-guided radiotherapy for postoperative uterine malignancy: a primary workflow set-up. Technol Cancer Res Treat, 2023, 22: 15330338231212082.
37. Avgousti R, Antypas C, Armpilia C, et al. Adaptive radiation therapy: when, how and what are the benefits that literature provides?. Cancer Radiother, 2022, 26(4): 622-636.
38. 許文哲, 王長建, 馬一鳴, 等. 核磁共振圖像引導的放療技術進展. 生物醫學工程學雜志, 2021, 38(1): 161-168.
39. Shelley C E, Barraclough L H, Nelde C L, et al. Adaptive radiotherapy in the management of cervical cancer: review of strategies and clinical implementation. Clin Oncol (R Coll Radiol), 2021, 33(9): 579-590.
40. Chuter R W, Whitehurst P, Choudhury A, et al. Technical note: investigating the impact of field size on patient selection for the 1. 5T MR-Linac. Med Phys, 2017, 44(11): 5667-5671.
41. 王光宇, 晏俊芳, 汪之群, 等. 基于iCBCT在線自適應放療在盆腔腫瘤中的臨床應用. 中華放射腫瘤學雜志, 2023, 32(6): 526-532.
42. Peng H, Zhang J, Xu N, et al. Fan beam CT-guided online adaptive external radiotherapy of uterine cervical cancer: a dosimetric evaluation. BMC Cancer, 2023, 23(1): 588.
43. 楊波, 汪之群, 孟祥銀, 等. Ethos宮頸癌在線自動生成自適應放療計劃魯棒性研究. 中華放射腫瘤學雜志, 2024, 33(2): 145-151.
44. Waters M, Price A, Laugeman E, et al. CT-based online adaptive radiotherapy improves target coverage and organ at risk (OAR) avoidance in stereotactic body radiation therapy (SBRT) for prostate cancer. Clin Transl Radiat Oncol, 2024, 44: 100693.
45. Gan G, Gong W, Jia L, et al. Study of peripheral dose from low-dose CT to adaptive radiotherapy of postoperative prostate cancer. Front Oncol, 2023, 13: 1227946.
46. 許銀, 左宗超, 張顯梅, 等. 含硫輻射防護劑的研究進展. 現代腫瘤醫學, 2021, 29(10): 1801-1805.
47. 曾福斌, 張火俊. 高壓氧增強胰腺癌放射治療敏感性的研究進展. 中華胰腺病雜志, 2023, 23(5): 397-400.
48. Ali Y F, Hong Z, Liu N A, et al. Clock in radiation oncology clinics: cost-free modality to alleviate treatment-related toxicity. Cancer Biol Ther, 2022, 23(1): 201-210.

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