How rapid advances in imaging are defining the future of precision radiation oncology

Laura Beaton,Ricky A. Sharma,Mark N. Gaze,Steve Bandula

doi:10.1038/s41416-019-0412-y

Laura Beaton, Ricky A. Sharma

Open Access

https://doi.org/10.1038/s41416-019-0412-y

Copy DOI

Abstract

Imaging has an essential role in the planning and delivery of radiotherapy. Recent advances in imaging have led to the development of advanced radiotherapy techniques—including image-guided radiotherapy, intensity-modulated radiotherapy, stereotactic body radiotherapy and proton beam therapy. The optimal use of imaging might enable higher doses of radiation to be delivered to the tumour, while sparing normal surrounding tissues. In this article, we review how the integration of existing and novel forms of computed tomography, magnetic resonance imaging and positron emission tomography have transformed tumour delineation in the radiotherapy planning process, and how these advances have the potential to allow a more individualised approach to the cancer therapy. Recent data suggest that imaging biomarkers that assess underlying tumour heterogeneity can identify areas within a tumour that are at higher risk of radio-resistance, and therefore potentially allow for biologically focussed dose escalation. The rapidly evolving concept of adaptive radiotherapy, including artificial intelligence, requires imaging during treatment to be used to modify radiotherapy on a daily basis. These advances have the potential to improve clinical outcomes and reduce radiation-related long-term toxicities. We outline how recent technological advances in both imaging and radiotherapy delivery can be combined to shape the future of precision radiation oncology.

Highlights

Dynamic contrast-enhanced-magnetic resonance imaging (MRI) Dynamic contrast-enhanced-MRI (DCE-MRI) is a quantitative MRI technique that allows investigation of tissue microvascular structure and function by evaluating the pharmacokinetics of an extracellular low molecular weight contrast agent as it passes through the tumour vasculature
As the range of a proton beam varies as a function of the relative stopping power (RSP) of the absorbing material, there is a degree of range uncertainty due to the conversion of Hounsfield units (HU) in the planning computed tomography (CT) scan to RSP
Integration of artificial intelligence into the radiotherapy planning pathway will allow adaptive radiotherapy to become a reality in clinical practice

Summary

REVIEW ARTICLE

How rapid advances in imaging are defining the future of precision radiation oncology Laura Beaton[1], Steve Bandula[1,2], Mark N. We review how the integration of existing and novel forms of computed tomography, magnetic resonance imaging and positron emission tomography have transformed tumour delineation in the radiotherapy planning process, and how these advances have the potential to allow a more individualised approach to the cancer therapy. The rapidly evolving concept of adaptive radiotherapy, including artificial intelligence, requires imaging during treatment to be used to modify radiotherapy on a daily basis. These advances have the potential to improve clinical outcomes and reduce radiation-related long-term toxicities. We outline how recent technological advances in both imaging and radiotherapy delivery can be combined to shape the future of precision radiation oncology.

INTRODUCTION

Vascular fraction fraction

CyberKnifeTM or dedicated linac

CONCLUSIONS

Findings

ADDITIONAL INFORMATION