Abstract
The key goal and main challenge of radiation therapy is the elimination of tumors without any concurring damages of the surrounding healthy tissues and organs. Radiation doses required to achieve sufficient cancer‐cell kill exceed in most clinical situations the dose that can be tolerated by the healthy tissues, especially when large parts of the affected organ are irradiated. High‐precision radiation oncology aims at optimizing tumor coverage, while sparing normal tissues. Medical imaging during the preparation phase, as well as in the treatment room for localization of the tumor and directing the beam, referred to as image‐guided radiotherapy (IGRT), is the cornerstone of precision radiation oncology. Sophisticated high‐resolution real‐time IGRT using X‐rays, computer tomography, magnetic resonance imaging, or ultrasound, enables delivery of high radiation doses to tumors without significant damage of healthy organs. IGRT is the most convincing success story of radiation oncology over the last decades, and it remains a major driving force of innovation, contributing to the development of personalized oncology, for example, through the use of real‐time imaging biomarkers for individualized dose delivery.
Highlights
Radiation therapy aims for destroying the tumor without damaging the surrounding normal tissues and organs
Clinical trials involving large numbers of patients suffering from cervical cancer have shown the effectiveness of adaptive RT taking into account tumor shrinkage at the end of initial chemoradiation, with a risk-adapted radiation dose prescription to different tumor regions, and adaptation of the treatment technique according to individual response and adjacent organs at risk (OAR) [88]
The proven concept that imageguided radiotherapy (IGRT) enables full tumor coverage with sufficient radiation dose and sparing normal tissue allows improving the outcome of many cancer patients belongs to the major contributions of radiation oncology in cancer medicine
Summary
Radiation therapy aims for destroying the tumor without damaging the surrounding normal tissues and organs. Radiation doses required to achieve sufficient cell kill in cancers exceed in most clinical situations the dose that is tolerated by the normal tissues, especially when large parts of the respective organ are being irradiated. This delicate balance between the radiation dose–response relationship for tumor cell kill and probability of normal tissue toxicity represents the core principle and the main challenge of radiation oncology. Medical imaging is required for the precise adjustment of radiation beams targeting tumors that are located in the inner of the body of the patient. We review quantitative imaging for response-adaptive radiation oncology
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