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：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

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.	林志悦, 许晨迪, 李宗泰, 等. 基于一体化CT直线加速器图像引导放疗的宫颈癌不同体位固定方式的对比研究. 中华肿瘤防治杂志, 2023, 30(15): 932-936.
3.	王宇留, 方涌文, 林晓生, 等. 基于CBCT分析三种体位固定技术在盆腔肿瘤放疗中的应用比较. 现代肿瘤医学, 2023, 31(17): 3237-3242.
4.	邱腾, 于大海, 赵迪, 等. 真空垫联合CIVCO俯卧位托架在直肠癌放疗摆位中的应用. 现代肿瘤医学, 2024, 32(2): 316-322.
5.	钟嘉健, 丘敏敏, 林泽煌, 等. 宫颈癌放疗腰围变化与两种体位的相关性研究. 中国当代医药, 2021, 28(10): 159-162.
6.	王新新, 刘桂芝, 梁广立. 基于锥形束CT直肠癌调强放疗固定方式的临床效果分析. 吉林医学, 2021, 42(5): 1082-1084.
7.	郭雨军, 李婷, 杨鑫, 等. 放疗计划定量评估在宫颈癌外照射精准放疗流程管理中的应用. 南方医科大学学报, 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.	许晨迪, 姜晓勃, 王亚娟, 等. 基于扇形束CT研究不同固定体位下宫颈癌术后放疗中膀胱体积改变对膀胱和小肠受照剂量的影响. 中国医学物理学杂志, 2023, 40(5): 529-535.
10.	罗丹, 孔为民, 陈姝宁. 宫颈癌放疗后放射性直肠炎发生情况及其相关因素分析. 医学综述, 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.	郑莲容, 黎桂华, 朱志鹏. 宫颈癌患者四种容积旋转调强计划小肠的剂量学比较. 影像研究与医学应用, 2022, 6(15): 34-37.
13.	郝金龙, 曾静, 宋明永, 等. 射野回避区域的设置对于宫颈癌容积旋转调强计划剂量学的影响. 现代肿瘤医学, 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.	马敏, 戴建荣. 非共面放疗技术的实现方式. 中华放射肿瘤学杂志, 2022, 31(1): 108-111.
16.	王东, 庞亚, 吴哲. 床转角对宫颈癌非共面调强放疗计划的影响. 医疗卫生装备, 2022, 43(7): 47-50, 59.
17.	董胜楠, 黄洋洋, 杨军, 等. 非共面IMRT在宫颈癌放疗计划中保护卵巢的可行性探讨. 现代肿瘤医学, 2023, 31(1): 140-143.
18.	陈旭明, 陈颖, 许奕. 非共面容积旋转调强在宫颈癌术后放射治疗中的剂量学研究. 中国医疗设备, 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.	马建萍, 夏新舍, 潘闻燕, 等. 膀胱充盈状态对宫颈癌调强放疗子宫及危及器官的影响. 中华放射医学与防护杂志, 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.	钟嘉健, 丘敏敏, 邓永锦, 等. 两种膀胱充盈方式在宫颈癌术后调强放疗中的对比. 中华肿瘤防治杂志, 2021, 28(12): 944-948.
24.	黄家文, 张梅芳, 傅万凯, 等. 膀胱不同充盈状态在宫颈癌调强放疗中的应用分析. 现代肿瘤医学, 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.	马晓欣, 向阳, 狄文, 等. 盆腔恶性肿瘤放疗前卵巢移位术中国专家共识(2023年版). 中国实用妇科与产科杂志, 2023, 39(11): 1114-1118.
32.	程晓龙, 吕晓娟, 刘吉平, 等. 子宫颈癌保留双侧卵巢功能的放疗方法研究. 实用肿瘤杂志, 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.	许文哲, 王长建, 马一鸣, 等. 核磁共振图像引导的放疗技术进展. 生物医学工程学杂志, 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在线自适应放疗在盆腔肿瘤中的临床应用. 中华放射肿瘤学杂志, 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.	杨波, 汪之群, 孟祥银, 等. Ethos宫颈癌在线自动生成自适应放疗计划鲁棒性研究. 中华放射肿瘤学杂志, 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.	许银, 左宗超, 张显梅, 等. 含硫辐射防护剂的研究进展. 现代肿瘤医学, 2021, 29(10): 1801-1805.
47.	曾福斌, 张火俊. 高压氧增强胰腺癌放射治疗敏感性的研究进展. 中华胰腺病杂志, 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. 林志悦, 许晨迪, 李宗泰, 等. 基于一体化CT直线加速器图像引导放疗的宫颈癌不同体位固定方式的对比研究. 中华肿瘤防治杂志, 2023, 30(15): 932-936.
3. 王宇留, 方涌文, 林晓生, 等. 基于CBCT分析三种体位固定技术在盆腔肿瘤放疗中的应用比较. 现代肿瘤医学, 2023, 31(17): 3237-3242.
4. 邱腾, 于大海, 赵迪, 等. 真空垫联合CIVCO俯卧位托架在直肠癌放疗摆位中的应用. 现代肿瘤医学, 2024, 32(2): 316-322.
5. 钟嘉健, 丘敏敏, 林泽煌, 等. 宫颈癌放疗腰围变化与两种体位的相关性研究. 中国当代医药, 2021, 28(10): 159-162.
6. 王新新, 刘桂芝, 梁广立. 基于锥形束CT直肠癌调强放疗固定方式的临床效果分析. 吉林医学, 2021, 42(5): 1082-1084.
7. 郭雨军, 李婷, 杨鑫, 等. 放疗计划定量评估在宫颈癌外照射精准放疗流程管理中的应用. 南方医科大学学报, 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. 许晨迪, 姜晓勃, 王亚娟, 等. 基于扇形束CT研究不同固定体位下宫颈癌术后放疗中膀胱体积改变对膀胱和小肠受照剂量的影响. 中国医学物理学杂志, 2023, 40(5): 529-535.
10. 罗丹, 孔为民, 陈姝宁. 宫颈癌放疗后放射性直肠炎发生情况及其相关因素分析. 医学综述, 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. 郑莲容, 黎桂华, 朱志鹏. 宫颈癌患者四种容积旋转调强计划小肠的剂量学比较. 影像研究与医学应用, 2022, 6(15): 34-37.
13. 郝金龙, 曾静, 宋明永, 等. 射野回避区域的设置对于宫颈癌容积旋转调强计划剂量学的影响. 现代肿瘤医学, 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. 马敏, 戴建荣. 非共面放疗技术的实现方式. 中华放射肿瘤学杂志, 2022, 31(1): 108-111.
16. 王东, 庞亚, 吴哲. 床转角对宫颈癌非共面调强放疗计划的影响. 医疗卫生装备, 2022, 43(7): 47-50, 59.
17. 董胜楠, 黄洋洋, 杨军, 等. 非共面IMRT在宫颈癌放疗计划中保护卵巢的可行性探讨. 现代肿瘤医学, 2023, 31(1): 140-143.
18. 陈旭明, 陈颖, 许奕. 非共面容积旋转调强在宫颈癌术后放射治疗中的剂量学研究. 中国医疗设备, 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. 马建萍, 夏新舍, 潘闻燕, 等. 膀胱充盈状态对宫颈癌调强放疗子宫及危及器官的影响. 中华放射医学与防护杂志, 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. 钟嘉健, 丘敏敏, 邓永锦, 等. 两种膀胱充盈方式在宫颈癌术后调强放疗中的对比. 中华肿瘤防治杂志, 2021, 28(12): 944-948.
24. 黄家文, 张梅芳, 傅万凯, 等. 膀胱不同充盈状态在宫颈癌调强放疗中的应用分析. 现代肿瘤医学, 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. 马晓欣, 向阳, 狄文, 等. 盆腔恶性肿瘤放疗前卵巢移位术中国专家共识(2023年版). 中国实用妇科与产科杂志, 2023, 39(11): 1114-1118.
32. 程晓龙, 吕晓娟, 刘吉平, 等. 子宫颈癌保留双侧卵巢功能的放疗方法研究. 实用肿瘤杂志, 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. 许文哲, 王长建, 马一鸣, 等. 核磁共振图像引导的放疗技术进展. 生物医学工程学杂志, 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在线自适应放疗在盆腔肿瘤中的临床应用. 中华放射肿瘤学杂志, 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. 杨波, 汪之群, 孟祥银, 等. Ethos宫颈癌在线自动生成自适应放疗计划鲁棒性研究. 中华放射肿瘤学杂志, 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. 许银, 左宗超, 张显梅, 等. 含硫辐射防护剂的研究进展. 现代肿瘤医学, 2021, 29(10): 1801-1805.
47. 曾福斌, 张火俊. 高压氧增强胰腺癌放射治疗敏感性的研究进展. 中华胰腺病杂志, 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.

Previous Article
In vivo tumor imaging and therapy based on near-infrared cadmium-free quantum dots
Next Article
Research progress on the mechanisms of probiotics promoting wound healing

Journal of Biomedical Engineering

Advances in research on organ-at-risk protection in pelvic tumor external beam radiotherapy

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content