RESUMEN
In recent years, the development of both medical imaging and new systemic agents (targeted therapy and immunotherapy) have revolutionized the field of oncology, leading to a new entity: oligometastatic disease. Adding local treatment of oligometastases to systemic treatment could lead to prolonged survival with no significant impact on quality of life. Given the high prevalence of lung oligometastases and the new systemic agents coming with increased pulmonary toxicity, this article provides a comprehensive review of the current state-of-art for radiotherapy of lung oligometastases. After reviewing pretreatment workup, the authors define several radiotherapy regimen based on the localization and size of the oligometastases. A comment on the synergistic combination of medical treatment and radiotherapy is also made, projecting on future steps in this specific clinical setting.
Asunto(s)
Neoplasias Pulmonares , Radiocirugia , Humanos , Calidad de Vida , Radiocirugia/métodos , Pulmón , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/patología , Diagnóstico por ImagenRESUMEN
Metastatic lung cancer classically portends a poor prognosis. The management of metastatic lung cancer has dramatically changed with the emergence of immune checkpoint inhibitors, targeted therapy and due to a better understanding of the oligometastatic process. In metastatic lung cancers, radiation therapy which was only used with palliative intent for decades, represents today a promising way to treat primary and oligometastatic sites with a curative intent. Herein we present through a literature review the role of radiotherapy in the management of synchronous metastatic lung cancers.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas , Neoplasias Pulmonares , Radiocirugia , Humanos , Neoplasias Pulmonares/patología , Carcinoma de Pulmón de Células no Pequeñas/patologíaRESUMEN
In radiotherapy, patient positioning has long been ensured by ionizing imaging (kV or MV). Over the past ten years, surface-guided radiotherapy has appeared in radiotherapy departments. It is a continuous three-dimensional acquisition of the surface of the patient, based on the use of several optical cameras. The acquired surface is compared to an expected surface (usually taken from the planning scanner). Operators can constantly appreciate poor position, anatomical deformity or patient shift. Thus, the system allows an aid to the positioning of the patient, possibly without tattooing, but also a follow-up of the patient during the duration of the session. The most obvious contribution of the system concerns the treatment of the breast. In fact, for this location, the bone registration is not ideal and the target is visible in surface-guided radiotherapy. These systems also make it possible to treat in deep inspiration breath hold. But several other locations can benefit from it (pelvis, thorax, etc.).
Asunto(s)
Braquiterapia , Oncología por Radiación , Radioterapia Guiada por Imagen , Humanos , Radioterapia Guiada por Imagen/métodos , Braquiterapia/métodos , Planificación de la Radioterapia Asistida por ComputadorRESUMEN
We present the update of the recommendations of the French society of oncological radiotherapy on respiratory motion management for external radiotherapy treatment. Since twenty years and the report 62 of ICRU, motion management during the course of radiotherapy treatment has become an increasingly significant concern, particularly with the development of hypofractionated treatments under stereotactic conditions, using reduced safety margins. This article related orders of motion amplitudes for different organs as well as the definition of the margins in radiotherapy. An updated review of the various movement management strategies is presented as well as main technological solutions enabling them to be implemented: when acquiring anatomical data, during planning and when carrying out treatment. Finally, the management of these moving targets, such as it can be carried out in radiotherapy departments, will be detailed for a few concrete examples of localizations (abdominal, thoracic and hepatic).
Asunto(s)
Neoplasias Abdominales/radioterapia , Contencion de la Respiración , Movimientos de los Órganos , Respiración , Espirometría/métodos , Neoplasias Torácicas/radioterapia , Neoplasias Abdominales/diagnóstico por imagen , Espiración , Francia , Humanos , Inhalación , Imagen por Resonancia Magnética , Movimientos de los Órganos/fisiología , Aceleradores de Partículas , Oncología por Radiación , Planificación de la Radioterapia Asistida por Computador , Sociedades Médicas , Neoplasias Torácicas/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodosRESUMEN
Herein are presented the recommendations from the Société française de radiothérapie oncologique regarding indications and modalities of lung cancer radiotherapy. The recommendations for delineation of the target volumes and organs at risk are detailed.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Neoplasias Pulmonares/radioterapia , Carcinoma Pulmonar de Células Pequeñas/radioterapia , Carcinoma de Pulmón de Células no Pequeñas/patología , Fraccionamiento de la Dosis de Radiación , Francia , Humanos , Neoplasias Pulmonares/patología , Estadificación de Neoplasias , Oncología por Radiación , Radioterapia/métodos , Dosificación Radioterapéutica , Radioterapia Guiada por Imagen , Respiración , Carcinoma Pulmonar de Células Pequeñas/patología , Carga TumoralRESUMEN
We present an update of the French society of oncological radiotherapy recommendation regarding indication, doses, and technique of radiotherapy for intrathoracic metastases. The recommendations for delineation of the target volumes and critical organs are detailed.
Asunto(s)
Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/secundario , Radiocirugia , Radioterapia Conformacional , Fraccionamiento de la Dosis de Radiación , Francia , Humanos , Órganos en Riesgo/efectos de la radiación , Cuidados Paliativos/métodos , Oncología por Radiación , Dosificación Radioterapéutica , Radioterapia Guiada por ImagenRESUMEN
Image-guided radiation therapy consists in acquiring in-room images to improve patient and mainly tumour set up accuracy. Many devices based on ionising or non-ionising radiations were designed in recent years. The use of such devices is of major importance in the management of patient radiotherapy courses. Those imaging sessions require to clearly define procedures in each radiotherapy department (image modality, acquisition frequency, corrective action, staff training and tasks). A quick review of the different existing image-guided radiation therapy devices is presented. In addition, the results of a French national survey about image-guided radiation therapy are presented: the survey is about both equipment and procedures. A total of 57 radiotherapy departments have participated, representing more than 160 treatment devices. About three linear accelerators out of four are equipped with an image-guiding device. The most common equipment is the CBCT system. Most centres have set up training sessions for the technicians to allow them to analyse online daily images. The management of in-room imaging dose is still under investigation, but many centres use an accounting scheme. While the devices are used to adjust the positioning of patients, in more than half of the centres, the practice had an impact on the choice of clinical and planning target volume margins. This survey led to an inventory in 2015, and could be renewed in some years.
Asunto(s)
Radioterapia Guiada por Imagen/instrumentación , Radioterapia Guiada por Imagen/normas , Francia , HumanosRESUMEN
The Laboratory of Ionizing Radiation Dosimetry of the IRSN (France) is developing an instrumented anthropomorphic phantom in order to measure the effective dose for photon fields at workplaces. This anthropomorphic phantom will be equipped with small active detectors located inside at chosen positions. The aim of this paper is to present the development of these new detectors showing the results of the characterisation of the prototype under metrological conditions. New evaluations of the effective dose for standard and non-homogenous irradiation configurations taking into account the real constraints of the project have been done validating the feasibility and utility of the instrument.