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首页> 外文期刊>Radiotherapy and oncology: Journal of the European Society for Therapeutic Radiology and Oncology >Tumor bed delineation for external beam accelerated partial breast irradiation: A systematic review
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Tumor bed delineation for external beam accelerated partial breast irradiation: A systematic review

机译：肿瘤床勾画外束加速局部乳房照射：系统评价

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In recent years, accelerated partial breast irradiation (APBI) has been considered an alternative to whole breast irradiation for patients undergoing breast-conserving therapy. APBI delivers higher doses of radiation in fewer fractions to the post-lumpectomy tumor bed with a 1-2 cm margin, targeting the area at the highest risk of local recurrence while sparing normal breast tissue. However, there are inherent challenges in defining accurate target volumes for APBI. Studies have shown that significant interobserver variation exists among radiation oncologists defining the lumpectomy cavity, which raises the question of how to improve the accuracy and consistency in the delineation of tumor bed volumes. The combination of standardized guidelines and surgical clips significantly improves an observer's ability in delineation, and it is the standard in multiple ongoing external-beam APBI trials. However, questions about the accuracy of the clips to mark the lumpectomy cavity remain, as clips only define a few points at the margin of the cavity. This paper reviews the techniques that have been developed so far to improve target delineation in APBI delivered by conformal external beam radiation therapy, including the use of standardized guidelines, surgical clips or fiducial markers, pre-operative computed tomography imaging, and additional imaging modalities, including magnetic resonance imaging, ultrasound imaging, and positron emission tomography/computed tomography. Alternatives to post-operative APBI, future directions, and clinical recommendations were also discussed.
机译：近年来，对于接受保乳治疗的患者，加速部分乳房照射（APBI）被认为是全乳房照射的替代方法。 APBI以较少的分数将更高剂量的辐射以1-2 cm的余量提供给-切除术后的肿瘤床，目标是局部复发风险最高的区域，同时保留了正常的乳房组织。但是，为APBI定义准确的目标量存在固有的挑战。研究表明，在定义肿块切除术腔的放射肿瘤学家之间存在着显着的观察者间差异，这引发了一个问题，即如何提高描绘肿瘤床体积的准确性和一致性。标准化指南和手术夹的结合可显着提高观察者的勾画能力，并且它是正在进行的多次外部束APBI试验的标准。然而，由于夹子仅在腔的边缘处限定了几个点，因此仍存在关于夹子在肿块切除术腔上标记的准确性的问题。本文回顾了迄今为止为改善保形外束放射治疗在APBI中的靶标定形所开发的技术，包括使用标准化指南，手术夹或基准标记，术前计算机断层扫描成像以及其他成像方式，包括磁共振成像，超声成像和正电子发射断层扫描/计算机断层扫描。还讨论了术后APBI的替代方法，未来方向和临床建议。

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