Recent advances in radiation oncology

Abstract

Radiotherapy (RT) is very much a technology-driven treatment modality in the management of cancer. RT techniques have changed significantly over the past few decades, thanks to improvements in engineering and computing. We aim to highlight the recent developments in radiation oncology, focusing on the technological and biological advances. We will present state-of-the-art treatment techniques, employing photon beams, such as intensity-modulated RT, volumetric-modulated arc therapy, stereotactic body RT and adaptive RT, which make possible a highly tailored dose distribution with maximum normal tissue sparing. We will analyse all the steps involved in the treatment: imaging, delineation of the tumour and organs at risk, treatment planning and finally image-guidance for accurate tumour localisation before and during treatment delivery. Particular attention will be given to the crucial role that imaging plays throughout the entire process. In the case of adaptive RT, the precise identification of target volumes as well as the monitoring of tumour response/modification during the course of treatment is mainly based on multimodality imaging that integrates morphological, functional and metabolic information. Moreover, real-time imaging of the tumour is essential in breathing adaptive techniques to compensate for tumour motion due to respiration.Brief reference will be made to the recent spread of particle beam therapy, in particular to the use of protons, but also to the yet limited experience of using heavy particles such as carbon ions.Finally, we will analyse the latest biological advances in tumour targeting. Indeed, the effectiveness of RT has been improved not only by technological developments but also through the integration of radiobiological knowledge to produce more efficient and personalised treatment strategies.

An Evaluation of Atlas Selection Methods for Atlas-Based Automatic Segmentation in Radiotherapy Treatment Planning

“…An earlier investigation by Ramus and Malandain [52], on 105 Head and Neck CTs, showed poor correlation between the similarity descriptors and segmentation performance. In this work, 1 we wish to answer the question "how does the best atlas selection method compare to optimal performance in the context of RT?." A large number of atlas selection methods are investigated, using a wide range of similarity descriptors.…”

“…C ONTOURING of organs-at-risk (OARs) in radiotherapy (RT) is a necessary step prior to treatment planning. Accurate delineation of OARs to be avoided is required to estimate and reduce the delivered dose in order to control side effects of treatment [1]. Delineation of OARs and targets (tumors) is typically performed by clinical experts on a 3D anatomical image, normally Computed Tomography (CT).…”

“…For instance, mean manual segmentation times for Head & Neck cases ranging from 28.5 minutes [2] up to 3 hours [3] are reported in literature, depending on which structures are delineated. As a consequence, automatic techniques have gained popularity in the last decade [1], [4], with atlas-based segmentation being favored in commercial systems [1], [5].…”

Current treatment, particle radiotherapy, and boron neutron capture therapy for advanced oral cancer in patients

“…Photons and fast neutrons are characterized by high energy near the body surface and an exponential decrease in energy with increase in depth . Normal tissues reaching the tumor and existing in the deep part of the tumor are all irradiated.…”

Development and Radiation Response Assessment in A Novel Syngeneic Mouse Model of Tongue Cancer: 2D Culture, 3D Organoids and Orthotopic Allografts

“…Radiation therapy is an integral part of the management of patients with OSCC [4]. Significant advancements in radiation delivery methods have led to improved outcomes in patients but resistance to radiation remains a clinical problem [5,6].…”