Hypoxia Imaging and Adaptive Radiotherapy: A State-of-the-Art Approach in the Management of Glioma.

摘要: Severe hypoxia [oxygen partial pressure (pO2) below 5-10 mmHg] is more frequent in glioblastoma multiforme (GBM) compared to lower-grade gliomas. Seminal studies the 1950s demonstrated that was associated with increased resistance low-linear energy transfer (LET) ionizing radiation. In experimental conditions, total radiation dose has be multiplied by a factor of 3 achieve same cell lethality anoxic situations. The presence human tumors assumed contribute treatment failures after radiotherapy (RT) cancer patients. Therefore, logical way overcome hypoxia-induced radioresistance would deliver substantially higher doses RT hypoxic volumes delineated on pre-treatment imaging as biological target (BTVs). Such an approach faces various fundamental, technical, and clinical challenges. present review addresses several technical points related delineation zones, which include: spatial accuracy, quantitative vs. relative threshold, variations levels during RT, availability tracers. feasibility assessment tool for early tumor response predicting long-term outcomes discussed. Hypoxia painting likewise examined. As oncologist's point view, maps should converted into dose-distribution objectives planning. Taking account physics radiobiology irradiation beams, preliminary silico are required investigate escalation terms normal tissue tolerance before trials undertaken.