Dose-Escalated High-Precision Radiotherapy: a Method to Overcome Variations in Biology and Radiosensitivity Limiting the Success of Conventional Approaches?

摘要: This chapter addresses the role of radiation dose escalation as a method to increase tumor cell eradication and improve local control thereby survival cancer patients. While treatment can be designed cover whole with homogeneously distributed full-radiation or simultaneously integrated boost defined subvolumes, normal tissue exposure ultimately limits that safely delivered. Exceeding certain thresholds critical structures might result in unacceptable permanent dysfunction sequelae, profound consequences on quality life. With improved methods target volume definition, image-guided external beam radiotherapy, advanced brachytherapy applications, advent proton heavy-ion-beam facilities, possibilities for safe have never been more promising than they are today. Whether such approaches will able overcome substantial variability sensitivity final outcome remains demonstrated sufficiently powered prospective studies. Preliminary experience suggests rates, e.g., limited stage non-small lung, nasopharyngeal, uterine cervix cancers, promising. It important predict which patients treated high-dose alone should receive radiosensitizers, hypoxia-modifying drugs or, general, modifiers response order optimize cure rates.