1Affiliated Cancer Hospital of Nanjing Medical University & Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing 210009, China; 2Fourth School of Clinical Medicine, Nanjing Medical University, Nanjing 210000, China
Abstract：The motion of the tumor limits further improvement in the accuracy of radiotherapy. Real-time monitoring and tracking of tumor location is an emerging technology to improve the accuracy of tumor radiotherapy. According to the adopted methods, it can be broadly divided into non-radiation-based and radiation-based systems. The former system includes ultrasound guidance, nuclear magnetic resonance guidance, electromagnetic tracking, optical image guidance, artificial intelligence-based technologies, and the latter system consists of KV, MV-grade X-ray imaging system and CT-based guidance system. In this review, research progresses on real-time tumor monitoring and tracking technology in radiotherapy, respective advantages and disadvantages and current clinical application were summarized.
Zhan Mengna,Guo Chang,Yin Li et al. Research progress on real-time tumor monitoring and tracking technology in radiotherapy[J]. Chinese Journal of Radiation Oncology, 2021, 30(6): 643-647.
[1] Korreman SS. Image-guided radiotherapy and motion management in lung cancer[J]. Br J Radiol,2015,88(1051):20150100.DOI:10.1259/bjr.20150100. [2] Wu V, Ng A, Cheung E. Intrafractional motion management in external beam radiotherapy[J]. J Xray Sci Technol, 2019, 27(6):1071-1086.DOI:10.3233/XST-180472. [3] O'Shea T, Bamber J, Fontanarosa D, et al. Review of ultrasound image guidance in external beam radiotherapy part Ⅱ:intra-fraction motion management and novel applications[J]. Phys Med Biol, 2016, 61(8):90-137.DOI:10.1088/0031-9155/61/8/r90. [4] Sihono DS, Vogel L, Weib C,et al. A 4D ultrasound real-time tracking system for external beam radiotherapy of upper abdominal lesions under breath-hold. Ein 4D-Ultraschall-Tracking-System für die externe Radiotherapie bei Oberbauchläsionen unter Atemanhalt[J]. Strahlenther Onkol, 2017, 193(3):213-220.DOI:10.1007/s00066-016-1076-7. [5] Hsu A, Miller NR, Evans PM, et al. Feasibility of using ultrasound for real-time tracking during radiotherapy[J]. Med Phys, 2005, 32(6 Pt 1):1500-1512. DOI:10.1118/1.1915934. [6] Lachaine MF, Falco T. Intrafractional prostate motion management with the clarity autoscan system[J]. Med Phys Int, 2013(1):72-80. [7] Ipsen S, Bruder R, O'Brien R, et al. Online 4D ultrasound guidance for real-time motion compensation by MLC tracking[J]. Med Phys, 2016, 43(10):5695-5704.DOI:10.1118/1.4962932. [8] Biston MC, Delcoudert L, Gorsse C, et al. Real-time ultrasound and electromagnetic transmitter based tracking systems for adaptive radiotherapy in prostate cancer patients[J]. Int J Radiat Oncol Biol Phys, 2017, 99(2):223.DOI:10.1016/j.ijrobp.2017.06.548. [9] Biston MC, Zaragori T, Delcoudert L, et al. Comparison of electromagnetic transmitter and ultrasound imaging for intrafraction monitoring of prostate radiotherapy[J]. Radiother Oncol, 2019, 136(1):1-8. DOI:10.1016/j.radonc.2019.03.020 [10] Prall M, Kaderka R, Saito N, et al. Ion beam tracking using ultrasound motion detection[J]. Med Phys, 2014, 41(4):041708. DOI:10.1118/1.4868459. [11] Mantel F, Richter A, Groh C, et al. Changes in penile bulb dose when using the clarity transperineal ultrasound probe:a planning study[J]. Pract Radiat Oncol, 2016, 6(6):337-344.DOI:10.1016/j.prro.2016.04.001. [12] KLÜter S. Technical design and concept of a 0.35 T MR-Linac[J]. Clin Transl Radiat Oncol, 2019, 18(1):98-101.DOI:10.1016/j.ctro.2019.04.007. [13] van Sörnsen de Koste JR, Palacios MA, Bruynzeel AME, et al. MR-guided gated stereotactic radiation therapy delivery for lung, adrenal, and pancreatic tumors:a geometric analysis[J]. Int J Radiat Oncol Biol Phys, 2018, 102(4):858-866.DOI:10.1016/j.ijrobp.2018.05.048. [14] Fast M, van de Schoot A, van de Lindt T, et al. Tumor trailing for liver SBRT on the MR-linac[J]. Int J Radiat Oncol Biol Phys, 2019, 103(2):468-478. DOI:10.1016/j.ijrobp.2018.09.011. [15] Chen AM, Hsu S, Lamb J, et al. MRI-guided radiotherapy for head and neck cancer:initial clinical experience[J]. Clin Trans Oncol, 2018, 20(2):160-168. DOI:10.1007/s12094-017-1704-4. [16] KLÜter S, Katayama S, Spindeldreier CK, et al. First prospective clinical evaluation of feasibility and patient acceptance of magnetic resonance-guided radiotherapy in Germany[J]. Strahlenther Onkol, 2020, 196(8):691-698. DOI:10.1007/s00066-020-01578-z. [17] Alongi F, Rigo M, Figlia V, et al. 1.5 T MR-guided and daily adapted SBRT for prostate cancer:feasibility, preliminary clinical tolerability, quality of life and patient-reported outcomes during treatment[J]. Radiat Oncol, 2020, 15(1):69. DOI:10.1186/s13014-020-01510-w. [18] Witt JS, Rosenberg SA, Bassetti MF. MRI-guided adaptive radiotherapy for liver tumours:visualising the future[J]. Lancet Oncol, 2020, 21(2):74-82. DOI:10.1016/s1470-2045(20)30034-6. [19] Boggs DH, Popple R, McDonald A, et al. Electromagnetic transponder based tracking and gating in the radiotherapeutic treatment of thoracic malignancies[J]. Pract Radiat Oncol, 2019, 9(6):456-464.DOI:10.1016/j.prro.2019.06.021. [20] Zilli T, Scorsetti M, Zwahlen D, et al. ONE SHOT-single shot radiotherapy for localized prostate cancer:study protocol of a single arm, multicenter phase Ⅰ/Ⅱ trial[J]. Radiat Oncol, 2018, 13(1):166.DOI:10.1186/s13014-018-1112-0. [21] Worm ES, Høyer M, Hansen R, et al. A Prospective cohort study of gated stereotactic liver radiation therapy using continuous internal electromagnetic motion monitoring[J]. Int J Radiat Oncol Biol Phys, 2018, 101(2):366-375. DOI:10.1016/j.ijrobp.2018.02.010. [22] James J, Cetnar A, Dunlap NE, et al. Technical note:validation and implementation of a wireless transponder tracking system for gated stereotactic ablative radiotherapy of the liver[J]. Med Phys, 2016, 43(6):2794-2801.DOI:10.1118/1.4948669. [23] Poulsen PR, Worm ES, Hansen R, et al. Respiratory gating based on internal electromagnetic motion monitoring during stereotactic liver radiation therapy:first results[J]. Acta Oncol, 2015, 54(9):1445-1452. DOI:10.3109/0284186x.2015.1062134. [24] Litzenberg DW, Balter JM, Hadley SW, et al. Prostate intrafraction translation margins for real-time monitoring and correction strategies[J]. Prostate Cancer, 2012, 2012:1-6.DOI:10.1155/2012/130579. [25] Keall PJ, Colvill E, O'Brien R, et al. The first clinical implementation of electromagnetic transponder-guided MLC tracking[J]. Med Phys, 2014, 41(2):020702. DOI:10.1118/1.4862509. [26] Sarkar V, Szegedi M, Paxton A, et al. Preliminary clinical experience with Calypso anchored beacons for tumor tracking in lung SBRT[J]. Med Phys, 2020, 47(9):4407-4415. DOI:10.1002/mp.14300. [27] Dang A, Kupelian PA, Cao M, et al. Image-guided radiotherapy for prostate cancer[J]. Transl Androl Urol, 2018, 7(3):308-320.DOI:10.21037/tau.2017.12.37. [28] Chen L, Bai S, Li G, et al. Accuracy of real-time respiratory motion tracking and time delay of gating radiotherapy based on optical surface imaging technique[J]. Radiat Oncol, 2020, 15(1):170.DOI:10.1186/s13014-020-01611-6. [29] Wiant D, Pursley J, Sintay B. SU-D-213CD-02:the accuracy of alignRT guided set-up for whole breast and chestwall irradiation[J]. Med Phys, 2012, 39(6 Pt 3):3617-3618. DOI:10.1118/1.4734687. [30] Zagar TM, Kaidar-Person O, Tang X, et al. Utility of deep inspiration breath hold for left-sided breast radiation therapy in preventing early cardiac perfusion defects:a prospective study[J]. Int J Radiat Oncol Biol Phys, 2017, 97(5):903-909. DOI:10.1016/j.ijrobp.2016.12.017. [31] Reitz D, Carl G, Schönecker S, et al. Real-time intra-fraction motion management in breast cancer radiotherapy:analysis of 2028 treatment sessions[J]. Radiat Oncol, 2018, 13(1):128. DOI:10.1186/s13014-018-1072-4. [32] Heinzerling JH, Hampton CJ, Robinson M, et al. Use of surface-guided radiation therapy in combination with IGRT for setup and intrafraction motion monitoring during stereotactic body radiation therapy treatments of the lung and abdomen[J]. J Appl Clin Med Phys, 2020, 21(5):48-55. DOI:10.1002/acm2.12852. [33] Liu M, Wei X, Ding Y, et al. Application of Optical Laser 3D Surface imaging system (Sentinel) in breast cancer radiotherapy[J]. Sci Rep, 2020, 10(1):7550.DOI:10.1038/s41598-020-64496-1. [34] Freislederer P, Kügele M,öllers M, et al. Recent advanced in surface guided radiation therapy[J]. Radiat Oncol, 2020, 15(1):187.DOI:10.1186/s13014-020-01629-w. [35] Siddique S, Chow JCL. Artificial intelligence in radiotherapy[J]. Rep Pract Oncol Radiother, 2020, 25(4):656-666.DOI:10.1016/j.rpor.2020.03.015. [36] Laurent R, Henriet J, Salomon M, et al. Utilisation d'un réseau de neurones artificiels pour la simulation des mouvements pulmonaires[J]. Cancer Radiother, 2011, 15(2):123-129. DOI:10.1016/j.canrad.2010.07.636. [37] Mafi M, Moghadam SM. Real-time prediction of tumor motion using a dynamic neural network[J]. Med Biol Eng Comput, 2020, 58(3):529-539. DOI:10.1007/s11517-019-02096-6. [38] Zhao W,Han B,Yang Y,et al. Incorporating imaging information from deep neural network layers into image guided radiation therapy (IGRT)[J]. Radiother Oncol,2019,140(1):167-174.DOI:10.1016/j.radonc.2019.06.027. [39] Esposito M, Villaggi E, Bresciani S, et al. Estimating dose delivery accuracy in stereotactic body radiation therapy:a review of in-vivo measurement methods[J]. Radiother Oncol, 2020, 149(1):158-167.DOI:10.1016/j.radonc.2020.05.014. [40] Katoh N, Soda I, Tamamura H, et al. Clinical outcomes of stage Ⅰ and ⅡA non-small cell lung cancer patients treated with stereotactic body radiotherapy using a real-time tumor-tracking radiotherapy system[J]. Radiat Oncol, 2017, 12(1):3.DOI:10.1186/s13014-016-0742-3. [41] Xuyao Y, Zhiyong Y, Yuwen W, et al. Improving stereotactic radiotherapy (SRT) planning process for brain metastases by Cyberknife system:reducing dose distribution in healthy tissues[J]. J Cancer, 2020, 11(14):4166-4172. DOI:10.7150/jca.41102. [42] Khadige M, Salleron J, Marchesi V, et al. Cyberknife® stereotacticradiation therapy for stage Ⅰ lung cancer and pulmonary metastases:evaluation of local control at 24 months[J]. J Thorac Dis, 2018, 10(8):4976-4984.DOI:10.21037/jtd.2018.07.26. [43] Orecchia R, Surgo A, Muto M, et al. VERO® radiotherapy for low burden cancer:789 patients with 957 lesions[J]. Ecancermedicalscience, 2016, 10:677.DOI:10.3332/ecancer.2016.677. [44] Depuydt T, Poels K, Verellen D, et al. Treating patients with real-time tumor tracking using the Vero gimbaled linac system:implementation and first review[J]. Radiother Oncol, 2014, 112(3):343-351.DOI:10.1016/j.radonc.2014.05.017. [45] Oh SA, Yea JW, Kang MK, et al. Analysis of the setup uncertainty and margin of the daily exactrac 6D image guide system for patients with brain tumors[J]. PLoS One, 2016, 11(3):e0151709. DOI:10.1371/journal.pone.0151709. [46] Tsuruta Y, Nakata M, Nakamura M, et al. Evaluation of intrafractional head motion for intracranial stereotactic radiosurgery with a thermoplastic frameless mask and ceiling-floor-mounted image guidance device[J]. Phys Med, 2021, 81(2):245-252. DOI:10.1016/j.ejmp.2020.12.019. [47] Schnarr E, Beneke M, Casey D, et al. Feasibility of real-time motion management with helical tomotherapy[J]. Med Phys, 2018, 45(4):1329-1337.DOI:10.1002/mp.12791. [48] Li Y, Netherton T, Nitsch PL, et al. Normal tissue doses from MV image-guided radiation therapy (IGRT) using orthogonal MV and MV-CBCT[J]. J Appl Clin Med Phys, 2018, 19(3):52-57.DOI:10.1002/acm2.12276.
2021, Vol. 30 
