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Determination of target volumes in radiotherapy and the implications of technological advances: a literature review

Published online by Cambridge University Press:  01 March 2009

Bongile Mzenda ,
M.E. Hosseini-Ashrafi ,
A. Palmer ,
D.F. Hodgson ,
H. Liu  and
D.J. Brown
Bongile Mzenda*
Affiliation:
Medical Physics Department, St. Mary's Hospital, Portsmouth, UK
M.E. Hosseini-Ashrafi
Affiliation:
Medical Physics Department, St. Mary's Hospital, Portsmouth, UK
A. Palmer
Affiliation:
Medical Physics Department, St. Mary's Hospital, Portsmouth, UK
D.F. Hodgson
Affiliation:
Medical Physics Department, St. Mary's Hospital, Portsmouth, UK
H. Liu
Affiliation:
Institute of Industrial Research, University of Portsmouth, Portsmouth, UK
D.J. Brown
Affiliation:
Institute of Industrial Research, University of Portsmouth, Portsmouth, UK
*
Correspondence to: Bongile Mzenda, Radiotherapy Physics Section, Medical Physics Department, St. Mary's Hospital, Milton Road, Portsmouth, PO3 6AD, UK. E-mail: Bongile.Mzenda@porthosp.nhs.uk
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Abstract

This study assesses the influence of new techniques and technologies in radiotherapy on the derivation and applicability of the margins currently used for treatment planning. The validity of the continued use of the recommendations of International Commission on Radiation Units and Measurements (ICRU) and other recommendations as a result of the additional information derived from these emerging techniques is also reviewed. The ICRU formulations still remain fundamental in the derivation of target volumes in radiotherapy; however, revisions to these have been recommended through various experimental and modelling techniques leading to the publication of various margin recipes. These recipes are used for margin definitions in new radiotherapy techniques including intensity-modulated radiotherapy (IMRT). The use of image-guided radiotherapy (IGRT) techniques leads to the reduction in organ motion uncertainties and setup errors, allowing for the adjustment of margins and treatment plans as well as dose escalation. Clinical trials are still needed to validate most of the new techniques in radiotherapy, particularly in IGRT techniques leading to adaptive radiotherapy. It is recommended that well devised clinical trials should be conducted to investigate fully the efficacy of these new techniques, particularly in radiotherapy image guidance and adaptive radiotherapy. Such trials would validate any recommendations regarding the current clinical margins and impact on their continued clinical use.

Keywords

Treatment uncertaintiesdelineationtarget volumesIMRTIGRTadaptive radiotherapyclinical trials
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 8 , Issue 1 , March 2009 , pp. 41 - 51
Copyright
Copyright © Cambridge University Press 2009

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