THE BIOLOGICAL BASIS FOR CONFORMAL 3-DIMENSIONAL RADIATION-THERAPY

被引:111
作者
LEIBEL, SA
LING, CC
KUTCHER, GJ
MOHAN, R
CORDONCORDO, C
FUKS, Z
机构
[1] MEM SLOAN KETTERING CANC CTR, DEPT MED PHYS, NEW YORK, NY 10021 USA
[2] MEM SLOAN KETTERING CANC CTR, DEPT PATHOL, NEW YORK, NY 10021 USA
来源
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS | 1991年 / 21卷 / 03期
关键词
CONFORMAL; 3-DIMENSIONAL; RADIATION THERAPY; LOCAL CONTROL; DISTANT METASTASES;
D O I
10.1016/0360-3016(91)90701-5
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
The recent introduction of new computer technology for treatment planning and computer-driven treatment delivery systems, such as multi-leaf collimators and on-line verification systems, has accelerated the development of 3-dimensional (3-D) radiation therapy as a modality for curative cancer treatment. The goal of 3-D treatment planning is to conform the spatial distribution of the high radiation dose to the shape of the tumor contour while concomitantly decreasing the volume of the surrounding normal tissues receiving high radiation doses. The improved precision of tumor coverage and the exclusion of normal tissues should permit tumor dose escalation and may enhance local tumor control. It has been suggested that any survival gains derived from improvements in local control may be offset by the subsequent appearance of distant metastases arising from micrometastases already present at the time of initial diagnosis. However, clinical and laboratory studies indicate that failure to control the primary tumor at the time of initial treatment significantly increases the incidence of metastatic dissemination. This phenomenon is consistent with the hypothesis that the enhanced mitotic activity associated with the re-growth process of locally recurring primary tumors promotes the multi-step transformation of non-metastatic tumor cells into clonogens with metastatic potential, leading to increased overall rates of metastatic disease. These biologic considerations provide support for the need to focus attention on the identification of more effective therapeutic strategies designed to eradicate the primary local tumor completely at the time of initial therapy and serve as the rationale for clinical studies using 3-D conformal radiation therapy.
引用
收藏
页码:805 / 811
页数:7
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