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<section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><svg xmlns="http://www.w3.org/2000/svg" x="0px" y="0px" viewbox="0 0 11 11" width="100%"><rect width="11" height="11" fill="rgb(220,219,223)"></rect><path d="M10,0v5H5v5H0v1h11V0H10z M10,10H6V6h4V10z" fill="rgb(125,133,151)"></path><rect x="6" y="6" width="4" height="4" fill="none"></rect><rect width="5" height="5" fill="rgb(125,133,151)"></rect></svg></section></section></section></section></section><section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><svg xmlns="http://www.w3.org/2000/svg" x="0px" y="0px" viewbox="0 0 11 11" width="100%"><rect width="11" height="11" fill="rgb(220, 219, 223)"></rect><path d="M10,0v5H5v5H0v1h11V0H10z M10,10H6V6h4V10z" fill="rgb(125,133,151)"></path><rect x="6" y="6" width="4" height="4" fill="none"></rect><rect width="5" height="5" fill="rgb(125,133,151)"></rect></svg></section></section></section></section></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><p>一个多世纪前，伦琴在偶然的机会发现了X线，从此为人类开启了一个新世界的大门，而人类生活也因此变得不同。仅仅两个月后，这个伟大的发现被智慧的人类以惊人的速度用到了临床医学中，率先进行了皮肤癌的治疗，这象征着<strong><span>放疗历史的开端</span></strong>。</p></section></section><section powered-by="gulangu"><section><p><img src="image/20201019/f108335d450158f02bb0e278b901996b_1.png" /></p></section></section><section powered-by="gulangu"><section><p><span>受初期条件的限制，医学家对射线的驾驭经历了40多年的野蛮探索期，直到1932年Coutard发明了适用于临床的分割照射技术, 才使得放疗成为真正被广泛接受的肿瘤治疗手段，开启了现代常规放射治疗的时代。进而，放疗历史又向前迈进了20年，Lars Leksell博士发明了立体放射治疗的先进技术，这象征着<strong><span>立体定向放射治疗的开端</span></strong>。</span><br /></p></section></section><section powered-by="gulangu"><section><p><img src="image/20201019/f3b58cdf97b1223b1a79cfaee947e012_2.jpg" /></p></section></section><section powered-by="gulangu"><section><p>HyperArc放射外科新技术</p></section></section><section powered-by="gulangu"><section><p>随着放疗历史进一步发展，在1998年，立体定向放射治疗被应用到了体部，至此立体定向放疗的大厦被全部建立起来了。今天，放射外科的边界又一次被瓦里安打破，<strong><span>HyperArc 一键式自动化SRS</span></strong>的到来是瓦里安用全新4? SRS技术向神经外科医生Coutard博士的致敬！那么明天的立体定向治疗又将走向何方呢？</p></section></section></section></section></section></section></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><svg xmlns="http://www.w3.org/2000/svg" x="0px" y="0px" viewbox="0 0 11 11" width="100%"><rect width="11" height="11" fill="rgb(220,219,223)"></rect><path d="M10,0v5H5v5H0v1h11V0H10z M10,10H6V6h4V10z" fill="rgb(125,133,151)"></path><rect x="6" y="6" width="4" height="4" fill="none"></rect><rect width="5" height="5" fill="rgb(125,133,151)"></rect></svg></section></section></section></section></section><section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><svg xmlns="http://www.w3.org/2000/svg" x="0px" y="0px" viewbox="0 0 11 11" width="100%"><rect width="11" height="11" fill="rgb(220,219,223)"></rect><path d="M10,0v5H5v5H0v1h11V0H10z M10,10H6V6h4V10z" fill="rgb(125,133,151)"></path><rect x="6" y="6" width="4" height="4" fill="none"></rect><rect width="5" height="5" fill="rgb(125,133,151)"></rect></svg></section></section></section></section></section></section></section></section></section></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p>回顾立体定向放疗技术的历史，可以很清晰地了解它的发展轨迹。放射治疗走向常规分割主要是考虑到当时质量控制的局限性，放射治疗走向立体定向是质量控制以及影像等精准治疗手段加持与发展的必然趋势，其中生物学效应起到了宏观调制的作用，当然最关键的还是临床治疗效果的拳头说了算。放射治疗已经走过了120多年， 经过漫长的起步与探索，在近十多年里它开始了正真地腾飞，而立体定向放疗则是这个时代被武装最全面的放疗手段，让我们一起了解一下它的前生，今世与未来。</p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section></section></section></section><section><section powered-by="gulangu"><section><p><img src="image/20201019/70528227c1cafd6021c864a801b361ec_3.gif" /></p></section></section></section><section><section powered-by="gulangu"><section></section></section></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><p><strong>前生-立体定向放疗的初级阶段</strong></p><p><strong>（1949-2006）</strong></p></section></section></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p>尽管放疗初期就有可能用到了高剂量，少分次甚至单分次的剂量治疗模式，但那时的高剂量单分次治疗只是有了立体定向的形（剂量模式），却没有立体定向的意（空间定位），更缺少生物基础的魂（理论思想），因而不能算是立体定向放疗的真正前生。不可否认，是神经外科医生手术刀的思路为立体定向放疗带来了新的生命，之后的临床实效又为立体定向放疗带来了旺盛的生命力，而生物基础学研究实证则成为立体定向放疗抗癌加强版的有力证据。我们看看在初期之际立体定向放疗都有哪些武器傍身吧。</p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><p><strong>伽马刀的产生</strong></p></section></section></section></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p>Lars Leksell 医生设计发明了呈半球形排列的201个钴-60源产生的伽马射线聚焦肿瘤，实施了在不开颅的条件下高剂量一次照射治疗颅内病变的先例，其主要局限性是脑转移瘤的治疗，局限于小病灶。</p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><p><img src="image/20201019/0ebed382903147dd75c657124b6745b2_4.png" /></p></section></section><section powered-by="gulangu"><p>伽马刀立体定向放射外科治疗（图片来自网络）</p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><p><strong>射波刀的产生</strong></p></section></section></section></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p>这种无框架影像引导治疗方式是由John Alder教授发明的，提高了治疗的位置精度，这对立体定向治疗而言是一个进步，其缺点是治疗时间长，多发病灶治疗受限。</p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><p><img src="image/20201019/59260c47a27276c56b21e10e947d3365_5.png" /></p></section></section><section powered-by="gulangu"><p>射波刀X射线影像引导系统（图片来自网络）</p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><p><strong>常规直线加速器</strong></p></section></section></section></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p>医用直线加速器是综合的放疗设备，可以满足放射治疗的各个需求，其中之一就是立体定向放射治疗，它是该阶段三类立体定向放射治疗设备的重要组成。</p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><p><img src="image/20201019/36ee46f74721397efe4297a39e987a02_6.jpg" /></p></section></section><section powered-by="gulangu"><p>瓦里安ix系列医用直线加速器</p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><section powered-by="gulangu"><p><strong>今世-立体定向放疗的高级发展阶段 （2006-now）</strong></p></section></section></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p>立体定向放疗的核心要素是通过对靶区病灶实施少分次，高剂量的精准照射，其效果类似锋利的手术刀对病灶进行锐利切割， 而同时又要求最大程度保护周围正常器官不受射线影响，这是对放疗设备的极大考验，从某种程度而言，放疗设备的先进程度是划分立体定向放疗时代的重要依据！</p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p><strong></strong></p><p><strong><span>常规直线加速器技术的高速发展是立体定向放疗时代真正来临的象征！</span></strong>它推进了立体定向放疗技术的普及应用，惠及了更广大的肿瘤患者，而瓦里安公司正是这个时代的缔造者！</p><p><br /></p><p>2006年加速器立体定向的一代王牌军Trilogy的出现成为直接推手，也标志着立体定向放疗今世的开启。由于Trilogy 在立体定向放疗技术的优势，放疗专家对立体定向放疗的研究热情也空前高涨，大量临床文献不断涌来，这又进一步带动了立体定向放疗技术的广泛应用，进而也带动了整个放疗行业的蓬勃发展，并提高了放疗在肿瘤治疗中的整体地位。</p><p><br /></p><p>随后，二代王牌军系列TrueBeam (2010)，Edge (2012)与VitalBeam（2014）的集中惊艳亮相更是将立体定向迅速带到了一个全新高度，并在专家们的共同实践下，将加速器立体定向放疗的时代推到了今天的4?超级空间放疗，在这只占整个放疗历史7.5%的时间窗内密集推出了大批前沿的放疗技术，这是瓦里安的骄傲，也是瓦里安人共同的骄傲。</p></section><section powered-by="gulangu"><section><p><img src="image/20201019/0305442bccf2b77e2495051126821cf9_7.jpg" /></p></section></section><section powered-by="gulangu"><p>瓦里安立体定向放射外科平台家族</p><p>（TrueBeam, Edge, VitalBeam）</p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p>装配了RapidArc与HyperArc的TrueBeam平台使得基于直线加速器的SRS/SBRT变得更加傲视群雄, 成为了立体定向放射治疗的效率与质量完美结合的真正王者！让其它立体定向放疗设备不得不遥望其项背的HyperArc技术的优势主要体现在两个方面：更优的计划质量与更短的治疗时间。</p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p>相关研究很多，此处只引用两项代表性研究结果以飨读者：韩国亚洲医学中心对比了HyperArc与伽马刀治疗方案在脑转移肿瘤患者的剂量学差异，发现HyperArc的剂量梯度与均匀度要更优，值得关注的是 HyperArc治疗短至10分钟，比伽马刀平均少66分钟；Krzysztof 等对比了HyperArc与CyberKnife <span>的脑转移肿瘤患者计划</span>, 发现4Gy与12Gy剂量线下的HyperArc更具优势，此外HyperArc治疗只需5-10分钟，比CyberKnife大约减少了32-66分钟。总之，RapidArc为常规直线加速器的SRS/SBRT配备了高速腾飞的翅膀，而HyperArc则更进一步把SRS在720度空间的超级维度上将治疗时间缩短到了整个行业的极致水平。<span></span></p><p><span></span></p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><p><img src="image/20201019/ad773253ae8e8131876b40937eaf431b_8.png" /></p></section></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><section powered-by="gulangu"><p><strong>未来——那或许属于</strong></p><p><strong>Flash立体定向时代吧</strong></p></section></section></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><p>Flash这种超高剂量的癌症治疗手段，以非侵入性的方式，超高速（小于1秒），极高剂量率（72万cGy/分）能为肿瘤放疗带来什么样的新未来呢？那可真是一个不可预知的未来，在这个剂量率下的立体定向也许会有新的名称了吧？让我们预测一下瓦里安将怎么再次独占花魁吧！</p></section></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><p><img src="image/20201019/8f79d88fa69920e742416ad1e4b6558b_9.jpg" /></p></section></section><section powered-by="gulangu"><p>超高剂量率Flash闪射治疗技术</p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p>阔论了立体定向放疗几个时代的发展与未来变化，那么从当今现实的角度我们又该如何看待它呢？从以下这两项研究成果中您就能得到答案！</p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><section><p><img src="image/20201019/a2f3ee762404f09a693094abf2e6f761_10.png" /></p></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section><section powered-by="gulangu"><section></section></section></section></section><section powered-by="gulangu"><section><p><strong></strong></p><p>2015年美国MD安德森癌症中心的报道，对于可手术的早期非小型细胞肺癌患者随机分组，手术组3年存活率为79%，SABR组95%，直接导致2018年NCCN指南中，将SABR作为不能或拒绝手术早期NSCLC的推荐治疗。</p></section></section><section powered-by="gulangu"><section><p><strong><span>2019年</span></strong>柳叶刀的寡转移随机对照研究表明，SABR联合标准姑息治疗方案的中位生存高达41个月，远远超出了标准姑息治疗对照组的28个月，这一项的研究结果震惊了全球放疗界。</p></section></section><section powered-by="gulangu"><section><section powered-by="gulangu"><section></section></section></section></section></section></section><section powered-by="gulangu"><section><p><img src="image/20201019/a2f3ee762404f09a693094abf2e6f761_10.png" /></p></section></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p>参考文献：Krzysztof Slosarek, et al, In silico assessment of the dosimetric quality of a novel, automated radiation treatment planning strategy for linac-based radiosurgery of multiple brain metastases and a comparison with robotic methods. Radiation Oncology (2018) 13:41</p></section><section powered-by="gulangu"><p><br /></p></section><section powered-by="gulangu"><p><br /></p><p>*TrueBeam_TrueBeam_STX_Edge医用直线加速器，国械注进20183052621</p><p>*VitalBeam医用直线加速器，国械注进20163322474</p><p>*Clinac 23EX, Clinac 21EX, Clinac iX、Trilogy、Clinac CX、Novalis TX医用直线加速器，国械注进20143325307</p><p>*HyperArc；Flash 技术 NMPA注册中</p></section></section><p><br /></p><section><section><section><section><section><section><p>推荐阅读：</p></section><section></section></section></section></section><p><span>▌</span>放射治疗——抗击癌症的利器！</p><h2><span>▌</span><span>从高智能到高精准，打造华南地区放射治疗又一高地</span></h2><h2><span>▌</span><span>中国癌症与放疗现状</span></h2></section></section><p><p><img src="image/20201019/a7761fdc55848e105984bc87db4eae7d_12.jpg" /></p></p><section><section><section><p><p><img src="image/20201019/04c836b82b9b9a32d0fba9850899f38c_13.jpg" /></p></p></section></section></section> |
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发表于 2020-10-19 09:47:03