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  • Review Article
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Image-guided radiotherapy: from current concept to future perspectives

Nature Reviews Clinical Oncology volume 9, pages 688–699 (2012)Cite this article

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Abstract

Radiotherapy is a highly effective, targeted therapy for the management of cancer. Technological innovations have enabled the direct integration of imaging technology into the radiation treatment device to increase the precision and accuracy of radiation delivery. As well as addressing a clinical need to better control the placement of the dose within the body, image-guided radiotherapy has enabled innovators in the field to accelerate their exploration of a number of different paradigms of radiation delivery, including toxicity reduction, dose escalation, hypofractionation, voxelization, and adaptation. Although these approaches are already innovative trends in radiation oncology, it is anticipated that they will work synergistically with other innovations in cancer management (including biomarker strategies, novel systemic and local therapies) as part of the broader goal of personalized cancer medicine. This Review discusses the rationale for adopting image-guidance approaches in radiotherapy, and the technology for achieving precision and accuracy in the context of different paradigms within the evolving radiation oncology practice. It also examines exciting advances in radiotherapy technology that suggest a convergence of radiotherapy practice in which patient-specific radiotherapy treatment courses are one of the most personalized forms of intervention in cancer medicine.

Key Points

  • Radiotherapy has rapidly adopted technologies that integrate imaging and treatment

  • There are multiple paradigms in radiation oncology that are enabled by the integration of imaging into design, guidance, and assessment of radiotherapy

  • An emerging '4D hypothesis' promises to increase the therapeutic ratio of radiotherapy for the individual patient, provided that key clinical and technological issues can be addressed

  • Novel treatment devices, algorithms, and information technologies will enable a greater degree of personalization of radiotherapy

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Figure 1: Image-guidance capable radiation treatment machines.
Figure 2: Targeting radiotherapy before each fraction.
Figure 3: The paradigms in radiotherapy innovation.
Figure 4: The development of MRI-guided radiotherapy.
Figure 5: Integration of imaging information in designing treatments.

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Acknowledgements

D. A. Jaffray would like to acknowledge the broad and collaborative community of researchers and clinicians at the Princess Margaret Cancer Centre for their valuable comments and discussions that contributed to some of the insights provided in this Review. He would like to recognize the support of the Princess Margaret Cancer Foundation, the Mary and Orey Fidani Family Chair in Radiation Physics, the Ontario Institute for Cancer Research, and the Canadian Institutes for Health Research for their support, without which the perspectives offered in this Review would be diminished. Finally, the editorial staff at Nature Reviews Clinical Oncology have been particularly supportive and this is greatly appreciated.

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    David A. Jaffray

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D. A. Jaffray declares he is a consultant for Elekta and RaySearch Laboratories. He receives grant support from Elekta, Philips Healthcare, RaySearch, IMRIS and General Electric, and he holds patents with Elekta, Philips Healthcare and IMRIS.

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Jaffray, D. Image-guided radiotherapy: from current concept to future perspectives. Nat Rev Clin Oncol 9, 688–699 (2012). https://doi.org/10.1038/nrclinonc.2012.194

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