["Dose-painting": myth or reality?].
"Dose-painting" radiotherapy allows for a heterogeneous delivery of radiation within the tumour volume by targeting radioresistant areas defined by functional imaging. Within gross tumour volume, it is possible to define one or more target volumes based on biology (biological target volume [BTV]) and to apply a strategy of intensity modulated radiation therapy (IMRT) that will deliver a higher dose to these regions. In this review of the literature, we will highlight the biological elements responsible for radioresistance, and how to image them, then we will detail the radiotherapy techniques necessary for this approach, before presenting clinical results in various situations (head and neck tumours, prostate, brain tumours, etc.). Despite many difficulties that make dose-painting IMRT unusable in routine nowadays, biology-guided radiation therapy represents one of the major pathways of development of radiotherapy in the coming years.
Supiot
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S
Service de Radiothérapie, Centre René-Gauducheau, Boulevard Jacques-Monod, 44800 Nantes-St-Herblain, France. s-supiot@nantes.fnclcc.fr
Lisbona
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A
Paris
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F
Azria
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D
Fenoglietto
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P
D001932:Brain Neoplasms / Q000532:radiotherapy; D002277:Carcinoma / Q000532:radiotherapy; D002453:Cell Cycle / Q000528:radiation effects; D015687:Cell Hypoxia; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D003952:Diagnostic Imaging; D004307:Dose-Response Relationship, Radiation; D006258:Head and Neck Neoplasms / Q000532:radiotherapy; D006689:Hodgkin Disease / Q000532:radiotherapy; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy; D008297:Male; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D009369:Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D014411:Neoplastic Stem Cells / Q000528:radiation effects; D009928:Organ Specificity; D011471:Prostatic Neoplasms / Q000532:radiotherapy; D011836:Radiation Tolerance; D011877:Radionuclide Imaging; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012004:Rectal Neoplasms / Q000532:radiotherapy