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Strategies for Biologic Image-Guided Dose Escalation: A Review

  • Åste Søvik
    Correspondence
    Reprint requests to: Dr. Åste Søvik, Department of Radiation Biology, Institute for Cancer Research, Rikshospitalet University Hospital, Montebello, 0310 Oslo, Norway. Tel: (+47) 22 93 42 71; Fax: (+47) 22 93 42 70
    Affiliations
    Department of Radiation Biology, Institute for Cancer Research, Rikshospitalet University Hospital, Oslo, Norway
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  • Eirik Malinen
    Affiliations
    Department of Medical Physics, Division of Cancer Medicine and Radiotherapy, Rikshospitalet University Hospital, Oslo, Norway
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  • Dag Rune Olsen
    Affiliations
    Department of Radiation Biology, Institute for Cancer Research, Rikshospitalet University Hospital, Oslo, Norway

    Department of Physics, University of Oslo, Oslo, Norway
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      There is increasing interest in how to incorporate functional and molecular information obtained by noninvasive, three-dimensional tumor imaging into radiotherapy. The key issues are to identify radioresistant regions that can be targeted for dose escalation, and to develop radiation dose prescription and delivery strategies providing optimal treatment for the individual patient. In the present work, we review the proposed strategies for biologic image-guided dose escalation with intensity-modulated radiation therapy. Biologic imaging modalities and the derived images are discussed, as are methods for target volume delineation. Different dose escalation strategies and techniques for treatment delivery and treatment plan evaluation are also addressed. Furthermore, we consider the need for response monitoring during treatment. We conclude with a summary of the current status of biologic image-based dose escalation and of areas where further work is needed for this strategy to become incorporated into clinical practice.
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