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Godin S, Durham AD, Schiappacasse L, Ozsahin EM, Vilotte F. Vertebral compression fracture during stereotactic body radiotherapy for spinal metastasis: A rare case of tracking failure. Cancer Radiother 2020; 24:866-869. [PMID: 33129716 DOI: 10.1016/j.canrad.2020.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/07/2020] [Accepted: 03/27/2020] [Indexed: 10/23/2022]
Abstract
Spinal metastasis are a daily challenge in clinical practice. Stereotactic body radiotherapy (SBRT) allows delivery of definitive treatment with excellent long-term control rates. Its implementation needs dedicated devices and day-to-day image-guided radiotherapy (IGRT). The XSight™ spine tracking system, integrates with the CyberKnife® (Accuray™), provides a fiducial-free tracking system for spinal SBRT. We report a rare case of tracking failure during treatment due to the occurrence of a vertebral compression fracture (VCF).
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Affiliation(s)
- S Godin
- Department of radiation oncology, centre hospitalier universitaire Vaudois, Bugnon 46, CH-1011 Lausanne, Switzerland
| | - A-D Durham
- Department of radiation oncology, centre hospitalier universitaire Vaudois, Bugnon 46, CH-1011 Lausanne, Switzerland
| | - L Schiappacasse
- Department of radiation oncology, centre hospitalier universitaire Vaudois, Bugnon 46, CH-1011 Lausanne, Switzerland
| | - E-M Ozsahin
- Department of radiation oncology, centre hospitalier universitaire Vaudois, Bugnon 46, CH-1011 Lausanne, Switzerland.
| | - F Vilotte
- Department of radiation oncology, centre hospitalier universitaire Vaudois, Bugnon 46, CH-1011 Lausanne, Switzerland
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Pasquier D, Lacornerie T, Mirabel X, Brassart C, Vanquin L, Lartigau E. [Stereotactic body radiotherapy. How to better protect normal tissues?]. Cancer Radiother 2019; 23:630-635. [PMID: 31447339 DOI: 10.1016/j.canrad.2019.07.153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 12/26/2022]
Abstract
The use of stereotactic body radiotherapy (SBRT) has increased rapidly over the past decade. Optimal preservation of normal tissues is a major issue because of their high sensitivity to high doses per session. Extreme hypofractionation can convert random errors into systematic errors. Optimal preservation of organs at risk requires first of all a rigorous implementation of this technique according to published guidelines. The robustness of the imaging modalities used for planning, and training medical and paramedical staff are an integral part of these guidelines too. The choice of SBRT indications, dose fractionation, dose heterogeneity, ballistics, are also means of optimizing the protection of normal tissues. Non-coplanarity and tracking of moving targets allow dosimetric improvement in some clinical settings. Automatic planning could also improve normal tissue protection. Adaptive SBRT, with new image guided radiotherapy modalities such as MRI, could further reduce the risk of toxicity.
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Affiliation(s)
- D Pasquier
- Département universitaire de radiothérapie, centre Oscar-Lambret, université de Lille, 3, rue Combemale, 59020 Lille cedex, France; Centre de recherche en informatique, signal et automatique de Lille UMR CNRS 9189, université de Lille, M3, avenue Carl-Gauss, 59650 Villeneuve-d'Ascq, France.
| | - T Lacornerie
- Service de physique médicale, centre Oscar-Lambret, 3, rue Combemale, 59020 Lille cedex, France
| | - X Mirabel
- Département universitaire de radiothérapie, centre Oscar-Lambret, université de Lille, 3, rue Combemale, 59020 Lille cedex, France
| | - C Brassart
- Département universitaire de radiothérapie, centre Oscar-Lambret, université de Lille, 3, rue Combemale, 59020 Lille cedex, France
| | - L Vanquin
- Service de physique médicale, centre Oscar-Lambret, 3, rue Combemale, 59020 Lille cedex, France
| | - E Lartigau
- Département universitaire de radiothérapie, centre Oscar-Lambret, université de Lille, 3, rue Combemale, 59020 Lille cedex, France; Centre de recherche en informatique, signal et automatique de Lille UMR CNRS 9189, université de Lille, M3, avenue Carl-Gauss, 59650 Villeneuve-d'Ascq, France
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Kim M, Phillips MH. A feasibility study of spatiotemporally integrated radiotherapy using the LQ model. Phys Med Biol 2018; 63:245016. [PMID: 30523816 DOI: 10.1088/1361-6560/aaf0c3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This paper investigates the feasibility of spatiotemporally modulated radiotherapy (STMRT)-integrated model with explicit constraints on the tumor dose heterogeneity. In particular, we demonstrate the effect of the tumor dose heterogeneity on the tumor biologically effective dose (BED) achievable and optimal fractionation. We propose an STMRT model that simultaneously optimizes the dose distributions and fractionation schedule for each individual case with the maximum and minimum constraints on the tumor BED to explicitly control the level of tumor dose heterogeneity. Sixteen thoracic phantom cases were planned using (1) STMRT and (2) standard fractionation (60 Gy in 30 fractions fixed) IMRT. Constraints on the organs-at-risk (OAR) BED were identical for both plans. BEDs were calculated using the [Formula: see text] ratio of 10 Gy for the tumor and 3 Gy for all OARs. The maximum tumor BED for STMRT plans was constrained to be less than 100%-150% of the maximum tumor BED resulted from the standard fractionation plans. The mean tumor BED from STMRT plans was up to 110.7%, 128.3%, 135.0% and 148.0% of that from the standard fractionation plans when the maximum tumor BED was constrained to be less than 100%, 120%, 130% and 150% of the maximum BED achieved using the standard plans. The optimal number of fractions varied widely for different phantom geometries for the same radiobiological parameter values. The increase in the tumor BED and the range of optimal fractionation was larger with a larger tumor dose heterogeneity allowed. The results have shown the feasibility of personalizing fractionation schedule using an STMRT integrated model to deliver a maximum feasible BED to the tumor for a fixed OAR BED. The potential increase in the tumor BED was positively correlated to the tumor dose heterogeneity allowed.
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Affiliation(s)
- M Kim
- Radiation Oncology, University of Washington Seattle, Washington, DC, United States of America
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Schernberg A, Hennequin C. [Normal tissue tolerance to external beam radiation therapy: Bone marrow and cortical bone structures]. Cancer Radiother 2017; 21:619-625. [PMID: 28774489 DOI: 10.1016/j.canrad.2017.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 06/16/2017] [Indexed: 12/25/2022]
Abstract
In patients undergoing external radiation therapy, bone marrow and cortical bone structures are all often neglected as organs at risk. Still, from increased febrile neutropenia risk in patients undergoing chemoradiation for a pelvic tumour to increased risk of vertebral fracture when undergoing hypofractioned stereotactic radiotherapy of a spinal metastasis, adverse effects are frequent and sometimes serious. This literature review first defines the rules for contouring these structures, then the dose constraints currently recommended. This article focuses first on conventional irradiation or intensity modulation radiotherapy considering classical fractionation. Secondly, it focuses on stereotactic radiotherapy. The considered organs will be haematopoietic structures, and bone cortical structures. Current recommendations are summarised in a table.
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Affiliation(s)
- A Schernberg
- Service de radiothérapie, hôpital Tenon, hôpitaux universitaires Est parisien, 4, rue de la Chine, 75020 Paris, France.
| | - C Hennequin
- Service de cancérologie-radiothérapie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75475 Paris, France
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