1
|
Fenwick JD, Mayhew C, Jolly S, Amos RA, Hawkins MA. Navigating the straits: realizing the potential of proton FLASH through physics advances and further pre-clinical characterization. Front Oncol 2024; 14:1420337. [PMID: 39022584 PMCID: PMC11252699 DOI: 10.3389/fonc.2024.1420337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 06/11/2024] [Indexed: 07/20/2024] Open
Abstract
Ultra-high dose-rate 'FLASH' radiotherapy may be a pivotal step forward for cancer treatment, widening the therapeutic window between radiation tumour killing and damage to neighbouring normal tissues. The extent of normal tissue sparing reported in pre-clinical FLASH studies typically corresponds to an increase in isotoxic dose-levels of 5-20%, though gains are larger at higher doses. Conditions currently thought necessary for FLASH normal tissue sparing are a dose-rate ≥40 Gy s-1, dose-per-fraction ≥5-10 Gy and irradiation duration ≤0.2-0.5 s. Cyclotron proton accelerators are the first clinical systems to be adapted to irradiate deep-seated tumours at FLASH dose-rates, but even using these machines it is challenging to meet the FLASH conditions. In this review we describe the challenges for delivering FLASH proton beam therapy, the compromises that ensue if these challenges are not addressed, and resulting dosimetric losses. Some of these losses are on the same scale as the gains from FLASH found pre-clinically. We therefore conclude that for FLASH to succeed clinically the challenges must be systematically overcome rather than accommodated, and we survey physical and pre-clinical routes for achieving this.
Collapse
Affiliation(s)
- John D. Fenwick
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Christopher Mayhew
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Simon Jolly
- Department of Physics and Astronomy, University College London, London, United Kingdom
| | - Richard A. Amos
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Maria A. Hawkins
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
- Clinical Oncology, Radiotherapy Department, University College London NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
2
|
Koide Y, Haimoto S, Shimizu H, Aoyama T, Kitagawa T, Shindo Y, Nagai N, Hashimoto S, Tachibana H, Kodaira T. Re-irradiation spine stereotactic body radiotherapy following high-dose conventional radiotherapy for metastatic epidural spinal cord compression: a retrospective study. Jpn J Radiol 2024; 42:662-672. [PMID: 38413551 PMCID: PMC11139739 DOI: 10.1007/s11604-024-01539-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/22/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE We aimed to evaluate the efficacy and safety of re-irradiation stereotactic body radiation therapy (SBRT) in patients with metastatic epidural spinal cord compression (MESCC) following high-dose conventional radiotherapy. MATERIALS AND METHODS Twenty-one patients met the following eligibility criteria: with an irradiation history of 50 Gy2 equivalent dose in 2-Gy fractions (EQD2) or more, diagnosed MESCC in the cervical or thoracic spines, and treated with re-irradiation SBRT of 24 Gy in 2 fractions between April 2018 and March 2023. Prior treatment was radiotherapy alone, not including surgery. The primary endpoint was a 1-year local failure rate. Overall survival (OS) and treatment-related adverse events were assessed as the secondary endpoints. Since our cohort includes one treatment-related death (TRD) of esophageal perforation, the cumulative esophageal dose was evaluated to find the dose constraints related to severe toxicities. RESULTS The median age was 68, and 14 males were included. The primary tumor sites (esophagus/lung/head and neck/others) were 6/6/7/2, and the median initial radiotherapy dose was 60 Gy2 EQD2 (range: 50-105 Gy2, 60-70/ > 70 Gy2 were 11/4). Ten patients underwent surgery followed by SBRT and 11 SBRT alone. At the median follow-up time of 10.4 months, 17 patients died of systemic disease progression including one TRD. No radiation-induced myelopathy or nerve root injuries occurred. Local failure occurred in six patients, with a 1-year local failure rate of 29.3% and a 1-year OS of 55.0%. Other toxicities included five cases of vertebral compression fractures (23.8%) and one radiation pneumonitis. The cumulative esophageal dose was recommended as follows: Dmax < 203, D0.035 cc < 187, and D1cc < 167 (Gy3 in biological effective dose). CONCLUSION Re-irradiation spine SBRT may be effective for selected patients with cervical or thoracic MESCC, even with high-dose irradiation histories. The cumulative dose assessment across the original and re-irradiated esophagus was recommended to decrease the risk of severe esophageal toxicities.
Collapse
Affiliation(s)
- Yutaro Koide
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-Ku, Nagoya, Aichi, Japan.
| | - Shoichi Haimoto
- Department of Neurosurgery, Aichi Cancer Center Hospital, Chikusa-Ku, Nagoya, Japan
| | - Hidetoshi Shimizu
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-Ku, Nagoya, Aichi, Japan
| | - Takahiro Aoyama
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-Ku, Nagoya, Aichi, Japan
| | - Tomoki Kitagawa
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-Ku, Nagoya, Aichi, Japan
| | - Yurika Shindo
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-Ku, Nagoya, Aichi, Japan
| | - Naoya Nagai
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-Ku, Nagoya, Aichi, Japan
| | - Shingo Hashimoto
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-Ku, Nagoya, Aichi, Japan
| | - Hiroyuki Tachibana
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-Ku, Nagoya, Aichi, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Kanokoden 1-1, Chikusa-Ku, Nagoya, Aichi, Japan
| |
Collapse
|
3
|
Song X, Zhao L, Jiang N, Ding N, Zong D, Zhang N, Wang D, Wen J, He X, Kong C, Zhu X. Long-term outcomes in patients with central and ultracentral non-small cell lung cancer treated with stereotactic body radiotherapy: single-institution experience. Curr Probl Cancer 2023; 47:100956. [DOI: 10.1016/j.currproblcancer.2023.100956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 03/13/2023]
|
4
|
Sun Z, Zhang J, Zeng F, Zhang S, Chai Z, Luo J, Cao J. Differentially Expressed mRNAs and Potential Mechanisms of
Radiation-Induced TUT4 −/− Esophageal Cell Injury. Dose Response 2022; 20:15593258221136810. [PMCID: PMC9620258 DOI: 10.1177/15593258221136810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 08/30/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022] Open
Abstract
Radiation-induced esophageal injury remains a limitation for the process of
radiotherapy for lung and esophageal cancer patients. Esophageal epithelial
cells are extremely sensitive to irradiation, nevertheless, factors involved in
the radiosensitivity of esophageal epithelial cells are still unknown. Terminal
uridyl transferase 4 (TUT4) could modify the sequence of miRNAs, which affect
their regulation on miRNA targets and function. In this study, we used
transcriptome sequencing technology to identify mRNAs that were differentially
expressed before and after radiotherapy in esophageal epithelial cells. We
further explored the mRNA expression profiles between wild-type and TUT4
knockout esophageal epithelial cells. Volcano and heatmap plots unsupervised
hierarchical clustering analysis were performed to classify the samples.
Enrichment analysis on Gene Ontology functional annotations and Kyoto
Encyclopedia of Genes and Genomes pathways was performed. We annotated
differential genes from metabolism, genetic information processing,
environmental information processing, cellular processes, and organismal systems
human diseases. The aberrantly expressed genes are significantly enriched in
irradiation-related biological processes, such as DNA replication, ferroptosis,
and cell cycle. Moreover, we explored the distribution of transcription factor
family and its target genes in differential genes. These mRNAs might serve as
therapeutic targets in TUT4-related radiation-induced esophageal injury.
Collapse
Affiliation(s)
- Zhiqiang Sun
- School of Radiation Medicine and
Protection,
Medical
College of Soochow University, Suzhou,
China,Collaborative Innovation Center of
Radiological Medicine of Jiangsu Higher Education
Institutions, Suzhou, China
| | - Jiaqi Zhang
- Department of
Radiotherapy,
The
Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical
University, Changzhou, China
| | - Fanye Zeng
- Second Department of Medical
Oncology,
The Fourth
Affiliated Hospital of Xinjiang Medical
University, Urumqi, China
| | - Shuyu Zhang
- School of Radiation Medicine and
Protection,
Medical
College of Soochow University, Suzhou,
China,Collaborative Innovation Center of
Radiological Medicine of Jiangsu Higher Education
Institutions, Suzhou, China
| | - Zhifang Chai
- School of Radiation Medicine and
Protection,
Medical
College of Soochow University, Suzhou,
China,Collaborative Innovation Center of
Radiological Medicine of Jiangsu Higher Education
Institutions, Suzhou, China
| | - Judong Luo
- Department of
Radiotherapy,
The
Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical
University, Changzhou, China,Judong Luo, Department of Radiotherapy, The
Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University,
Tianning District, Changzhou 213000, China.
| | - Jianping Cao
- School of Radiation Medicine and
Protection,
Medical
College of Soochow University, Suzhou,
China,Collaborative Innovation Center of
Radiological Medicine of Jiangsu Higher Education
Institutions, Suzhou, China
| |
Collapse
|
5
|
Cassidy V, Amdur RJ. Esophageal Damage from Thoracic Spine SBRT. Pract Radiat Oncol 2022; 12:392-396. [PMID: 35513255 DOI: 10.1016/j.prro.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/12/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
The risk of serious esophageal damage from stereotactic body radiotherapy (SBRT) for a spine metastasis increases when the target is in the upper thoracic or cervical spine because the esophagus almost touches the anterior edge of the vertebral body at these levels. This report describes a case of severe esophageal damage from SBRT to the T-2 vertebral body, reviews pertinent literature, and suggests implications for future research and practice.
Collapse
Affiliation(s)
- Vincent Cassidy
- From the Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL
| | - Robert J Amdur
- From the Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL.
| |
Collapse
|
6
|
Jasper K, Liu B, Olson R, Matthews Q. Evidence-Based Planning Target Volume Margin Reduction for Modern Lung Stereotactic Ablative Radiation Therapy Using Deformable Registration. Adv Radiat Oncol 2021; 6:100750. [PMID: 34401609 PMCID: PMC8349747 DOI: 10.1016/j.adro.2021.100750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 05/20/2021] [Accepted: 06/25/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Standard planning target volume (PTV) margins for lung stereotactic ablative radiation therapy (SABR) are 5 mm. High-dose-rate volumetric modulated arc therapy delivered using flattening filter-free (FFF) beams with modern immobilization systems may allow for PTV margin reduction. This study assesses whether PTV margins can be reduced from 5 to 3 mm. METHODS Target intrafractional motions derived from pretreatment and posttreatment cone beam computed tomography (CBCT) scans for 33 patients receiving lung SABR treated with 10XFFF energy and 5-mm PTV margins from 2016 to 2019 were used to calculate the required PTV margin. Deformable registration of the planning CT scan and internal gross tumor volume (IGTV) contour to posttreatment CBCT scans for 36 consecutive patients with 4 fraction schedules was completed to capture volume changes and intrafractional movement. Plans were replanned with 3-mm margins and recalculated on each deformed CT scan to assess deformed IGTV (d-IGTV) coverage and organ-at-risk doses. RESULTS Margin analysis showed PTV margins may be reduced to 3 mm. The mean d-IGTV coverage (percentage of the d-IGTV receiving ≥100% of the prescription dose [V100%] and the minimum dose covering 99.9% of the d-IGTV volume [D99.9%]) over 4 fractions for each patient was >95% with both margins. With 5-mm PTV margins, all 144 fractions had a d-IGTV V100% of >95% and a D99.9% >95%. With 3-mm PTV margins, the d-IGTV V100% was >95% in 99.3% of fractions (143 of 144) and the D99.9% was >95% in 98.6% of fractions (142 of 144). With 3-mm PTV margins, significant reductions in body V50%, body V80%, the volume of the lung receiving ≥20 Gy, and the mean lung dose and chest wall dose to 0.035 cm3 and 30 cm3 were observed (all P < .001). Using theoretical models, the normal tissue complication probability for radiation pneumonitis decreased by a mean of 0.8% (range, 0.1%-2.7%), and the mean 2-year tumor control probability was 96.1% and 95.2% with 5-mm and 3-mm PTV margins, respectively. CONCLUSION With modern treatment and immobilization techniques in lung SABR, 3-mm PTV margins maintain acceptable IGTV coverage, modestly reduce toxicity to organs at risk, and maintain a calculated 2-year local control rate of >95%.
Collapse
Affiliation(s)
- Katie Jasper
- BC Cancer–Vancouver, Vancouver, British Columbia, Canada
- Division of Radiation Oncology, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Baochang Liu
- BC Cancer–Prince George, Prince George, British Columbia, Canada
- Radiation Medicine Program, Walker Family Cancer Centre, St. Catharines, Ontario, Canada
| | - Robert Olson
- Division of Radiation Oncology, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
- BC Cancer–Prince George, Prince George, British Columbia, Canada
| | - Quinn Matthews
- BC Cancer–Prince George, Prince George, British Columbia, Canada
| |
Collapse
|
7
|
Gottumukkala S, Srivastava U, Brocklehurst S, Mendel JT, Kumar K, Yu FF, Agarwal A, Shah BR, Vira S, Raj KM. Fundamentals of Radiation Oncology for Treatment of Vertebral Metastases. Radiographics 2021; 41:2136-2156. [PMID: 34623944 DOI: 10.1148/rg.2021210052] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The fields of both radiology and radiation oncology have evolved considerably in the past few decades, resulting in an increased ability to delineate between tumor and normal tissue to precisely target and treat vertebral metastases with radiation therapy. These scientific advances have also led to improvements in assessing treatment response and diagnosing toxic effects related to radiation treatment. However, despite technological innovations yielding greatly improved rates of palliative relief and local control of osseous spinal metastases, radiation therapy can still lead to a number of acute and delayed posttreatment complications. Treatment-related adverse effects may include pain flare, esophageal toxic effects, dermatitis, vertebral compression fracture, radiation myelopathy, and myositis, among others. The authors provide an overview of the multidisciplinary approach to the treatment of spinal metastases, indications for surgical management versus radiation therapy, various radiation technologies and techniques (along with their applications for spinal metastases), and current principles of treatment planning for conventional and stereotactic radiation treatment. Different radiologic criteria for assessment of treatment response, recent advances in radiologic imaging, and both common and rare complications related to spinal irradiation are also discussed, along with the imaging characteristics of various adverse effects. Familiarity with these topics will not only assist the diagnostic radiologist in assessing treatment response and diagnosing treatment-related complications but will also allow more effective collaboration between diagnostic radiologists and radiation oncologists to guide management decisions and ensure high-quality patient care. ©RSNA, 2021.
Collapse
Affiliation(s)
- Sujana Gottumukkala
- From the Department of Radiation Oncology (S.G., S.B., K.K.), Department of Radiology (U.S., F.F.Y., A.A., B.R.S., K.M.R.), and Departments of Orthopaedic Surgery and Neurosurgery (S.V.), The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390; and Rio Grande Urology, El Paso, Tex (J.T.M.)
| | - Udayan Srivastava
- From the Department of Radiation Oncology (S.G., S.B., K.K.), Department of Radiology (U.S., F.F.Y., A.A., B.R.S., K.M.R.), and Departments of Orthopaedic Surgery and Neurosurgery (S.V.), The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390; and Rio Grande Urology, El Paso, Tex (J.T.M.)
| | - Samantha Brocklehurst
- From the Department of Radiation Oncology (S.G., S.B., K.K.), Department of Radiology (U.S., F.F.Y., A.A., B.R.S., K.M.R.), and Departments of Orthopaedic Surgery and Neurosurgery (S.V.), The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390; and Rio Grande Urology, El Paso, Tex (J.T.M.)
| | - J Travis Mendel
- From the Department of Radiation Oncology (S.G., S.B., K.K.), Department of Radiology (U.S., F.F.Y., A.A., B.R.S., K.M.R.), and Departments of Orthopaedic Surgery and Neurosurgery (S.V.), The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390; and Rio Grande Urology, El Paso, Tex (J.T.M.)
| | - Kiran Kumar
- From the Department of Radiation Oncology (S.G., S.B., K.K.), Department of Radiology (U.S., F.F.Y., A.A., B.R.S., K.M.R.), and Departments of Orthopaedic Surgery and Neurosurgery (S.V.), The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390; and Rio Grande Urology, El Paso, Tex (J.T.M.)
| | - Fang F Yu
- From the Department of Radiation Oncology (S.G., S.B., K.K.), Department of Radiology (U.S., F.F.Y., A.A., B.R.S., K.M.R.), and Departments of Orthopaedic Surgery and Neurosurgery (S.V.), The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390; and Rio Grande Urology, El Paso, Tex (J.T.M.)
| | - Amit Agarwal
- From the Department of Radiation Oncology (S.G., S.B., K.K.), Department of Radiology (U.S., F.F.Y., A.A., B.R.S., K.M.R.), and Departments of Orthopaedic Surgery and Neurosurgery (S.V.), The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390; and Rio Grande Urology, El Paso, Tex (J.T.M.)
| | - Bhavya R Shah
- From the Department of Radiation Oncology (S.G., S.B., K.K.), Department of Radiology (U.S., F.F.Y., A.A., B.R.S., K.M.R.), and Departments of Orthopaedic Surgery and Neurosurgery (S.V.), The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390; and Rio Grande Urology, El Paso, Tex (J.T.M.)
| | - Shaleen Vira
- From the Department of Radiation Oncology (S.G., S.B., K.K.), Department of Radiology (U.S., F.F.Y., A.A., B.R.S., K.M.R.), and Departments of Orthopaedic Surgery and Neurosurgery (S.V.), The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390; and Rio Grande Urology, El Paso, Tex (J.T.M.)
| | - Karuna M Raj
- From the Department of Radiation Oncology (S.G., S.B., K.K.), Department of Radiology (U.S., F.F.Y., A.A., B.R.S., K.M.R.), and Departments of Orthopaedic Surgery and Neurosurgery (S.V.), The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390; and Rio Grande Urology, El Paso, Tex (J.T.M.)
| |
Collapse
|
8
|
Voglhuber T, Eitz KA, Oechsner M, Vogel MME, Combs SE. Analysis of using high-precision radiotherapy in the treatment of liver metastases regarding toxicity and survival. BMC Cancer 2021; 21:780. [PMID: 34229642 PMCID: PMC8259027 DOI: 10.1186/s12885-021-08488-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022] Open
Abstract
Background Hepatic metastases occur frequently in the context of many tumor entities. Patients with colorectal carcinoma have already developed liver metastases in 20% at the time of diagnosis, and 25–50% develop metastases in the further course of the disease and therapy. The frequent manifestation and the variable appearance of liver metastases result in an interdisciplinary challenge, regarding treatment management. The aim of this study was to evaluate high-precision stereotactic body radiotherapy (SBRT) for liver metastases. Methods A cohort of 115 patients with 150 irradiated liver metastases was analyzed. All metastases were treated between May 2004 and January 2020 using SBRT. A contrast-enhanced computed tomography (CT) was performed in all patients for treatment planning, followed by image-guided high-precision radiotherapy using cone-beam CT. A median cumulative dose of 35 Gy and a median single dose of 7 Gy was applied. Results Median OS was 20.4 months and median LC was 35.1 months with a 1-year probability of local failure of 18% (95%-CI: 12.0–24.3%). In this cohort, 18 patients were still alive at the time of evaluation. The median FU-time in total was 11.4 months and for living patients 26.6 months. 70.4% of patients suffered from acute toxicities. There were several cases of grade 1 and 2 toxicities, such as constipation (13.9%), nausea (24.4%), loss of appetite (7.8%), vomiting (10.4%), diarrhea (7.8%), and abdominal pain (16.5%). 10 patients (8.7%) suffered from grade 3 toxicities. Late toxicities affected 42.6% of patients, the majority of these affected the gastrointestinal system. Conclusion SBRT is becoming increasingly important in the field of radiation oncology. It has evolved to be a highly effective treatment for primary and metastasized tumors, and offers a semi-curative treatment option also in the case of oligometastatic patients. Overall, it represents a very effective and well-tolerated therapy option to treat hepatic metastases. Based on the results of this work and the studies already available, high-precision radiotherapy should be considered as a valid and promising treatment alternative in the interdisciplinary discussion.
Collapse
Affiliation(s)
- Theresa Voglhuber
- Department of Radiation Oncology, University Hospital Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 2, 81675, Munich, Germany.
| | - Kerstin A Eitz
- Department of Radiation Oncology, University Hospital Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 2, 81675, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Markus Oechsner
- Department of Radiation Oncology, University Hospital Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 2, 81675, Munich, Germany
| | - Marco M E Vogel
- Department of Radiation Oncology, University Hospital Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 2, 81675, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, University Hospital Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 2, 81675, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| |
Collapse
|
9
|
Andruska N, Stowe HB, Crockett C, Liu W, Palma D, Faivre-Finn C, Badiyan SN. Stereotactic Radiation for Lung Cancer: A Practical Approach to Challenging Scenarios. J Thorac Oncol 2021; 16:1075-1085. [PMID: 33901637 DOI: 10.1016/j.jtho.2021.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/02/2021] [Accepted: 04/07/2021] [Indexed: 12/18/2022]
Abstract
Stereotactic body radiation therapy (SBRT) is an effective and well-tolerated treatment for medically inoperable patients with early stage NSCLC. SBRT is a noninvasive treatment involving the delivery of ablative radiation doses with high precision in the course of a few treatments. Relative to conventionally fractionated radiation, SBRT achieves superior local control and survival. SBRT use has increased dramatically in the past 15 years and is currently considered the standard of care in cases of inoperable early stage NSCLC. It is being increasingly applied to more complex patient populations at higher risk of treatment-related toxicity. In these more complex patients, there is an increasing need to balance patient and treatment factors in selecting the optimal patients for SBRT. Here, we review several challenging clinical scenarios often encountered in thoracic multidisciplinary tumor boards.
Collapse
Affiliation(s)
- Neal Andruska
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St Louis, Missouri
| | - Hayley B Stowe
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St Louis, Missouri
| | - Cathryn Crockett
- Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Wei Liu
- Division of Radiation Oncology, Western University, London, Ontario, Canada
| | - David Palma
- Division of Radiation Oncology, Western University, London, Ontario, Canada; Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, University of Manchester and The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Shahed N Badiyan
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St Louis, Missouri.
| | | |
Collapse
|
10
|
Seyedin SN, Gannon MK, Plichta KA, Abushahin L, Berg DJ, Arshava EV, Parekh KR, Keech JC, Caster JM, Welsh JW, Allen BG. Safety and Efficacy of Stereotactic Body Radiation Therapy for Locoregional Recurrences After Prior Chemoradiation for Advanced Esophageal Carcinoma. Front Oncol 2020; 10:1311. [PMID: 32850412 PMCID: PMC7412633 DOI: 10.3389/fonc.2020.01311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/23/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose: This study aimed to investigate the feasibility of stereotactic body radiation therapy (SBRT) as salvage therapy for locally recurrent esophageal cancer. We hypothesized that SBRT would provide durable treated tumor control with minimal associated toxicity in patients with progressive disease after definitive radiation, chemotherapy, and surgical resection. Methods: This single-institution retrospective study assessed outcomes in patients who received SBRT for locoregional failure of esophageal cancer after initial curative-intent treatment. Only patients who had received neoadjuvant chemoradiation (≥41.4 Gy) for esophageal cancer were selected. Subsequent surgical resection was optional but institutional follow-up by an oncologist was required. The primary endpoints of this study were gastrointestinal and constitutional toxicity, scored with the Common Terminology Criteria for Adverse Events v5.0. A secondary outcome, treated-tumor control, was assessed with RECIST v1.1. Results: Nine patients (11 locoregional recurrences) treated with SBRT were reviewed, with a median follow-up time of 10.5 months. Most patients initially presented with T3 (88.9%), N1 (55.6%), moderately differentiated (66.7%) adenocarcinoma (88.9%), and had received a median 50.4 Gy delivered over 28 fractions with concurrent carboplatin/paclitaxel chemotherapy followed by surgical resection. Median time to recurrence was 16.3 months. Median total dose delivered by SBRT was 27.5 Gy (delivered in five fractions). Two patients experienced acute grade 1 fatigue and vomiting. No patient experienced grade 3 or higher toxicity. One patient experienced failure in the SBRT treatment field at 5.8 months after treatment and six patients developed distant failure. The median progression-free survival time for SBRT-treated tumors was 5.0 months, and median overall survival time was 12.9 months. Conclusions: This single-institution study demonstrated the feasibility of SBRT for locoregional recurrence of esophageal cancer with minimal treatment-related toxicity and high rates of treated tumor control. Prospective studies identifying ideal salvage SBRT candidates for locoregional failure as well as validating its safety are needed.
Collapse
Affiliation(s)
- Steven N. Seyedin
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa, IA, United States
| | | | - Kristin A. Plichta
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa, IA, United States
| | - Laith Abushahin
- Division of Hematology/Oncology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa, IA, United States
| | - Daniel J. Berg
- Division of Hematology/Oncology, Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa, IA, United States
| | - Evgeny V. Arshava
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa, IA, United States
| | - Kalpaj R. Parekh
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa, IA, United States
| | - John C. Keech
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa, IA, United States
| | - Joseph M. Caster
- Carver College of Medicine, University of Iowa, Iowa, IA, United States
| | - James W. Welsh
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Bryan G. Allen
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa, IA, United States
| |
Collapse
|
11
|
Schaub SK, Tseng YD, Chang EL, Sahgal A, Saigal R, Hofstetter CP, Foote M, Ko AL, Yuh WTC, Mossa-Basha M, Mayr NA, Lo SS. Strategies to Mitigate Toxicities From Stereotactic Body Radiation Therapy for Spine Metastases. Neurosurgery 2020; 85:729-740. [PMID: 31264703 DOI: 10.1093/neuros/nyz213] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/24/2019] [Indexed: 11/12/2022] Open
Abstract
Improvements in systemic therapy are translating into more patients living longer with metastatic disease. Bone is the most common site of metastasis, where spinal lesions can result in significant pain impacting quality of life and possible neurological dysfunction resulting in a decline in performance status. Stereotactic body radiation therapy (SBRT) of the spine has emerged as a promising technique to provide durable local control, palliation of symptoms, control of oligoprogressive sites of disease, and possibly augment the immune response. SBRT achieves this by delivering highly conformal radiation therapy to allow for dose escalation due to a steep dose gradient from the planning target volume to nearby critical organs at risk. In our review, we provide an in-depth review and expert commentary regarding seminal literature that defined clinically meaningful toxicity endpoints with actionable dosimetric limits and/or clinical management strategies to mitigate toxicity potentially attributable to SBRT of the spine. We placed a spotlight on radiation myelopathy (de novo, reirradiation after conventional external beam radiation therapy or salvage after an initial course of spinal SBRT), plexopathy, vertebral compression fracture, pain flare, esophageal toxicity, myositis, and safety regarding combination with concurrent targeted or immune therapies.
Collapse
Affiliation(s)
- Stephanie K Schaub
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Yolanda D Tseng
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Eric L Chang
- Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Canada
| | - Rajiv Saigal
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Christoph P Hofstetter
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Matthew Foote
- Department of Radiation Oncology, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Andrew L Ko
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington
| | - William T C Yuh
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Mahmud Mossa-Basha
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Nina A Mayr
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| |
Collapse
|
12
|
Kissel M, Martel-Lafay I, Lequesne J, Faivre JC, Le Péchoux C, Stefan D, Barraux V, Loiseau C, Grellard JM, Danhier S, Lerouge D, Chouaid C, Gervais R, Thariat J. Stereotactic ablative radiotherapy and systemic treatments for extracerebral oligometastases, oligorecurrence, oligopersistence and oligoprogression from lung cancer. BMC Cancer 2019; 19:1237. [PMID: 31856742 PMCID: PMC6924047 DOI: 10.1186/s12885-019-6449-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 12/11/2019] [Indexed: 12/25/2022] Open
Abstract
Background Stereotactic irradiation (SBRT) is a standard of care for inoperable stage I lung cancer and brain oligometastases from lung cancer but is controversial for extracranial oligometastases. We assessed outcomes of lung cancer patients with extracranial metastases in oligometastatic, oligorecurrent, oligopersistent and oligoprogressive settings (“oligometastatic spectrum”) under strategies using SBRT +/− systemic treatments. Methods A retrospective multicentric study of consecutive lung cancer adult patients with 1–5 extracranial metastases treated with SBRT was conducted. Results Of 91 patients (99 metastases, median age 63, 64.8% adenocarcinomas, 19.8% molecular alterations), 11% had oligometastases, 49.5% oligorecurrence, 19.8% oligopersistence and 19.8% oligoprogression. Of 36% of patients under systemic treatments at initiation of SBRT, systemic treatment interruption was performed in 58% of them. With median follow up of 15.3 months, crude local control at irradiated metastases was 91%, while median distant progression-free survival (dPFS) and overall survival were 6.3 and 28.4 months (2-year survival 54%). Initial nodal stage and oligometastatic spectrum were prognostic factors for dPFS; age, initial primary stage and oligometastatic spectrum were prognostic factors for survival on multivariate analysis. Patients with oncogene-addicted tumors more frequently had oligoprogressive disease. Repeat ablative irradiations were preformed in 80% of patients who had oligorelapses. Worst acute toxicities consisted of 5.5% and one late toxic death occurred. Conclusion The oligometastatic spectrum is a strong prognosticator in patients undergoing SBRT for extracranial metastases. Median survival was over two years but dPFS was about 6 months. Continuation of systemic therapy in oligoprogressive patients should be investigated.
Collapse
Affiliation(s)
- Manon Kissel
- Centre de lutte contre le cancer François Baclesse/ ARCHADE, radiotherapy department, 3 avenue du Général Harris, 14000, Caen, France. .,Institut Gustave Roussy, radiotherapy department, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
| | - Isabelle Martel-Lafay
- Centre de lutte contre le cancer Léon Bérard, radiotherapy department, 28 Promenade Léa et Napoléon Bullukian, 69008, Lyon, France
| | - Justine Lequesne
- Centre de lutte contre le cancer François Baclesse, clinical research department, 3 avenue du Général Harris, 14000, Caen, France
| | - Jean-Christophe Faivre
- Institut de Cancérologie de Lorraine, radiotherapy department, 6 Avenue de Bourgogne, 54519, Vandœuvre-lès-Nancy, France
| | - Cécile Le Péchoux
- Institut Gustave Roussy, radiotherapy department, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Dinu Stefan
- Centre de lutte contre le cancer François Baclesse/ ARCHADE, radiotherapy department, 3 avenue du Général Harris, 14000, Caen, France
| | - Victor Barraux
- Centre de lutte contre le cancer François Baclesse/ ARCHADE, radiotherapy department, 3 avenue du Général Harris, 14000, Caen, France
| | - Cédric Loiseau
- Centre de lutte contre le cancer François Baclesse/ ARCHADE, radiotherapy department, 3 avenue du Général Harris, 14000, Caen, France
| | - Jean-Michel Grellard
- Centre de lutte contre le cancer François Baclesse, clinical research department, 3 avenue du Général Harris, 14000, Caen, France
| | - Serge Danhier
- Centre de lutte contre le cancer François Baclesse/ ARCHADE, radiotherapy department, 3 avenue du Général Harris, 14000, Caen, France
| | - Delphine Lerouge
- Centre de lutte contre le cancer François Baclesse/ ARCHADE, radiotherapy department, 3 avenue du Général Harris, 14000, Caen, France
| | - Christos Chouaid
- CHI de Créteil, pneumology department, 40 Avenue De Verdun, 94000, Créteil, France
| | - Radj Gervais
- Centre de lutte contre le cancer François Baclesse/ ARCHADE, radiotherapy department, 3 avenue du Général Harris, 14000, Caen, France
| | - Juliette Thariat
- Centre de lutte contre le cancer François Baclesse/ ARCHADE, radiotherapy department, 3 avenue du Général Harris, 14000, Caen, France
| |
Collapse
|
13
|
Duijm M, van der Voort van Zyp NC, van de Vaart P, Oomen-de Hoop E, Mast ME, Hoogeman MS, Nuyttens JJ. Predicting High-Grade Esophagus Toxicity After Treating Central Lung Tumors With Stereotactic Radiation Therapy Using a Normal Tissue Complication Probability Model. Int J Radiat Oncol Biol Phys 2019; 106:73-81. [PMID: 31499137 DOI: 10.1016/j.ijrobp.2019.08.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE The treatment of central lung tumors with stereotactic body radiation therapy (SBRT) is challenged by the risk of excessive esophageal toxicity. To improve clinical decision making, we aimed to derive normal tissue complication probability (NTCP) models in a patient cohort with central lung tumors treated with SBRT and to evaluate the currently used esophagus dose constraints. METHODS AND MATERIALS Patients with a central lung tumor who received SBRT (8 fractions of 7.5 Gy or 12 fractions of 5 Gy) were included. Doses were recalculated to an equivalent dose of 2 Gy with an α/β-ratio of 10 Gy for acute and 3 Gy for late toxicity (the cut-off was 3 months). The esophagus was manually delineated. NTCP modeling based on logistic regression was used to relate dose-volume histogram parameters (Dmax, D1cc, D2cc, D5cc) to acute and late toxicity. Parameters with a P < .05 were included in the model. Based on the NTCP models, we determined the probability of toxicity for the currently used dose constraints: D1cc ≤40 Gy for 8 fractions and D1cc ≤48 Gy for 12 fractions. RESULTS For this study, 188 patients with 203 tumors were eligible. Esophagus toxicity occurred in 33 patients (18%). Late high-grade toxicity consisted of 2 possible treatment-related deaths (grade 5) and 2 patients with grade 3 toxicity. Acute toxicity consisted of only grade 1 (n = 19) and grade 2 toxicity (n = 10). All investigated dose-volume histogram parameters were significantly correlated to acute and late toxicity. The probability of late high-grade toxicity is 1.1% for 8 fractions and 1.4% for 12 fractions when applying the current dose constraints. CONCLUSIONS High-grade esophageal toxicity occurred in 2.1% of the patients, including 2 possible treatment-related deaths. The currently used dose constraints correspond to a low risk of high-grade toxicity.
Collapse
Affiliation(s)
- Marloes Duijm
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | | | - Paul van de Vaart
- Department of Radiation Oncology, Haaglanden MC, The Hague, The Netherlands
| | - Esther Oomen-de Hoop
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Mirjam E Mast
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Mischa S Hoogeman
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Joost J Nuyttens
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| |
Collapse
|
14
|
Sun Z, Li J, Lin M, Zhang S, Luo J, Tang Y. An RNA-seq-Based Expression Profiling of Radiation-Induced Esophageal Injury in a Rat Model. Dose Response 2019; 17:1559325819843373. [PMID: 31105479 PMCID: PMC6505253 DOI: 10.1177/1559325819843373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 11/16/2022] Open
Abstract
Radiation-induced acute injury is the main reason for the suspension of radiotherapy and unsuccessful treatment of cancer. It is of great importance to understand the molecular mechanism of radiation-induced esophageal injury. We used RNA-seq data from normal esophageal tissue and irradiated esophageal tissues and applied computational approaches to identify and characterize differentially expressed genes and detected 40 059 messenger RNAs (mRNAs) previously annotated and 717 novel long noncoding RNAs (lncRNAs). There were 14 upregulated and 32 downregulated lncRNAs among the differentially expressed lncRNA group. Their target genes were involved in the mRNA surveillance pathway, pathological immune responses, and cellular homeostasis. Additionally, we found 853 differentially expressed mRNAs, and there were 384 upregulated and 469 downregulated mRNAs. Notably, we found that the differentially expressed mRNAs were enriched for steroid biosynthesis, the tumor necrosis factor signaling pathway, focal adhesion, pathways in cancer, extracellular matrix-receptor interaction, and so on. The response of normal esophageal tissues to ionizing radiation is multifarious. The radiation-induced cell damage response by multiple pathways followed by pathological immune responses activated. Studies on the dynamic network of molecules involved in radiation-induced esophageal injury are under way to clarify the regulatory mechanisms and identify the candidate targets.
Collapse
Affiliation(s)
- Zhiqiang Sun
- Department of Oncology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Jinhui Li
- Department of Gastroenterology, South Campus, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Min Lin
- Department of Gastroenterology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Shuyu Zhang
- School of Radiation Medicine and Protection and Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, Soochow University, Suzhou, China
| | - Judong Luo
- Department of Oncology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yiting Tang
- Department of Radiotherapy, Changzhou Tumor Hospital, Soochow University, Changzhou, China
| |
Collapse
|
15
|
Chen H, Laba JM, Zayed S, Boldt RG, Palma DA, Louie AV. Safety and Effectiveness of Stereotactic Ablative Radiotherapy for Ultra-Central Lung Lesions: A Systematic Review. J Thorac Oncol 2019; 14:1332-1342. [PMID: 31075543 DOI: 10.1016/j.jtho.2019.04.018] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/04/2019] [Accepted: 04/06/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The safety and effectiveness of stereotactic ablative radiotherapy (SABR) in patients with ultra-central lung tumors is currently unclear. We performed a systematic review to summarize existing data and identify trends in treatment-related toxicity and local control following SABR in patients with ultra-central lung lesions. METHODS We performed a systematic review based on the Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines using the PubMed and Embase databases. The databases were queried from dates of inception until September 27, 2018. Studies in the English language that reported treatment-related toxicity and local control outcomes post-SABR for patients with ultra-central lung lesions were included. Guidelines, reviews, non-peer reviewed correspondences, studies focused on re-irradiation, and studies with fewer than five patients were excluded. RESULTS A total of 446 studies were identified, with 10 meeting all criteria for inclusion. The total sample size from the identified studies was 250 ultra-central lung patients and all studies were retrospective in design. Radiotherapy dose and fractionation ranged from 30 to 60 Gy in 3 to 12 fractions, with biologically effective doses (BED10) ranging from 48 to 138 Gy10 (median, 78-103 Gy10). Median treatment-related grade 3 or greater toxicity was 10% (range, 0-50%). Median treatment-related mortality was 5% (range, 0-22%), most commonly from pulmonary hemorrhage (55%). High-risk indicators for SABR-related mortality included gross endobronchial disease, maximum dose to the proximal bronchial tree greater than or equal to 180 Gy3 (BED3, corresponding to 45 Gy in 5 fractions or 55 Gy in 8 fractions), peri-SABR bevacizumab use, and antiplatelet/anticoagulant use. Median 1-year local control rate was 96% (range, 63%-100%) and 2-year local control rate was 92% (range, 57%-100%). CONCLUSIONS SABR for ultra-central lung lesions appears feasible but there is a potential for severe toxicity in patients receiving high doses to the proximal bronchial tree, those with endobronchial disease, and those receiving bevacizumab or anticoagulants around the time of SABR. Prospective studies are required to establish the optimal doses, volumes, and normal tissue tolerances for SABR in this patient population.
Collapse
Affiliation(s)
- Hanbo Chen
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Joanna M Laba
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Sondos Zayed
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - R Gabriel Boldt
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - David A Palma
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Alexander V Louie
- Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
| |
Collapse
|
16
|
Lenglet A, Campeau MP, Mathieu D, Bahig H, Lambert L, Vu T, Roberge D, Bilodeau L, Filion E. Risk-adapted stereotactic ablative radiotherapy for central and ultra-central lung tumours. Radiother Oncol 2019; 134:178-184. [DOI: 10.1016/j.radonc.2019.01.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 12/25/2022]
|
17
|
Jereczek-Fossa BA, Muto M, Durante S, Ferrari A, Piperno G, Fodor C, Comi S, Ricotti R, Garibaldi C, Dicuonzo S, Mazza S, Golino F, Spaggiari L, De Marinis F, Orecchia R, Ciardo D, Fossati P. Stereotactic body radiation therapy for mediastinal lymph node metastases: how do we fly in a 'no-fly zone'? Acta Oncol 2018; 57:1532-1539. [PMID: 30280618 DOI: 10.1080/0284186x.2018.1486040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the treatment-induced toxicity (as primary endpoint) and the efficacy (as secondary endpoint) of stereotactic body radiation therapy (SBRT) in the treatment of mediastinal lymph nodes (LNs) in the so-called no-fly zone (NFZ) in cancers with various histology. MATERIAL AND METHODS Forty-two patients were retrospectively analyzed. Institutional dose/volume constraints for organs at risk (OARs) derived by published data were strictly respected. The correlation between treatment-related variables and toxicity was investigated by logistic regression, Chi-squared test or Fisher's exact test. Overall survival (OS), cause-specific survival (CSS), progression-free survival (PFS) and local control (LC) were collected from the follow-up reports. The impact of potential predictive factors on LC, PFS and OS were estimated by Cox proportional-hazard regression. RESULTS Median follow-up time was 16 months (range 1-41). Four patients had esophageal G1 toxicity. Ten and six patients had G1 and G2 pulmonary toxicity, respectively. Treatment site and irradiation technique were significantly correlated with G ≥ 2 and G ≥ 1 toxicity, respectively. OS probability at 19 months was 88.3% and corresponded to CSS. LC probability at 16 months was 66.3% (median LC duration: 22 months, range 1-41). Fifteen patients (35.7%) were disease-free at 25 months (median time, range 1-41). The biologically effective dose (BED) and the target dose coverage indexes were significantly correlated with LC. CONCLUSIONS SBRT can be considered as a safe treatment option for selected patients with oligo-metastases/recurrences in the NFZ, if strict dose/volume constraints are applied.
Collapse
Affiliation(s)
- Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Matteo Muto
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
- Department of Clinical Medicine and Surgery, Federico II University School of Medicine, Naples, Italy
| | - Stefano Durante
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Annamaria Ferrari
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Gaia Piperno
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Cristiana Fodor
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Stefania Comi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Rosalinda Ricotti
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | | | - Samantha Dicuonzo
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Stefano Mazza
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Federica Golino
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Filippo De Marinis
- Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy
| | - Roberto Orecchia
- Scientific Direction, European Institute of Oncology, Milan, Italy
| | - Delia Ciardo
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Piero Fossati
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
- Clinical Division, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| |
Collapse
|
18
|
Luo J, Zhang C, Zhan Q, An F, Zhu W, Jiang H, Ma C. Profiling circRNA and miRNA of radiation-induced esophageal injury in a rat model. Sci Rep 2018; 8:14605. [PMID: 30279559 PMCID: PMC6168520 DOI: 10.1038/s41598-018-33038-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 09/20/2018] [Indexed: 12/26/2022] Open
Abstract
Evidence has also shown that micro ribonucleic acid (miRNA) plays an important role in many cellular processes. However, it is unclear how ionizing radiation causes the miRNA and circular ribonucleic acid (circRNA) expression levels to change and how this change relates to esophageal injury. We analyzed RNA Sequencing (RNA-seq) data from normal esophageal tissue and irradiated esophageal tissues and used computational approaches to identify and characterize differentially expressed miRNAs and circRNAs. We detected 27 miRNAs and 197 circRNAs that had significantly different expression levels after ionizing radiation treatment compared with normal control.Among the 27 miRNAs, 7 miRNAs were down-regulated, and the other 20 were up-regulated. Their target genes were found to be involved in responses to wound, lipid biosynthesis, cell proliferation, cell migration, chemokine activity, hairpin binding, and the cell membrane system. We also found 197 differentially expressed circRNAs in total, of which 87 were up-regulated and 110 were down-regulated. Notably, we found that differentially expressed circRNAs were enriched in cell differentiation, epithelial cell migration, striatum development, protein binding, extracellular exosome, and focal adhesion functions. Of the related processes, sphingolipid metabolism was notable. Many of the differentially expressed circRNAs were involved in sphingolipid metabolism pathways. Cells responded to ionizing radiation (IR) using multiple pathways, which led to sphingolipid metabolism and other immune responses, ultimately leading to esophageal injury.IR-induced esophageal injury is worth studying, especially the dynamic network of circRNA and miRNA. By knowing the regulatory details of related pathways, radiation-related esophageal injury can be prevented, and the efficiency of radiation therapy can be enhanced.
Collapse
Affiliation(s)
- Judong Luo
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China.,Medical college of Shandong University, Jinan, China.,Department of Oncology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Changsong Zhang
- Department of Oncology, Changzhou Tumor Hospital, Soochow University, Changzhou, China
| | - Qiang Zhan
- Department of Gastroenterology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Fangmei An
- Department of Gastroenterology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Wenyu Zhu
- Department of Oncology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Hua Jiang
- Department of Oncology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Changsheng Ma
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China. .,Medical college of Shandong University, Jinan, China.
| |
Collapse
|
19
|
Aoki S, Yamashita H, Haga A, Ota T, Takahashi W, Ozaki S, Nawa K, Imae T, Abe O, Nakagawa K. Stereotactic body radiotherapy for centrally-located lung tumors with 56 Gy in seven fractions: A retrospective study. Oncol Lett 2018; 16:4498-4506. [PMID: 30214585 PMCID: PMC6126178 DOI: 10.3892/ol.2018.9188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 07/03/2018] [Indexed: 12/25/2022] Open
Abstract
Stereotactic body radiotherapy (SBRT) for centrally-located lung tumors remains a challenge because of the increased risk of treatment-related adverse events (AEs), and uncertainty around prescribing the optimal dose. The present study reported the results of central tumor SBRT with 56 Gy in 7 fractions (fr) at the University of Tokyo Hospital. A total of 35 cases that underwent SBRT with or without volumetric-modulated arc therapy consisting of 56 Gy/7 fr for central lung lesions between 2010 and 2016 at the University of Tokyo Hospital were reveiwed. A central lesion was defined as a tumor within 2 cm of the proximal bronchial tree (RTOG 0236 definition) or within 2 cm in all directions of any critical mediastinal structure. Local control (LC), overall survival (OS), and AEs were investigated. The Kaplan-Meier method was used to estimate LC and OS. AEs were scored per the Common Terminology Criteria for Adverse Events Version 4.0. Thirty-five patients with 36 central lung lesions were included. Fifteen lesions were primary non-small cell lung cancer (NSCLC), 13 were recurrences of NSCLC, and 8 had oligo-recurrences from other primaries. Median tumor diameter was 29 mm. Eighteen patients had had prior surgery. At a median follow-up of 13.1 months for all patients and 18.3 months in surviving patients, 22 patients had died, ten due to primary disease (4 NSCLC), while three were treatment-related. The 1- and 2-year OS were 57.3 and 40.4%, respectively, and median OS was 15.7 months. Local recurrence occurred in only two lesions. 1- and 2-year LC rates were both 96%. Nine patients experienced grade ≥3 toxicity, representing 26% of the cohort. Two of these were grade 5, one pneumonitis and one hemoptysis. Considering the background of the subject, tumor control of our central SBRT is promising, especially in primary NSCLC. However, the safety of SBRT to central lung cancer remains controversial.
Collapse
Affiliation(s)
- Shuri Aoki
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Hideomi Yamashita
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Akihiro Haga
- Medical and Dentistry Laboratory, University of Tokushima, Tokushima 770-8501, Japan
| | - Takeshi Ota
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Wataru Takahashi
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Sho Ozaki
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Kanabu Nawa
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Toshikazu Imae
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Osamu Abe
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Keiichi Nakagawa
- Department of Radiology, University of Tokyo Hospital, Tokyo 113-8655, Japan
| |
Collapse
|
20
|
Stereotactic ablative radiotherapy (SABR) for early-stage central lung tumors: New insights and approaches. Lung Cancer 2018; 123:142-148. [PMID: 30089586 DOI: 10.1016/j.lungcan.2018.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/01/2018] [Indexed: 12/22/2022]
Abstract
The use of stereotactic ablative radiotherapy (SABR) for central lung tumors is increasing. Centrally located lung tumors can be subdivided into two categories, namely the 'moderately central' tumors where the planning target volume is located within 2 cm of the proximal bronchial tree, and the 'ultracentral' tumors where a planning target volume (PTV) overlaps the trachea or main stem bronchi. The toxicity of SABR appears acceptable when 'moderately central' tumors are treated using techniques that comply with organs at risk tolerance doses used for prospective trials and in recent publications. A high toxicity is seen when ultracentral tumors are treated using SABR, and conventional radiotherapy appears more appropriate in such tumors as the true normal organ tolerance doses remain unknown. When ultracentral tumors are treated with non-SABR hypofractionated radiotherapy, a homogenous dose distribution in the planning target volume and limitation of both normal organ maximum point doses and volumes receiving high doses seems to be needed.
Collapse
|
21
|
Vellayappan BA, Chao ST, Foote M, Guckenberger M, Redmond KJ, Chang EL, Mayr NA, Sahgal A, Lo SS. The evolution and rise of stereotactic body radiotherapy (SBRT) for spinal metastases. Expert Rev Anticancer Ther 2018; 18:887-900. [DOI: 10.1080/14737140.2018.1493381] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Balamurugan A. Vellayappan
- Department of Radiation Oncology, National University Cancer Institute Singapore, National University Health System, Singapore
| | - Samuel T. Chao
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Matthew Foote
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Kristin J. Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University, Baltimore, MD, USA
| | - Eric L. Chang
- Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Nina A. Mayr
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Simon S. Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| |
Collapse
|
22
|
Nouvelles définitions de la maladie oligométastatique et nouveaux concepts de prise en charge globale de la maladie métastatique. Bull Cancer 2018; 105:696-706. [DOI: 10.1016/j.bulcan.2018.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/16/2018] [Accepted: 04/18/2018] [Indexed: 01/16/2023]
|
23
|
Raman S, Yau V, Pineda S, Le LW, Lau A, Bezjak A, Cho BCJ, Sun A, Hope AJ, Giuliani M. Ultracentral Tumors Treated With Stereotactic Body Radiotherapy: Single-Institution Experience. Clin Lung Cancer 2018; 19:e803-e810. [PMID: 30007498 DOI: 10.1016/j.cllc.2018.06.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/01/2018] [Accepted: 06/10/2018] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Patients with ultracentral lung tumors, whose planning target volume directly contacts or overlaps the proximal bronchial tree, trachea, esophagus, pulmonary vein, or pulmonary artery, may be at higher risk of toxicity when treated with stereotactic body radiotherapy (SBRT). We reviewed the outcomes and toxicities of ultracentral lung tumors and compared the results with central lung tumors. PATIENTS AND METHODS A review of our institutional prospective database of patients treated with lung SBRT from January 2006 to December 2015 was conducted. Patients with central tumors (RTOG 0813 definition) and ultracentral tumors were included. RESULTS In total, 180 central and 26 ultracentral tumors were analyzed. The majority of patients received 60 Gy in 8 fractions (53.9%) or 48 Gy in 4 fractions (29.1%). The rates of any grade 2 or higher toxicity were 8.4% (n = 16) in the central group and 7.9% (n = 2) in the ultracentral group (P = .88). There were no observed grade 4 or 5 toxicities. In the nonmetastatic primary lung cancer cohort (n = 182), the median overall survival was 39.4 months versus 23.8 months (P = .40) and cause-specific survival was 55.5 months versus 28.2 months (P = .34) for central and ultracentral tumors, respectively. The 2-year cumulative local, regional, and distant failure rates were 3.3% versus 0 (P = .36), 9.1% versus 5.0% (P = .5), and 17.7% versus 18.7% (P = .63) in the central and ultracentral groups, respectively. CONCLUSION In our experience, with strict adherence to planning parameters, SBRT to ultracentral tumors resulted in effective local control and no excessive risk of toxicity compared to central tumors.
Collapse
MESH Headings
- Adenocarcinoma/mortality
- Adenocarcinoma/secondary
- Adenocarcinoma/surgery
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/secondary
- Carcinoma, Non-Small-Cell Lung/surgery
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/secondary
- Carcinoma, Squamous Cell/surgery
- Female
- Follow-Up Studies
- Humans
- Lung Neoplasms/mortality
- Lung Neoplasms/pathology
- Lung Neoplasms/surgery
- Lymphatic Metastasis
- Male
- Middle Aged
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/surgery
- Prognosis
- Prospective Studies
- Radiosurgery/mortality
- Retrospective Studies
- Survival Rate
Collapse
Affiliation(s)
- Srinivas Raman
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Vivian Yau
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Sandra Pineda
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Lisa W Le
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Anthea Lau
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Andrea Bezjak
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - B C John Cho
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Alexander Sun
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Andrew J Hope
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Meredith Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
24
|
Donovan EK, Swaminath A. Stereotactic body radiation therapy (SBRT) in the management of non-small-cell lung cancer: Clinical impact and patient perspectives. LUNG CANCER-TARGETS AND THERAPY 2018; 9:13-23. [PMID: 29588624 PMCID: PMC5859907 DOI: 10.2147/lctt.s129833] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Stereotactic body radiation therapy (SBRT) has emerged as a new technology in radiotherapy delivery, allowing for potentially curative treatment in many patients previously felt not to be candidates for radical surgical resection of stage I non-small-cell lung cancer (NSCLC). Several studies have demonstrated very high local control rates using SBRT, and more recent data have suggested overall survival may approach that of surgery in operable patients. However, SBRT is not without unique toxicities, and the balance of toxicity, and effect on patient-reported quality of life need to be considered with respect to oncologic outcomes. We therefore aim to review SBRT in the context of important patient-related factors, including quality of life in several domains (and in comparison to other therapies such as conventional radiation, surgery, or no treatment). We will also describe scenarios in which SBRT may be reasonably offered (i.e. elderly patients and those with severe COPD), and where it may need to be approached with some caution due to increased risks of toxicity (i.e. tumor location, patients with interstitial lung disease). In total, we hope to characterize the physical, emotional, and functional consequences of SBRT, in relation to other management strategies, in order to aid the clinician in deciding whether SBRT is the optimal treatment choice for each patient with early stage NSCLC.
Collapse
Affiliation(s)
- Elysia K Donovan
- Department of Oncology, McMaster University, Hamilton, ON, Canada.,Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada
| | - Anand Swaminath
- Department of Oncology, McMaster University, Hamilton, ON, Canada.,Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, ON, Canada
| |
Collapse
|
25
|
Esophagus toxicity after stereotactic and hypofractionated radiotherapy for central lung tumors: Normal tissue complication probability modeling. Radiother Oncol 2018; 127:233-238. [PMID: 29478763 DOI: 10.1016/j.radonc.2018.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/26/2018] [Accepted: 02/05/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE To correlate esophagus toxicity and dose-volume histogram (DVH) parameters in order to assess risks, and derive a Normal Tissue Complication Probability (NTCP) model. METHODS AND MATERIALS Patients with a central lung tumor from 2 centers, who underwent stereotactic or hypofractionated radiotherapy (≤12 fractions), were analyzed. Doses were recalculated to an equivalent dose of 2 Gy with an α/β ratio of 10 (EQD210). The esophagus was manually delineated and DVH-parameters (Dmax,EQD2, D1cc,EQD2, D2cc,EQD2, D5cc,EQD2) were analyzed and used for NTCP modeling based on logistic regression analysis. RESULTS Two-hundred-and-thirty-one patients with 252 tumors were eligible. No acute or late grade 3-5 esophageal toxicity was reported. Acute grade 1-2 esophagus toxicity was recorded in 38 patients (17%). All DVH-parameters were significantly higher in patients with toxicity. NTCP models showed a 50% probability of acute grade 1-2 toxicity at a Dmax of 67 Gy EQD210 and D1cc of 42 Gy EQD210. No difference in overall survival was observed between patients with and without toxicity (p = 0.428). CONCLUSION As no grade 3-5 esophageal toxicity was observed in our cohort, a Dmax of 56 Gy EQD210 and a D5cc of 35.5 Gy EQD210 could be delivered without high risks of severe toxicity. The NTCP models of this study might be used as practical guidelines for the treatment of central lung tumors with stereotactic radiotherapy.
Collapse
|
26
|
Choi JI. Medically inoperable stage I non-small cell lung cancer: best practices and long-term outcomes. Transl Lung Cancer Res 2018; 8:32-47. [PMID: 30788233 DOI: 10.21037/tlcr.2018.06.11] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Early-stage non-small cell lung cancer (ES-NSCLC) currently represents a minority of all NSCLC diagnoses but, with ongoing refinement and improvement of treatment approaches, is a group with increasing likelihood of long-term disease control and survival. A significant proportion of this population will not be optimal candidates for definitive surgical resection due to tumor characteristics, patient frailty, or comorbid status. The clinical evidence to support the use of stereotactic body radiation therapy (SBRT) in patients with medically inoperable stage I NSCLC is growing as long-term data are obtained. In this review, initial workup, SBRT delivery considerations, recent trial data, and post-treatment surveillance of this population are discussed.
Collapse
Affiliation(s)
- J Isabelle Choi
- Department of Radiation Oncology, University of Maryland, Baltimore, MD, USA
| |
Collapse
|
27
|
Cardenas ML, Mazur TR, Tsien CI, Green OL. A rapid, computational approach for assessing interfraction esophageal motion for use in stereotactic body radiation therapy planning. Adv Radiat Oncol 2017; 3:209-215. [PMID: 29904747 PMCID: PMC6000025 DOI: 10.1016/j.adro.2017.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 08/30/2017] [Accepted: 10/03/2017] [Indexed: 01/15/2023] Open
Abstract
Purpose We present a rapid computational method for quantifying interfraction motion of the esophagus in patients undergoing stereotactic body radiation therapy on a magnetic resonance (MR) guided radiation therapy system. Methods and materials Patients who underwent stereotactic body radiation therapy had simulation computed tomography (CT) and on-treatment MR scans performed. The esophagus was contoured on each scan. CT contours were transferred to MR volumes via rigid registration. Digital Imaging and Communications in Medicine files containing contour points were exported to MATLAB. In-plane CT and MR contour points were spline interpolated, yielding boundaries with centroid positions, CCT and CMR. MR contour points lying outside of the CT contour were extracted. For each such point, BMR(j), a segment from CCT intersecting BMR(j), was produced; its intersection with the CT contour, BCT(i), was calculated. The length of the segment Sij, between BCT(i) and BMR(j), was found. The orientation θ was calculated from Sij vector components: θ = arctan[(Sij)y / (Sij)x] A set of segments {Sij} was produced for each slice and binned by quadrant with 0° < θ ≤ 90°, 90° < θ ≤ 180°, 180° < θ ≤ 270°, and 270° < θ ≤ 360° for the left anterior, right anterior, right posterior, and left posterior quadrants, respectively. Slices were binned into upper, middle, and lower esophageal (LE) segments. Results Seven patients, each having 3 MR scans, were evaluated, yielding 1629 axial slices and 84,716 measurements. The LE segment exhibited the greatest magnitude of motion. The mean LE measurements in the left anterior, left posterior, right anterior, and right posterior were 5.2 ± 0.07 mm, 6.0 ± 0.09 mm, 4.8 ± 0.08 mm, and 5.1 ± 0.08 mm, respectively. There was considerable interpatient variability. Conclusions The LE segment exhibited the greatest magnitude of mobility compared with the middle and upper esophageal segments. A novel computational method enables personalized, nonuniform esophageal margins to be tailored to individual patients.
Collapse
Affiliation(s)
| | | | | | - Olga L Green
- Washington University in St. Louis, St. Louis, Missouri
| |
Collapse
|
28
|
Five-fraction SBRT for ultra-central NSCLC in-field recurrences following high-dose conventional radiation. Radiat Oncol 2017; 12:162. [PMID: 29052514 PMCID: PMC5649069 DOI: 10.1186/s13014-017-0897-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/03/2017] [Indexed: 12/25/2022] Open
Abstract
Purpose/objective Local treatment options for patients with in-field non-small cell lung cancer (NSCLC) recurrence following conventionally fractionated external beam radiation therapy (CF-EBRT) are limited. Stereotactic body radiation therapy (SBRT) is a promising modality to achieve reasonable local control, although toxicity remains a concern. Materials/methods Patients previously treated with high-dose CF-EBRT (≥59.4 Gy, ≤3 Gy/fraction) for non-metastatic NSCLC who underwent salvage SBRT for localized ultra-central in-field recurrence were included in this analysis. Ultra-central recurrences were defined as those abutting the trachea, mainstem bronchus, or esophagus and included both parenchymal and nodal recurrences. The Kaplan-Meier method was used to estimate local control and overall survival. Durable local control was defined as ≥12 months. Toxicity was scored per the CTC-AE v4.0. Results Twenty patients were treated with five-fraction robotic SBRT for ultra-central in-field recurrence following CF-EBRT. Fifty percent of recurrences were adenocarcinoma, while 35% of tumors were classified as squamous cell carcinoma. The median interval between the end of CF-EBRT and SBRT was 23.3 months (range: 2.6 – 93.6 months). The median CF-EBRT dose was 63 Gy (range: 59.4 – 75 Gy), the median SBRT dose was 35 Gy (range: 25 – 45 Gy), and the median total equivalent dose in 2 Gy fractions (EQD2) was 116 Gy (range: 91.3 – 136.7 Gy). At a median follow-up of 12 months for all patients and 37.5 months in surviving patients, the majority of patients (90%) have died. High-dose SBRT was associated with improved local control (p < .01), and the one-year overall survival and local control were 77.8% and 66.7% respectively in this sub-group. No late esophageal toxicity was noted, although a patient who received an SBRT dose of 45 Gy (total EQD2: 129.7 Gy) experienced grade 5 hemoptysis 35 months following treatment. Conclusions Although the overall prognosis for patients with in-field ultra-central NSCLC recurrences following CF-EBRT remains grim, five-fraction SBRT was well tolerated with an acceptable toxicity profile. Dose escalation above 35 Gy may offer improved local control, however caution is warranted when treating high-risk recurrences with aggressive regimens.
Collapse
|
29
|
Dose-Volume Predictors of Esophagitis After Thoracic Stereotactic Body Radiation Therapy. Am J Clin Oncol 2017; 40:477-482. [DOI: 10.1097/coc.0000000000000195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
30
|
|
31
|
Pham AHN, Yorke E, Rimner A, Wu AJC. Potential for Interfraction Motion to Increase Esophageal Toxicity in Lung SBRT. Technol Cancer Res Treat 2017; 16:935-943. [PMID: 28573929 PMCID: PMC5640496 DOI: 10.1177/1533034617711353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Purpose: To characterize the effect of the relative motion of esophagus and tumor on radiation doses to the esophagus in patients treated with stereotactic body radiation therapy for central lung tumors. Methods and Materials: Fifty fractions of stereotactic body radiation therapy in 10 patients with lung tumors within 2.5 cm of the esophagus were reviewed. The esophagus was delineated on each treatment’s cone-beam computed tomography scan and compared to its position on the planning scan. Dose–volume histograms were calculated using the original treatment beams to determine the actual dose delivered to the esophagus for each fraction of stereotactic body radiation therapy. Results: Median interfraction right–left shift of the esophagus was 0.9 mm (range, −5.4 to 3.3 mm) toward the left. Median interfraction anteroposterior shift was 0.7 mm (range, −3.7 to 11.5 mm) posteriorly. The median percentage increase in dose to 1 cm3, dose to 3.5 cm3, and dose to 5 cm3 was 1.7%, 5.6%, and 6.6%, respectively. Two cases of significant late esophageal toxicity were observed, with change in esophageal position relative to the planning target volume resulting in significantly higher D5cc values than anticipated. Conclusion: Interfraction shifts between the internal target volume and esophagus can lead to unanticipated increases in the volume of esophagus receiving high doses when treating central lung tumors with stereotactic body radiation therapy. Certain practical steps, such as considering deep breath hold for internal target volume reduction, using a planning risk volume for esophagus, and carefully visualizing and considering esophageal position at the time of stereotactic body radiation therapy, can be taken to minimize unanticipated dose increases that could cause unexpected esophageal toxicity.
Collapse
Affiliation(s)
- Anthony Hoai-Nam Pham
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Ellen Yorke
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Andreas Rimner
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | |
Collapse
|
32
|
Swaminath A, Wierzbicki M, Parpia S, Wright JR, Tsakiridis TK, Okawara GS, Kundapur V, Bujold A, Ahmed N, Hirmiz K, Kurien E, Filion E, Gabos Z, Faria S, Louie AV, Owen T, Wai E, Ramchandar K, Chan EK, Julian J, Cline K, Whelan TJ. Canadian Phase III Randomized Trial of Stereotactic Body Radiotherapy Versus Conventionally Hypofractionated Radiotherapy for Stage I, Medically Inoperable Non–Small-Cell Lung Cancer – Rationale and Protocol Design for the Ontario Clinical Oncology Group (OCOG)-LUSTRE Trial. Clin Lung Cancer 2017; 18:250-254. [DOI: 10.1016/j.cllc.2016.08.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 08/23/2016] [Indexed: 12/27/2022]
|
33
|
Huo M, Sahgal A, Pryor D, Redmond K, Lo S, Foote M. Stereotactic spine radiosurgery: Review of safety and efficacy with respect to dose and fractionation. Surg Neurol Int 2017; 8:30. [PMID: 28303210 PMCID: PMC5339918 DOI: 10.4103/2152-7806.200581] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/30/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Stereotactic body radiotherapy (SBRT) is an emerging treatment option for spinal metastases with demonstrated efficacy in the upfront, postoperative, and re-treatment settings, as well as for tumor histologies considered radioresistant. Uncertainty exists regarding the optimal dose and fractionation schedule, with single and multifraction regimens commonly utilized. METHODS A literature search of the PubMed and Medline databases was conducted to identify papers specific to spine SBRT and the effect of varying dose/fractionation regimens on outcomes. Bibliographies of relevant papers were searched for further references, and international spine SBRT experts were consulted. RESULTS Local control rates generally exceed 80% at 1 year, while high rates of pain control have been attained. There is insufficient evidence to suggest superiority of either single or multiple fraction regimens with respect to local control and pain control. Low rates of toxicity have been reported, assuming strict dose constraints are respected. Radiation myelopathy may be the most morbid toxicity, although the rates are low. The risk of vertebral compression fracture appears to be associated with higher doses per fraction such as those used in single-fraction regimens. The Spinal Instability Neoplastic Score should be considered when evaluating patients for spine SBRT, and prophylactic stabilisation may be warranted. Pain flare is a relatively common toxicity which may be mediated with prophylactic dexamethasone. Because of the treatment complexity and potentially serious toxicities, strict quality assurance should occur at the organizational, planning, dosimetric, and treatment delivery levels. CONCLUSION Both single and multifraction regimens are safe and efficacious in spine SBRT for spinal metastases. There may be advantages to hypofractionated treatment over single-fraction regimens with respect to toxicity. Ongoing investigation is underway to define optimal dose and fractionation schedules.
Collapse
Affiliation(s)
- Michael Huo
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - David Pryor
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Kristin Redmond
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, USA
| | - Simon Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, USA
| | - Matthew Foote
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| |
Collapse
|
34
|
Pollom EL, Chin AL, Diehn M, Loo BW, Chang DT. Normal Tissue Constraints for Abdominal and Thoracic Stereotactic Body Radiotherapy. Semin Radiat Oncol 2017; 27:197-208. [PMID: 28577827 DOI: 10.1016/j.semradonc.2017.02.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Although stereotactic body radiotherapy (SBRT) or stereotactic ablative radiotherapy has become an established standard of care for the treatment of a variety of malignancies, our understanding of normal tissue dose tolerance with extreme hypofractionation remains immature. Since Timmerman initially proposed normal tissue dose constraints for SBRT in the 2008 issue of Seminars of Radiation Oncology, experience with SBRT has grown, and more long-term clinical outcome data have been reported. This article reviews the modern toxicity literature and provides updated clinically practical and useful recommendations of SBRT dose constraints for extracranial sites. We focus on the major organs of the thoracic and upper abdomen, specifically the liver and the lung.
Collapse
Affiliation(s)
- Erqi L Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Alexander L Chin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Daniel T Chang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA.
| |
Collapse
|
35
|
Onimaru R, Onishi H, Shibata T, Hiraoka M, Ishikura S, Karasawa K, Matsuo Y, Kokubo M, Shioyama Y, Matsushita H, Ito Y, Shirato H. Phase I study of stereotactic body radiation therapy for peripheral T2N0M0 non-small cell lung cancer (JCOG0702): Results for the group with PTV⩾100cc. Radiother Oncol 2016; 122:281-285. [PMID: 27993416 DOI: 10.1016/j.radonc.2016.11.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/27/2016] [Accepted: 11/27/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE A dose escalation study to determine the recommended dose (RD) with stereotactic body radiation therapy (SBRT) for peripheral T2N0M0 non-small cell carcinomas (NSCLC) was conducted. The results of the group with PTV⩾100cc are reported in this paper. MATERIALS AND METHODS The continual reassessment method (CRM) was used to determine the dose level that patients should be assigned to and to estimate the maximum tolerated dose (MTD). Dose limiting toxicity (DLT) was Grade 3 or higher radiation pneumonitis (RP), and Grade 2 or higher RP was used as a surrogate DLT. The RD was equal to the MTD. The dose was prescribed at D95 of the PTV. RESULTS Thirteen patients were accrued. More patients should have been enrolled but we decided not to prolong the study period. No patients experienced Grade 3 RP. Two patients experienced Grade 2 RP at 50Gy in 4 fractions. The predicted MTD was 50.2Gy. The posterior probability of the Grade 2 RP frequency over 40% was 5.3% for the dose level of 50Gy. The RD was determined to be 50Gy. CONCLUSIONS The RD was determined to be 50Gy in 4 fractions in this population.
Collapse
Affiliation(s)
- Rikiya Onimaru
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi Graduate School of Medical Science, Chuo, Japan
| | - Taro Shibata
- JCOG Data Center, Center for Research Administration and Support, National Cancer Center, Tokyo, Japan
| | - Masahiro Hiraoka
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Ishikura
- Department of Radiology, Koshigaya Municipal Hospital, Koshigaya, Japan
| | - Katsuyuki Karasawa
- Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yukinori Matsuo
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masaki Kokubo
- Department of Image-based Medicine, Institute of Biomedical Research and Innovation, Kobe, Japan
| | - Yoshiyuki Shioyama
- Department of Clinical Radiology, Kyushu University Graduate School of Medicine, Fukuoka, Japan
| | - Haruo Matsushita
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshinori Ito
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroki Shirato
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|
36
|
Specific toxicity after stereotactic body radiation therapy to the central chest : A comprehensive review. Strahlenther Onkol 2016; 193:173-184. [PMID: 27812733 DOI: 10.1007/s00066-016-1063-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 10/06/2016] [Indexed: 12/25/2022]
Abstract
The toxicity of stereotactic body radiation therapy in the central chest remains an unsettled issue. The collected data concerning the observed complications are poorly understood and are limited in their quantity and quality, thus hampering a precise delineation of treatment-specific toxicity. The majority of complications scored as toxicity grade 5, namely respiratory failure and fatal hemoptysis, are most likely related to multiple competing risks and occurred at different dose fractionation schemas, e. g., 10-12 fractions of 4-5 Gy, 5 fractions of 10 Gy, 3 fractions of 20-22 Gy, and 1 fraction of 15-30 Gy. Further investigations with longer follow-up and more details of patients' pretreatment and tumor characteristics are required. Furthermore, satisfactory documentation of complications and details of dosimetric parameters, as well as limitation of the wide range of possible fractionation schemes is also warranted for a better understanding of the risk factors relevant for macroscopic damage to the serially organized anatomic structure within the central chest.
Collapse
|
37
|
Antoni D, Bockel S, Deutsch E, Mornex F. [Radiotherapy and targeted therapy/immunotherapy]. Cancer Radiother 2016; 20:434-41. [PMID: 27614521 DOI: 10.1016/j.canrad.2016.07.082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 07/29/2016] [Indexed: 12/15/2022]
Abstract
Thanks to recent advances achieved in oncologic systemic and local ablative treatment, the treatments become more and more efficient in term of local control and overall survival. Thus, the targeted therapies, immunotherapy or stereotactic radiotherapy have modified the management of patients, especially in case of oligometastatic disease. Many questions are raised by these innovations, particularly the diagnosis and management of new side effects or that of the combination of these different treatments, depending on the type of primary tumor. Fundamental data are available, while clinical data are still limited. Ongoing trials should help to clarify the clinical management protocols. This manuscript is a review of the combination of radiotherapy and targeted therapy/immunotherapy.
Collapse
Affiliation(s)
- D Antoni
- Département universitaire de radiothérapie, centre Paul-Strauss, UNICANCER, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France; EA 3430, fédération de médecine translationnelle de Strasbourg (FMTS), université de Strasbourg, 67200 Strasbourg, France
| | - S Bockel
- Département universitaire de radiothérapie, centre Paul-Strauss, UNICANCER, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - E Deutsch
- Département de radiothérapie, institut de cancérologie Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France; UMR 1030 « radiosensibilité des tumeurs et tissus sains », Inserm, 114, rue Édouard-Vaillant, 94805 Villejuif, France
| | - F Mornex
- Département de radiothérapie oncologique, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; EA 3738, université Claude-Bernard Lyon-1, domaine Rockefeller, 8, avenue Rockefeller, 69373 Lyon cedex 08, France.
| |
Collapse
|
38
|
Adebahr S, Schimek-Jasch T, Nestle U, Brunner TB. Oesophagus side effects related to the treatment of oesophageal cancer or radiotherapy of other thoracic malignancies. Best Pract Res Clin Gastroenterol 2016; 30:565-80. [PMID: 27644905 DOI: 10.1016/j.bpg.2016.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 07/20/2016] [Indexed: 01/31/2023]
Abstract
The oesophagus as a serial organ located in the central chest is frequent subject to "incidental" dose application in radiotherapy for several thoracic malignancies including oesophageal cancer itself. Especially due to the radiosensitive mucosa severe radiotherapy induced sequelae can occur, acute oesophagitis and strictures as late toxicity being the most frequent side-effects. In this review we focus on oesophageal side effects derived from treatment of gastrointestinal cancer and secondly provide an overview on oesophageal toxicity from conventional and stereotactic fractionated radiotherapy to the thoracic area in general. Available data on pathogenesis, frequency, onset, and severity of oesophageal side effects are summarized. Whereas for conventional radiotherapy the associations of applied doses to certain volumes of the oesophagus are well described, the tolerance dose to the mediastinal structures for hypofractionated therapy is unknown. The review provides available attempts to predict the risk of oesophageal side effects from dosimetric parameters of SBRT.
Collapse
Affiliation(s)
- Sonja Adebahr
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Germany.
| | - Tanja Schimek-Jasch
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Ursula Nestle
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Germany
| | - Thomas B Brunner
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Germany.
| |
Collapse
|
39
|
Blanck O, Ipsen S, Chan MK, Bauer R, Kerl M, Hunold P, Jacobi V, Bruder R, Schweikard A, Rades D, Vogl TJ, Kleine P, Bode F, Dunst J. Treatment Planning Considerations for Robotic Guided Cardiac Radiosurgery for Atrial Fibrillation. Cureus 2016; 8:e705. [PMID: 27588226 PMCID: PMC4999353 DOI: 10.7759/cureus.705] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose Robotic guided stereotactic radiosurgery has recently been investigated for the treatment of atrial fibrillation (AF). Before moving into human treatments, multiple implications for treatment planning given a potential target tracking approach have to be considered. Materials & Methods Theoretical AF radiosurgery treatment plans for twenty-four patients were generated for baseline comparison. Eighteen patients were investigated under ideal tracking conditions, twelve patients under regional dose rate (RDR = applied dose over a certain time window) optimized conditions (beam delivery sequence sorting according to regional beam targeting), four patients under ultrasound tracking conditions (beam block of the ultrasound probe) and four patients with temporary single fiducial tracking conditions (differential surrogate-to-target respiratory and cardiac motion). Results With currently known guidelines on dose limitations of critical structures, treatment planning for AF radiosurgery with 25 Gy under ideal tracking conditions with a 3 mm safety margin may only be feasible in less than 40% of the patients due to the unfavorable esophagus and bronchial tree location relative to the left atrial antrum (target area). Beam delivery sequence sorting showed a large increase in RDR coverage (% of voxels having a larger dose rate for a given time window) of 10.8-92.4% (median, 38.0%) for a 40-50 min time window, which may be significant for non-malignant targets. For ultrasound tracking, blocking beams through the ultrasound probe was found to have no visible impact on plan quality given previous optimal ultrasound window estimation for the planning CT. For fiducial tracking in the right atrial septum, the differential motion may reduce target coverage by up to -24.9% which could be reduced to a median of -0.8% (maximum, -12.0%) by using 4D dose optimization. The cardiac motion was also found to have an impact on the dose distribution, at the anterior left atrial wall; however, the results need to be verified. Conclusion Robotic AF radiosurgery with 25 Gy may be feasible in a subgroup of patients under ideal tracking conditions. Ultrasound tracking was found to have the lowest impact on treatment planning and given its real-time imaging capability should be considered for AF robotic radiosurgery. Nevertheless, advanced treatment planning using RDR or 4D respiratory and cardiac dose optimization may be still advised despite using ideal tracking methods.
Collapse
Affiliation(s)
- Oliver Blanck
- Department for Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany ; Saphir Radiosurgery Center, Frankfurt and Güstrow, Germany
| | - Svenja Ipsen
- Robotics and Cognitive Systems, University of Lübeck
| | - Mark K Chan
- Department for Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany ; Department for Radiation Oncology, Tuen Mun Hospital, Hong Kong, Hong Kong
| | - Ralf Bauer
- Institute for Diagnostics and Interventional Radiology, University Clinic Frankfurt, Germany ; Department for Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Switzerland
| | - Matthias Kerl
- Institute for Diagnostics and Interventional Radiology, University Clinic Frankfurt, Germany ; Radiology, Darmstadt, Germany
| | - Peter Hunold
- Clinic for Radiology and Nuclear Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| | - Volkmar Jacobi
- Institute for Diagnostics and Interventional Radiology, University Clinic Frankfurt, Germany
| | - Ralf Bruder
- Institute for Robotics and Cognitive Systems, University of Lubeck
| | - Achim Schweikard
- Institute for Robotics and Cognitive Systems, University of Luebeck, Institute for Robotics and Cognitive Systems, University of Lubeck
| | - Dirk Rades
- Department for Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| | - Thomas J Vogl
- Institute for Diagnostics and Interventional Radiology, University Clinic Frankfurt, Germany
| | - Peter Kleine
- Department for Thoracic, Cardiac and Thoracic Vascular Surgery, University Clinic Frankfurt, Germany
| | - Frank Bode
- Cardiology Department, Sana Clinic Oldenburg in Holstein
| | - Jürgen Dunst
- Department for Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany ; Department for Radiation Oncology, University Medical Center Copenhagen, Denmark
| |
Collapse
|
40
|
Xia P, Kotecha R, Sharma N, Andrews M, Stephans KL, Oberti C, Lin S, Wazni O, Tchou P, Saliba WI, Suh J. A Treatment Planning Study of Stereotactic Body Radiotherapy for Atrial Fibrillation. Cureus 2016; 8:e678. [PMID: 27563504 PMCID: PMC4985047 DOI: 10.7759/cureus.678] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose: To explore the feasibility of using stereotactic body radiotherapy (SBRT) to irradiate the antra of the four pulmonary veins while protecting nearby critical organs, such as the esophagus. Materials and Methods: Twenty patients who underwent radiofrequency catheter ablation for atrial fibrillation were selected. For each patient, the antra of the four pulmonary veins were identified as the target volumes on a pre-catheterization contrast or non-contrast CT scan. On each CT scan, the esophagus, trachea, heart, and total lung were delineated and the esophagus was identified as the critical organ. For each patient, three treatment plans were designed with 0, 2, and 5 mm planning margins around the targets while avoiding overlap with a planning organ at risk volume (PRV) generated by a 2 mm expansion of the esophagus. Using three non-coplanar volumetric modulated arcs (VMAT), 60 plans were created to deliver a prescription dose of 50 Gy in five fractions, following the SBRT dose regimen for central lung tumors. With greater than 97% of the planning target volumes (PTV) receiving the prescription doses, we examined dosimetry to 0.03 cc and 5 cc of the esophagus PRV volume as well as other contoured structures. Results: The average PTV-0 mm, PTV-2 mm, and PTV-5 mm volumes were 3.05 ± 1.90 cc, 14.70 ± 5.00 cc, and 40.85 ± 10.20 cc, respectively. With three non-coplanar VMAT arcs, the average conformality indices (ratio of prescription isodose volume to the PTV volume) for the PTV-0 mm, PTV-2 mm and PTV-5 mm were 4.81 ± 2.0, 1.71 ± 0.19, and 1.23 ± 0.08, respectively. Assuming patients were treated under breath-hold with 2 mm planning margins to account for cardiac motion, all plans met esophageal PRV maximum dose limits < 50 Gy to 0.03 cc and 16 plans (80%) met < 27.5 Gy to 5 cc of the esophageal PRVs. For PTV-5 mm plans, 18 plans met the maximum dose limit < 50 Gy to 0.03 cc and only two plans met the maximum dose limit < 27.5 Gy to 5 cc of the esophageal PRV. Conclusions: The anatomical relationship between the antra of the four pulmonary veins and the esophagus varies from patient to patient. Adding 2 mm planning margins and a 2 mm PRV to the esophagus can meet the dose constraints developed for SBRT central lung tumors. Future studies are needed to validate the safety and efficacy of the planning dose, tolerance dose to normal cardiac tissue, and adequate planning margins.
Collapse
Affiliation(s)
- Ping Xia
- Department of Radiation Oncology, Cleveland Clinic
| | | | | | | | | | - Carlos Oberti
- Department of Cardiovascular Medicine, Cleveland Clinic
| | - Sara Lin
- Department of Radiation Oncology, Cleveland Clinic
| | - Oussama Wazni
- Department of Cardiovascular Medicine, Cleveland Clinic
| | | | | | | |
Collapse
|
41
|
Woerner A, Roeske JC, Harkenrider MM, Fan J, Aydogan B, Koshy M, Laureckas R, Vali F, Campana M, Surucu M. A multi-institutional study to assess adherence to lung stereotactic body radiotherapy planning goals. Med Phys 2016; 42:4629-35. [PMID: 26233190 DOI: 10.1118/1.4926551] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE A multi-institutional planning study was performed to evaluate the frequency that current guidelines established by Radiation Therapy Oncology Group (RTOG) protocols and other literature for lung stereotactic body radiotherapy (SBRT) treatments are followed. METHODS A total of 300 patients receiving lung SBRT treatments in four different institutions were retrospectively reviewed. The treatments were delivered using Linac based SBRT (160 patients) or image guided robotic radiosurgery (140). Most tumors were located peripherally (250/300). Median fractional doses and ranges were 18 Gy (8-20 Gy), 12 Gy (6-15 Gy), and 10 Gy (5-12 Gy) for three, four, and five fraction treatments, respectively. The following planning criteria derived from RTOG trials and the literature were used to evaluate the treatment plans: planning target volumes, PTVV 100 ≥ 95% and PTVV 95 ≥ 99%; conformality indices, CI100% < 1.2 and CI50% range of 2.9-5.9 dependent on PTV; total lung-ITV: V20Gy < 10%, V12.5Gy < 15%, and V5Gy < 37%; contralateral lung V5Gy < 26%; and maximum doses for spinal cord, esophagus, trachea/bronchus, and heart and great vessels. Populations were grouped by number of fractions, and dosimetric criteria satisfaction rates (CSRs) were reported. RESULTS Five fraction regimens were the most common lung SBRT fractionation (46%). The median PTV was 27.2 cm(3) (range: 3.8-419.5 cm(3)). For all plans: mean PTVV 100 was 94.5% (±5.6%, planning CSR: 69.8%), mean PTVV 95 was 98.1% (±4.1%, CSR: 69.5%), mean CI100% was 1.14 (±0.21, CSR: 79.1%, and 16.5% within minor deviation), and mean CI50% was 5.63 (±2.8, CSR: 33.0%, and 28.0% within minor deviation). When comparing plans based on location, peripherally located tumors displayed higher PTVV 100 and PTVV 95 CSR (71.5% and 71.9%, respectively) than centrally located tumors (61.2% and 57.1%, respectively). Overall, the planning criteria were met for all the critical structure such as lung, heart, spinal cord, esophagus, and trachea/bronchus for at least 85% of the patients. CONCLUSIONS Among the various parameters that were used to evaluate the SBRT plans, the CI100% and CI50% were the most challenging criteria to meet. Although the CSRs of organs at risk were higher among all cases, their proximity to the PTV was a significant factor.
Collapse
Affiliation(s)
- Andrew Woerner
- Loyola University Medical Center, Maywood, Illinois 60153
| | - John C Roeske
- Loyola University Medical Center, Maywood, Illinois 60153
| | | | - John Fan
- Edward Cancer Center, Naperville, Illinois 60540
| | - Bulent Aydogan
- Department of Radiation Oncology, University of Illinois at Chicago, Chicago, Illinois 60612
| | - Matthew Koshy
- Department of Radiation Oncology, University of Illinois at Chicago, Chicago, Illinois 60612
| | | | - Faisal Vali
- Advocate Christ Medical Center, Oak Lawn, Illinois 60453
| | - Maria Campana
- Loyola University Medical Center, Maywood, Illinois 60153
| | - Murat Surucu
- Loyola University Medical Center, Maywood, Illinois 60153
| |
Collapse
|
42
|
Chaudhuri AA, Chen JJ, Carter JN, Binkley MS, Kumar KA, Dudley SA, Sung AW, Loo BW. Tracheal Diverticulum Following Paratracheal Hypofractionated Radiotherapy in the Setting of Prior and Subsequent Bevacizumab. Cureus 2016; 8:e578. [PMID: 27226939 PMCID: PMC4873316 DOI: 10.7759/cureus.578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
We present the case of a 63-year-old woman with limited metastatic colorectal cancer to the lungs and liver treated with FOLFIRI-bevacizumab, followed by consolidative hypofractionated radiotherapy to right paratracheal metastatic lymphadenopathy. We treated the right paratracheal site with 60 Gy in 15 fractions (70 Gy equivalent dose in 2 Gy fractions). The patient tolerated the treatment well, and six months later started a five-month course of FOLFIRI-bevacizumab for new metastatic disease. She presented to our clinic six months after completing this, complaining of productive cough with scant hemoptysis, and was found to have localized tracheal wall breakdown and diverticulum in the region of prior high-dose radiation therapy, threatening to progress to catastrophic tracheovascular fistula. This was successfully repaired surgically after a lack of response to conservative measures. We urge caution in treating patients with vascular endothelial growth factor (VEGF) inhibitors in the setting of hypofractionated radiotherapy involving the mucosa of tubular organs, even when these treatments are separated by months. Though data is limited as to the impact of sequence, this may be particularly an issue when VEGF inhibitors follow prior radiotherapy.
Collapse
Affiliation(s)
- Aadel A Chaudhuri
- Department of Radiation Oncology, Stanford University School of Medicine
| | - Jie Jane Chen
- Department of Radiation Oncology, Stanford University School of Medicine
| | - Justin N Carter
- Department of Radiation Oncology, Stanford University School of Medicine
| | - Michael S Binkley
- Department of Radiation Oncology, Stanford University School of Medicine
| | - Kiran A Kumar
- Department of Radiation Oncology, Stanford University School of Medicine
| | - Sara A Dudley
- Department of Radiation Oncology, Stanford University School of Medicine
| | - Arthur W Sung
- Department of Pulmonary and Critical Care Medicine, Stanford University School of Medicine
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine ; Stanford Cancer Institute, Stanford University School of Medicine
| |
Collapse
|
43
|
LaCouture TA, Xue J, Subedi G, Xu Q, Lee JT, Kubicek G, Asbell SO. Small Bowel Dose Tolerance for Stereotactic Body Radiation Therapy. Semin Radiat Oncol 2016; 26:157-64. [DOI: 10.1016/j.semradonc.2015.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
44
|
Nuyttens JJ, Moiseenko V, McLaughlin M, Jain S, Herbert S, Grimm J. Esophageal Dose Tolerance in Patients Treated With Stereotactic Body Radiation Therapy. Semin Radiat Oncol 2016; 26:120-8. [DOI: 10.1016/j.semradonc.2015.11.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
45
|
Stereotactic ablative radiotherapy for centrally located early stage non-small-cell lung cancer: what we have learned. J Thorac Oncol 2015; 10:577-85. [PMID: 25514807 DOI: 10.1097/jto.0000000000000453] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Image-guided stereotactic ablative radiotherapy (SABR; also called stereotactic body radiotherapy or radiosurgery) has become a standard treatment for medically inoperable peripherally located stage I non-small-cell lung cancer (NSCLC) and can achieve local control rates in excess of 90%. However, the role of SABR for centrally located lesions remains controversial because of concerns about the potential for severe toxic effects. When cutting-edge technologies and knowledge-based optimization of SABR planning that considers both target coverage and normal tissue sparing are used, some patients with central lesions can be safely and effectively cured of early stage NSCLC. However, delivery of ablative doses of radiation to critical structures such as bronchial tree, esophagus, major vessels, heart, and the brachial plexus/phrenic nerve could produce severe, potentially lethal toxic effects. Here, we address the current understanding of indications, dose regimens, planning optimization, and normal tissue dose-volume constraints for using SABR to treat central NSCLC.
Collapse
|
46
|
Stereotactic ablative radiotherapy (SABR) for central lung tumors: Plan quality and long-term clinical outcomes. Radiother Oncol 2015; 117:64-70. [DOI: 10.1016/j.radonc.2015.09.028] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/04/2015] [Accepted: 09/26/2015] [Indexed: 02/06/2023]
|
47
|
Pollom EL, Deng L, Pai RK, Brown JM, Giaccia A, Loo BW, Shultz DB, Le QT, Koong AC, Chang DT. Gastrointestinal Toxicities With Combined Antiangiogenic and Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2015; 92:568-76. [PMID: 26068491 DOI: 10.1016/j.ijrobp.2015.02.016] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 02/03/2015] [Accepted: 02/09/2015] [Indexed: 12/14/2022]
Abstract
Combining the latest targeted biologic agents with the most advanced radiation technologies has been an exciting development in the treatment of cancer patients. Stereotactic body radiation therapy (SBRT) is an ablative radiation approach that has become established for the treatment of a variety of malignancies, and it has been increasingly used in combination with biologic agents, including those targeting angiogenesis-specific pathways. Multiple reports have emerged describing unanticipated toxicities arising from the combination of SBRT and angiogenesis-targeting agents, particularly of late luminal gastrointestinal toxicities. In this review, we summarize the literature describing these toxicities, explore the biological mechanism of action of toxicity with the combined use of antiangiogenic therapies, and discuss areas of future research, so that this combination of treatment modalities can continue to be used in broader clinical contexts.
Collapse
Affiliation(s)
- Erqi L Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Lei Deng
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Reetesh K Pai
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - J Martin Brown
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Amato Giaccia
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - David B Shultz
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Quynh Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Albert C Koong
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Daniel T Chang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.
| |
Collapse
|
48
|
Oskan F. The Quality of Toxicity Reporting and the Story of the Lung SBRT "No-Fly Zone". Int J Radiat Oncol Biol Phys 2015; 92:514-5. [PMID: 26068486 DOI: 10.1016/j.ijrobp.2015.01.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 01/24/2015] [Accepted: 01/28/2015] [Indexed: 01/14/2023]
Affiliation(s)
- Feras Oskan
- Department of Radiation Oncology, University Hospital of Saarland, Homburg, Saarland, Germany.
| |
Collapse
|
49
|
Troost EG, Wink KC, Zindler JD, De Ruysscher D. Management of early stage lung cancer: a radiation oncologist's perspective. Lung Cancer 2015. [DOI: 10.1183/2312508x.10010214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
50
|
Adebahr S, Collette S, Shash E, Lambrecht M, Le Pechoux C, Faivre-Finn C, De Ruysscher D, Peulen H, Belderbos J, Dziadziuszko R, Fink C, Guckenberger M, Hurkmans C, Nestle U. LungTech, an EORTC Phase II trial of stereotactic body radiotherapy for centrally located lung tumours: a clinical perspective. Br J Radiol 2015; 88:20150036. [PMID: 25873481 PMCID: PMC4628529 DOI: 10.1259/bjr.20150036] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/02/2015] [Accepted: 04/13/2015] [Indexed: 12/16/2022] Open
Abstract
Evidence supports stereotactic body radiotherapy (SBRT) as a curative treatment option for inoperable early stage non-small-cell lung cancer (NSCLC) resulting in high rates of tumour control and low risk of toxicity. However, promising results are mainly derived from SBRT of peripheral pulmonary lesions, whereas SBRT for the central tumours can lead to severe radiation sequelae owing to the spatial proximity to the serial organs at risk. Robust data on the tolerance of mediastinal structures to high-dose hypofractionated radiation are limited; furthermore, there are many open questions regarding the efficiency, safety and response assessment of SBRT in inoperable, centrally located early stage NSCLC, which are addressed in a prospective multicentre study [sponsored by the European Organization for Research and Treatment of Cancer (EORTC 22113-08113-LungTech)]. In this review, we summarize the current status regarding SBRT for centrally located early stage NSCLC that leads to the rationale of the LungTech trial. Outline and some essential features of the study with focus on a summary of current experiences in dose/fraction-toxicity coherences after SBRT to the mediastinal structures that lead to LungTech normal tissue constraints are provided.
Collapse
Affiliation(s)
- S Adebahr
- Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Partner Site Freiburg, Germany
| | | | - E Shash
- EORTC Headquarters, Brussels, Belgium
| | - M Lambrecht
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, Netherlands
| | - C Le Pechoux
- Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France
| | - C Faivre-Finn
- Institute of Cancer Sciences, Radiotherapy Related Research, The Christie NHS Foundation Trust and University of Manchester, Manchester, UK
| | - D De Ruysscher
- KU Leuven–University of Leuven, University Hospitals Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - H Peulen
- Department of Radiation Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - J Belderbos
- Department of Radiation Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - R Dziadziuszko
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - C Fink
- Department of Radiology, Allgemeines Krankenhaus Celle, Celle, Germany
| | - M Guckenberger
- Department of Radiation Oncology, University of Zurich, Zurich, Switzerland
| | - C Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, Netherlands
| | - U Nestle
- Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Partner Site Freiburg, Germany
| |
Collapse
|