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Ehret F, Rueß D, Blanck O, Fichte S, Chatzikonstantinou G, Wolff R, Mose L, Mose S, Fortmann T, Lehrke R, Turna M, Caglar HB, Mortasawi F, Bleif M, Krug D, Ruge MI, Fürweger C, Muacevic A. Stereotactic radiosurgery and radiotherapy for brainstem metastases: An international multicenter analysis. Int J Cancer 2024; 155:916-924. [PMID: 38720427 DOI: 10.1002/ijc.34980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/06/2024] [Accepted: 02/20/2024] [Indexed: 07/06/2024]
Abstract
Brainstem metastases (BSM) present a significant neuro-oncological challenge, resulting in profound neurological deficits and poor survival outcomes. Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) offer promising therapeutic avenues for BSM despite their precarious location. This international multicenter study investigates the efficacy and safety of SRS and FSRT in 136 patients with 144 BSM treated at nine institutions from 2005 to 2022. The median radiographic and clinical follow-up periods were 6.8 and 9.4 months, respectively. Predominantly, patients with BSM were managed with SRS (69.4%). The median prescription dose and isodose line for SRS were 18 Gy and 65%, respectively, while for FSRT, the median prescription dose was 21 Gy with a median isodose line of 70%. The 12-, 24-, and 36-month local control (LC) rates were 82.9%, 71.4%, and 61.2%, respectively. Corresponding overall survival rates at these time points were 61.1%, 34.7%, and 19.3%. In the multivariable Cox regression analysis for LC, only the minimum biologically effective dose was significantly associated with LC, favoring higher doses for improved control (in Gy, hazard ratio [HR]: 0.86, p < .01). Regarding overall survival, good performance status (Karnofsky performance status, ≥90%; HR: 0.43, p < .01) and prior whole brain radiotherapy (HR: 2.52, p < .01) emerged as associated factors. In 14 BSM (9.7%), treatment-related adverse events were noted, with a total of five (3.4%) radiation necrosis. SRS and FSRT for BSM exhibit efficacy and safety, making them suitable treatment options for affected patients.
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Affiliation(s)
- Felix Ehret
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), partner site Berlin, a partnership between DKFZ and Charité - Universitätsmedizin Berlin, Berlin, Germany
- European Radiosurgery Center Munich, Munich, Germany
| | - Daniel Rueß
- Department of Stereotactic and Functional Neurosurgery, Centre of Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Oliver Blanck
- Department of Radiation Oncology, University Hospital Schleswig-Holstein and Saphir Radiosurgery Center Northern Germany, Kiel, Germany
| | | | - Georgios Chatzikonstantinou
- Department of Radiation Oncology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Robert Wolff
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University Frankfurt and Saphir Radiosurgery Center, Frankfurt am Main, Germany
| | - Lucas Mose
- Department of Radiation Oncology, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Mose
- Department of Radiation Oncology, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany
| | | | | | - Menekse Turna
- Department of Radiation Oncology, Anadolu Medical Center, Gebze, Turkey
| | - Hale Basak Caglar
- Department of Radiation Oncology, Anadolu Medical Center, Gebze, Turkey
| | | | - Martin Bleif
- RadioChirurgicum, CyberKnife Südwest, Göppingen, Germany
| | - David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein and Saphir Radiosurgery Center Northern Germany, Kiel, Germany
| | - Maximilian I Ruge
- Department of Stereotactic and Functional Neurosurgery, Centre of Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Christoph Fürweger
- European Radiosurgery Center Munich, Munich, Germany
- Department of Stereotactic and Functional Neurosurgery, Centre of Neurosurgery, University Hospital Cologne, Cologne, Germany
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Bilski M, Korab K, Stąpór-Fudzińska M, Ponikowska J, Brzozowska A, Sroka Ł, Wojtyna E, Sroka S, Szlag M, Cisek P, Napieralska A. HDR brachytherapy versus robotic-based and linac-based stereotactic ablative body radiotherapy in the treatment of liver metastases - A dosimetric comparison study of three radioablative techniques. Clin Transl Radiat Oncol 2024; 48:100815. [PMID: 39070028 PMCID: PMC11279445 DOI: 10.1016/j.ctro.2024.100815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 07/30/2024] Open
Abstract
Purpose The aim of our study was to compare dosimetric aspects of three radioablation modalities - direct high-dose-rate brachytherapy (HDR-BT) and virtually planned stereotactic body radiation therapy performed on CyberKnife (SBRTck) and Elekta Versa HD LINAC (SBRTe) applied in patients with liver metastases. Material and methods We selected 30 patients with liver metastases, who received liver interstitial HDR-BT and virtually prepared plans for SBRTck and SBRTe. In all the cases, the prescribed dose was a single fraction of 25 Gy. Treatment delivery time, doses delivered to PTV and organs at risk, as well as conformity indices, were calculated and compared. Results The longest median treatment delivery time was observed in SBRTck in contrast to HDR-BT and SBRTe which were significantly shorter and comparable. HDR-BT plans achieved better coverage of PTV (except for D98%) in contrast to SBRT modalities. Between both SBRT modalities, SBRTck plans resulted in better dose coverage in Dmean, D50%, and D90% values compared to SBRTe without difference in D98%. The SBRTe was the most advantageous considering the PCI and R100%. SBRTck plans achieved the best HI, while R50% value was comparable between SBRTe and SBRTck. The lowest median doses delivered to uninvolved liver volume (V5Gy, V9.1Gy) were achieved with HDR-BT, while the difference between SBRT modalities was insignificant. SBRT plans were better regarding more favourable dose distribution in the duodenum and right kidney, while HDR-BT achieved lower doses in the stomach, heart, great vessels, ribs, skin and spinal cord. There were no significant differences in bowel and biliary tract dose distribution between all selected modalities. Conclusions HDR-BT resulted in more favourable dose distribution within PTVs and lower doses in organs at risk, which suggests that this treatment modality could be regarded as an alternative to other local ablative therapies in carefully selected patients' with liver malignancies. Future studies should further address the issue of comparing treatment modalities in different liver locations and clinical scenarios.
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Affiliation(s)
- Mateusz Bilski
- Radiotherapy Department, Medical University of Lublin, Lublin, Poland
- Brachytherapy Department, Saint John’s Cancer Center, Lublin, Poland
- Radiotherapy Department, Saint John’s Cancer Center, Lublin, Poland
| | - Katarzyna Korab
- Department of Medical Physics, Saint John’s Cancer Center, Lublin, Poland
| | - Małgorzata Stąpór-Fudzińska
- Radiotherapy Planning Department, Maria Skłodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Julia Ponikowska
- Department of Medical Physics, Saint John’s Cancer Center, Lublin, Poland
| | - Agnieszka Brzozowska
- Department of Medical Mathematics and Statistics with e-Health Laboratory, Medical University of Lublin, Lublin, Poland
| | - Łukasz Sroka
- Radiotherapy Planning Department, Maria Skłodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Ewa Wojtyna
- Department of Medical Physics, Saint John’s Cancer Center, Lublin, Poland
| | - Sylwia Sroka
- Department of Medical Physics, Saint John’s Cancer Center, Lublin, Poland
| | - Marta Szlag
- Radiotherapy Planning Department, Maria Skłodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Paweł Cisek
- Radiotherapy Department, Medical University of Lublin, Lublin, Poland
- Brachytherapy Department, Saint John’s Cancer Center, Lublin, Poland
| | - Aleksandra Napieralska
- Radiotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology in Gliwice and Kraków, Poland
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Wang J, Zheng Q, Wang Y, Wang C, Xu S, Ju Z, Pan L, Bai J, Liu Y, Qu B, Dai X. Dosimetric comparison of ZAP-X, Gamma Knife, and CyberKnife stereotactic radiosurgery for single brain metastasis. BMC Cancer 2024; 24:936. [PMID: 39090564 PMCID: PMC11295608 DOI: 10.1186/s12885-024-12710-y] [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: 09/15/2023] [Accepted: 07/26/2024] [Indexed: 08/04/2024] Open
Abstract
PURPOSE To evaluate the dosimetric characteristics of ZAP-X stereotactic radiosurgery (SRS) for single brain metastasis by comparing with two mature SRS platforms. METHODS Thirteen patients with single brain metastasis treated with CyberKnife (CK) G4 were selected retrospectively. The prescription dose for the planning target volume (PTV) was 18-24 Gy for 1-3 fractions. The PTV volume ranged from 0.44 to 11.52 cc.Treatment plans of thirteen patients were replanned using the ZAP-X plan system and the Gamma Knife (GK) ICON plan system with the same prescription dose and organs at risk (OARs) constraints. The prescription dose of PTV was normalized to 70% for both ZAP-X and CK, while it was 50% for GK. The dosimetric parameters of three groups included the plan characteristics (CI, GI, GSI, beams, MUs, treatment time), PTV (D2, D95, D98, Dmin, Dmean, Coverage), brain tissue (volume of 100%-10% prescription dose irradiation V100%-V10%, Dmean) and other OARs (Dmax, Dmean),all of these were compared and evaluated. All data were read and analyzed with MIM Maestro. One-way ANOVA or a multisample Friedman rank sum test was performed, where p < 0.05 indicated significant differences. RESULTS The CI of GK was significantly lower than that of ZAP-X and CK. Regarding the mean value, ZAP-X had a lower GI and higher GSI, but there was no significant difference among the three groups. The MUs of ZAP-X were significantly lower than those of CK, and the mean value of the treatment time of ZAP-X was significantly shorter than that of CK. For PTV, the D95, D98, and target coverage of CK were higher, while the mean of Dmin of GK was significantly lower than that of CK and ZAP-X. For brain tissue, ZAP-X showed a smaller volume from V100% to V20%; the statistical results of V60% and V50% showed a difference between ZAP-X and GK, while the V40% and V30% showed a significant difference between ZAP-X and the other two groups; V10% and Dmean indicated that GK was better. Excluding the Dmax of the brainstem, right optic nerve and optic chiasm, the mean value of all other OARs was less than 1 Gy. For the brainstem, GK and ZAP-X had better protection, especially at the maximum dose. CONCLUSION For the SRS treating single brain metastasis, all three treatment devices, ZAP-X system, CyberKnife G4 system, and GammaKnife system, could meet clinical treatment requirements. The newly platform ZAP-X could provide a high-quality plan equivalent to or even better than CyberKnife and Gamma Knife, with ZAP-X presenting a certain dose advantage, especially with a more conformal dose distribution and better protection for brain tissue. As the ZAP-X systems get continuous improvements and upgrades, they may become a new SRS platform for the treatment of brain metastasis.
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Affiliation(s)
- Jinyuan Wang
- Department of Radiation Oncology, The First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Qingzeng Zheng
- Department of Radiotherapy, Beijing Geriatric Hospital, Beijing, 100095, China
| | - Yanping Wang
- Department of Radiation Oncology, Hebei Yizhou Cancer Hospital, Zhuozhou, 072750, China
| | - Chengcheng Wang
- Department of Radiation Oncology, The First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Shouping Xu
- National Cancer Center, National Clincal Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zhongjian Ju
- Department of Radiation Oncology, The First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Longsheng Pan
- Department of Neurosurgery, the First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Jingmin Bai
- Department of Radiation Oncology, The First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Yunmo Liu
- Department of Neurosurgery, the First Medical Center of PLA General Hospital, Beijing, 100853, China
| | - Baolin Qu
- Department of Radiation Oncology, The First Medical Center of PLA General Hospital, Beijing, 100853, China.
| | - Xiangkun Dai
- Department of Radiation Oncology, The First Medical Center of PLA General Hospital, Beijing, 100853, China.
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Namysl-Kaletka A, Wydmanski J, Debosz-Suwinska I, Kaszuba M, Gabrys D, Roch-Zniszczol A, Handkiewicz-Junak D. Stereotactic Body Radiation Therapy for Symptomatic Pancreatic Insulinoma: Two-Case Report and Literature Review. Curr Oncol 2024; 31:4123-4132. [PMID: 39057179 PMCID: PMC11275479 DOI: 10.3390/curroncol31070307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/14/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Insulinoma is the most common functional neuroendocrine tumor of the pancreas, with the main clinical symptom being hypoglycemia. The standard treatment is surgery, but some patients are not eligible for surgery, while in those operated on, the risk of perioperative complications is up to 30%. Diazoxide treatment to prevent hypoglycemia is effective only in 50% of patients. To prevent tumor growth and hormonal excess, stereotactic radiotherapy may be an alternative to surgical treatment. In our paper, we present two cases of patients with insulinoma treated successfully with stereotactic body radiation therapy (SBRT).
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Affiliation(s)
- Agnieszka Namysl-Kaletka
- Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Jerzy Wydmanski
- Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Iwona Debosz-Suwinska
- Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Malgorzata Kaszuba
- Radiology and Diagnostic Imaging Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Dorota Gabrys
- Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Agata Roch-Zniszczol
- Radiotherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Daria Handkiewicz-Junak
- Department of Nuclear Medicine and Endocrine Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
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Liu Y, Liu P, Gao XS, Wang Z, Lyu F, Shi A, Wang W, Gao Y, Liao A, Zhao J, Ding X. Dosimetric comparison of IMPT vs VMAT for multiple lung lesions: an NTCP model-based decision-making strategy. Med Dosim 2024:S0958-3947(24)00029-3. [PMID: 39013723 DOI: 10.1016/j.meddos.2024.06.001] [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: 02/11/2024] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 07/18/2024]
Abstract
To compare the dosimetric differences in volumetric modulated arc therapy (VMAT) and intensity modulated proton therapy (IMPT) in stereotactic body radiation therapy (SBRT) of multiple lung lesions and determine a normal tissue complication probability (NTCP) model-based decision strategy that determines which treatment modality the patient will use. A total of 41 patients were retrospectively selected for this study. The number of patients with 1-6 lesions was 5, 16, 7, 6, 3, and 4, respectively. A prescription dose of 70 GyRBE in 10 fractions was given to each lesion. SBRT plans were generated using VMAT and IMPT. All the IMPT plans used robustness optimization with ± 3.5% range uncertainties and 5 mm setup uncertainties. Dosimetric metrics and the predicted NTCP value of radiation pneumonitis (RP), esophagitis, and pericarditis were analyzed to evaluate the potential clinical benefits between different planning groups. In addition, a threshold for the ratio of PTV to lungs (%) to determine whether a patient would benefit highly from IMPT was determined using receiver operating characteristic curves. All plans reached target coverage (V70GyRBE ≥ 95%). Compared with VMAT, IMPT resulted in a significantly lower dose of most thoracic normal tissues. For the 1-2, 3-4 and 5-6 lesion groups, the lung V5 was 29.90 ± 9.44%, 58.33 ± 13.35%, and 81.02 ± 5.91% for VMAT and 11.34 ± 3.11% (p < 0.001), 21.45 ± 3.80% (p < 0.001), and 32.48 ± 4.90% (p < 0.001) for IMPT, respectively. The lung V20 was 12.07 ± 4.94%, 25.57 ± 6.54%, and 43.99 ± 11.83% for VMAT and 6.76 ± 1.80% (p < 0.001), 13.14 ± 2.27% (p < 0.01), and 19.62 ± 3.48% (p < 0.01) for IMPT. The Dmean of the total lung was 7.65 ± 2.47 GyRBE, 14.78 ± 2.75 GyRBE, and 21.64 ± 4.07 GyRBE for VMAT and 3.69 ± 1.04 GyRBE (p < 0.001), 7.13 ± 1.41 GyRBE (p < 0.001), and 10.69 ± 1.81 GyRBE (p < 0.001) for IMPT. Additionally, in the VMAT group, the maximum NTCP value of radiation pneumonitis was 73.91%, whereas it was significantly lower in the IMPT group at 10.73%. The accuracy of our NTCP model-based decision model, which combines the number of lesions and PTV/Lungs (%), was 97.6%. The study demonstrated that the IMPT SBRT for multiple lung lesions had satisfactory dosimetry results, even when the number of lesions reached 6. The NTCP model-based decision strategy presented in our study could serve as an effective tool in clinical practice, aiding in the selection of the optimal treatment modality between VMAT and IMPT.
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Affiliation(s)
- Yang Liu
- Department of Radiation Oncology, Peking University First Hospital, Beijing, 100034, China
| | - Peilin Liu
- Department of Radiation Oncology, William Beaumont University hospital, Corewell Health, Detroit, 48073, USA
| | - Xian-Shu Gao
- Department of Radiation Oncology, Peking University First Hospital, Beijing, 100034, China.
| | - Zishen Wang
- Department of Radiation Oncology, Hebei Yizhou Cancer Hospital, Baoding, 072750, China
| | - Feng Lyu
- Department of Radiation Oncology, Peking University First Hospital, Beijing, 100034, China
| | - Anhui Shi
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Weihu Wang
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Yan Gao
- Department of Radiation Oncology, Peking University First Hospital, Beijing, 100034, China
| | - Anyan Liao
- Department of Radiation Oncology, Beijing United Family Medical Center, Beijing, 100015, China
| | - Jing Zhao
- Department of Radiation Oncology, Beijing United Family Medical Center, Beijing, 100015, China
| | - Xuanfeng Ding
- Department of Radiation Oncology, William Beaumont University hospital, Corewell Health, Detroit, 48073, USA.
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Barbour AB, Upadhyay R, Anderson AC, Kutuk T, Kumar R, Wang SJ, Psutka SP, Fekrmandi F, Skalina KA, Bruynzeel AME, Correa RJM, Dal Pra A, Biancia CD, Hannan R, Louie A, Singh AK, Swaminath A, Tang C, Teh BS, Zaorsky NG, Lo SS, Siva S. Stereotactic Body Radiation Therapy for Primary Renal Cell Carcinoma: A Case-Based Radiosurgery Society Practice Guide. Pract Radiat Oncol 2024:S1879-8500(24)00156-5. [PMID: 39019209 DOI: 10.1016/j.prro.2024.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/24/2024] [Accepted: 06/06/2024] [Indexed: 07/19/2024]
Abstract
Traditionally, renal cell carcinoma (RCC) was considered a radioresistant tumor, thereby limiting definitive radiation therapy management options. However, several recent studies have demonstrated that stereotactic body radiation therapy (SBRT) can achieve high rates of local control for the treatment of primary RCC. In the setting of expanding use of SBRT for primary RCC, it is crucial to provide guidance on practical considerations such as patient selection, fractionation, target delineation, and response assessment. This is particularly important in challenging scenarios where a paucity of evidence exists, such as in patients with a solitary kidney, bulky tumors, or tumor thrombus. The Radiosurgery Society endorses this case-based guide to provide a practical framework for delivering SBRT to primary RCC, exemplified by 3 cases. This article explores topics of tumor size and dose fractionation, impact on renal function and treatment in the setting of a solitary kidney, and radiation's role in the management of inferior vena cava tumor thrombus. Additionally, we review existing evidence and expert opinion on target delineation, advanced techniques such as magnetic resonance imaging guided SBRT, and SBRT response assessment.
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Affiliation(s)
- Andrew B Barbour
- Department of Radiation Oncology, Fred Hutchinson Cancer Center, University of Washington, Seattle, Washington
| | - Rituraj Upadhyay
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - August C Anderson
- Department of Radiation Oncology, Fred Hutchinson Cancer Center, University of Washington, Seattle, Washington
| | - Tugce Kutuk
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | - Ritesh Kumar
- Department of Radiation Oncology, Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Shang-Jui Wang
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sarah P Psutka
- Department of Urology, Fred Hutchinson Cancer Center, University of Washington, Seattle, Washington
| | - Fatemeh Fekrmandi
- Department of Radiation Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Karin A Skalina
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York
| | - Anna M E Bruynzeel
- Department of Radiation Oncology, Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Rohann J M Correa
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Alan Dal Pra
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida
| | - Cesar Della Biancia
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Raquibul Hannan
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alexander Louie
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre and the University of Toronto, Toronto, Ontario, Canada
| | - Anurag K Singh
- Department of Radiation Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Anand Swaminath
- Division of Radiation Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, Ontario, Canada
| | - Chad Tang
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Bin S Teh
- Department of Radiation Oncology, Cancer Center and Research Institute, Houston Methodist Hospital, Houston, Texas
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve, Cleveland, Ohio
| | - Simon S Lo
- Department of Radiation Oncology, Fred Hutchinson Cancer Center, University of Washington, Seattle, Washington.
| | - Shankar Siva
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Center, University of Melbourne, Melbourne, Victoria, Australia
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7
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Brunner TB, Boda-Heggemann J, Bürgy D, Corradini S, Dieckmann UK, Gawish A, Gerum S, Gkika E, Grohmann M, Hörner-Rieber J, Kirste S, Klement RJ, Moustakis C, Nestle U, Niyazi M, Rühle A, Lang ST, Winkler P, Zurl B, Wittig-Sauerwein A, Blanck O. Dose prescription for stereotactic body radiotherapy: general and organ-specific consensus statement from the DEGRO/DGMP Working Group Stereotactic Radiotherapy and Radiosurgery. Strahlenther Onkol 2024:10.1007/s00066-024-02254-2. [PMID: 38997440 DOI: 10.1007/s00066-024-02254-2] [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: 05/29/2024] [Accepted: 06/02/2024] [Indexed: 07/14/2024]
Abstract
PURPOSE AND OBJECTIVE To develop expert consensus statements on multiparametric dose prescriptions for stereotactic body radiotherapy (SBRT) aligning with ICRU report 91. These statements serve as a foundational step towards harmonizing current SBRT practices and refining dose prescription and documentation requirements for clinical trial designs. MATERIALS AND METHODS Based on the results of a literature review by the working group, a two-tier Delphi consensus process was conducted among 24 physicians and physics experts from three European countries. The degree of consensus was predefined for overarching (OA) and organ-specific (OS) statements (≥ 80%, 60-79%, < 60% for high, intermediate, and poor consensus, respectively). Post-first round statements were refined in a live discussion for the second round of the Delphi process. RESULTS Experts consented on a total of 14 OA and 17 OS statements regarding SBRT of primary and secondary lung, liver, pancreatic, adrenal, and kidney tumors regarding dose prescription, target coverage, and organ at risk dose limitations. Degree of consent was ≥ 80% in 79% and 41% of OA and OS statements, respectively, with higher consensus for lung compared to the upper abdomen. In round 2, the degree of consent was ≥ 80 to 100% for OA and 88% in OS statements. No consensus was reached for dose escalation to liver metastases after chemotherapy (47%) or single-fraction SBRT for kidney primaries (13%). In round 2, no statement had 60-79% consensus. CONCLUSION In 29 of 31 statements a high consensus was achieved after a two-tier Delphi process and one statement (kidney) was clearly refused. The Delphi process was able to achieve a high degree of consensus for SBRT dose prescription. In summary, clear recommendations for both OA and OS could be defined. This contributes significantly to harmonization of SBRT practice and facilitates dose prescription and reporting in clinical trials investigating SBRT.
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Affiliation(s)
- Thomas B Brunner
- Department of Radiation Oncology, Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria.
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, 8036, Graz, Austria.
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medicine Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel Bürgy
- Department of Radiation Oncology, University Medicine Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Ute Karin Dieckmann
- Department of Radiation Oncology, Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria
| | - Ahmed Gawish
- Department of Radiotherapy, University Medical Center Giessen-Marburg, Marburg, Germany
| | - Sabine Gerum
- Department of Radiation Oncology, Paracelsus University Salzburg, Salzburg, Austria
| | - Eleni Gkika
- Department of Radiation Oncology, University Hospital Bonn, 53127, Bonn, Germany
| | - Maximilian Grohmann
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Simon Kirste
- Department of Radiation Oncology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Rainer J Klement
- Department of Radiotherapy and Radiation Oncology, Leopoldina Hospital Schweinfurt, Robert-Koch-Straße 10, 97422, Schweinfurt, Germany
| | - Christos Moustakis
- Department of Radiation Oncology, University Hospital Leipzig, Stephanstraße 9a, 04103, Leipzig, Germany
| | - Ursula Nestle
- Department of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Alexander Rühle
- Department of Radiation Oncology, University Hospital Leipzig, Stephanstraße 9a, 04103, Leipzig, Germany
| | - Stephanie-Tanadini Lang
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Peter Winkler
- Department of Radiation Oncology, Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, 8036, Graz, Austria
| | - Brigitte Zurl
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, 8036, Graz, Austria
| | | | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
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8
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Schep DG, Vansantvoort J, Dayes I, Lukka H, Quan K, Kapoor A, Chow T, Chu W, Swaminath A. Evaluation of Volumetric Response Assessment From SABR for Renal Cell Carcinoma. Int J Radiat Oncol Biol Phys 2024; 119:832-837. [PMID: 38092258 DOI: 10.1016/j.ijrobp.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/28/2023] [Accepted: 12/05/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE SABR is increasingly used to treat renal cell carcinoma (RCC). However, the optimal method to assess treatment response is unclear. We aimed to quantify changes in both volume and maximum linear size of tumors after SABR and evaluate the utility of the 2 approaches in treatment response assessment. METHODS AND MATERIALS We retrospectively studied patients with RCC treated with SABR at our institution between 2013 and 2020. All available follow-up computed tomography scans were aligned, and tumors were contoured on all scans. Volume and maximum linear size were measured at each follow-up, relative to these measurements at the time of computed tomography simulation. RESULTS Twenty-four patients with 25 tumors were included. Median follow-up was 32 months (range, 16-67). Nineteen tumors (76%) had 30% volumetric response at a median time of 7 months after SABR, and 12 tumors (48%) had 30% decrease in maximum linear size at a median time of 16 months. Eighteen tumors (72%) decreased in volume on first follow-up scan and continued to shrink, and 5 tumors (20%) displayed transient growth after SABR (average 24% increase in volume). Compared with T1a tumors, T1b or larger tumors were more likely to have transient growth (8% vs 33%; P = .16) and had higher average relative volume 24 months after SABR (0.47 vs 0.8; P = .022). CONCLUSIONS Volume measurement results in more pronounced and earlier change compared with linear size measurement when assessing response to SABR. These findings may provide guidance when assessing treatment response for patients with RCC treated with SABR.
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Affiliation(s)
- Daniel G Schep
- Juravinski Cancer Centre, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada
| | | | - Ian Dayes
- Juravinski Cancer Centre, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada
| | - Himanshu Lukka
- Juravinski Cancer Centre, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada
| | - Kimmen Quan
- Juravinski Cancer Centre, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada
| | - Anil Kapoor
- Juravinski Cancer Centre, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada
| | - Tom Chow
- Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - William Chu
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Anand Swaminath
- Juravinski Cancer Centre, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada.
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9
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Haisraely O, Weiss I, Jaffe M, Appel S, Person-Kaidar O, Symon Z, Ben-Ayun M, Dubinski S, Lawrence Y. Total dose, fraction dose and respiratory motion management impact adrenal SBRT outcome. Clin Transl Radiat Oncol 2024; 47:100788. [PMID: 38745963 PMCID: PMC11090868 DOI: 10.1016/j.ctro.2024.100788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 04/10/2024] [Accepted: 04/27/2024] [Indexed: 05/16/2024] Open
Abstract
Purpose/Objectives Stereotactic body radiotherapy (SBRT) is an effective treatment for oligometastatic disease in multiple sites. However, the optimal radiation dose for long-term local control of adrenal metastases has yet to be determined. The aim of this study is to evaluate outcomes of adrenal SBRT and to evaluate factors that correlate with local control. Materials/Methods After IRB approval, a retrospective data review of patients treated with SBRT for adrenal metastases at a medical center in Israel between 2015 and 2021 was conducted. A biological effective dose was calculated using an alpha beta ratio of 10. Kaplan Meier and Cox regression were calculated using SPSS software to describe the hazard ratio for local control and survival. Results 83 cases of adrenal SBRT were identified. The average age was 67 (range 42-92 years old). Non-small cell lung cancer was the primary site in 44 % of patients. A total of 70 % of the patients had oligometastatic disease (less than five lesions), and the rest were polymetastatic, responding to systemic therapy with oligo progression in the adrenal. The average gross tumor volume (GTV) was 42 ml. Respiratory control was applied in 88 % of cases; 49.3 % used 4-D/ITV, and 38.5 % used breath-hold or continuous positive airway pressure (CPAP) with free breathing. On multivariable analysis, Dose above 75 Gy (biological effective Dose) (HR = 0.41, p = 0.031), Dose above 8 Gy per fraction (HR = 0.53p = 0.038), and breath-holds or CPAP (HR = 0.65, p = 0.047) were significant for local control. From multivariable analysis, we computed a predicted nomogram curve using seven clinical parameters to evaluate local control odds. Conclusion In this single institution series reported to date, we found unilateral adrenal SBRT safe, yet bilateral treatment harbors a risk of adrenal insufficiency. Biological effective Dose > 75 Gy (BED), motion management with breath-hold or CPAP, and Dose per fraction > 8 Gy were the enhanced local controls. We propose a nomogram to help in decision-making regarding total Dose and Dose per fraction when treating adrenal SBRT.
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Affiliation(s)
- Ory Haisraely
- Sheba Medical Center, Radiation Oncology Unit, Israel
| | - Ilana Weiss
- Sheba Medical Center, Radiation Oncology Unit, Israel
| | - Marcia Jaffe
- University of Nicosia (UNIC) Medical School, Cyprus
| | - Sarit Appel
- Sheba Medical Center, Radiation Oncology Unit, Israel
| | | | - Zvi Symon
- Sheba Medical Center, Radiation Oncology Unit, Israel
| | - Maoz Ben-Ayun
- Sheba Medical Center, Radiation Oncology Unit, Israel
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10
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Okamoto H, Nonaka M, Chiba T, Kaneda T, Kobayashi Y, Nakamura S, Nakayama H, Iijima K, Shuto Y, Yonemura M, Oshika R, Kishida H, Urago Y, Nishitani M, Nishina S, Sakamoto T, Shibata Y, Goka T, Igaki H. Dosimetric impact of the respiratory motion of the liver dome in stereotactic body radiotherapy for spine metastasis: A planning study. J Appl Clin Med Phys 2024:e14403. [PMID: 38952067 DOI: 10.1002/acm2.14403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 07/03/2024] Open
Abstract
PURPOSE This study aimed to clarify the dosimetric impact of the respiratory motion of the liver on stereotactic body radiation therapy (SBRT) for spine metastasis and examine the utility of introducing beam avoidance (beam-off at specific gantry angles). METHODS A total of 112 consecutive patients who underwent SBRT for spine metastasis between 2018 and 2024 were examined. Overall, 15 patients who had lesions near the liver dome were included in this study. Retrospective treatment plans were generated using computed tomography (CT) images acquired during inhalation and exhalation to evaluate the dosimetric impact of respiratory motion of the liver. The dose difference (DD) and relative value (DD%) were evaluated using the dose-volume histogram (DVH) metrics, planning target volume Dmax, D95%, spinal cord D0.035 cc, and esophagus D2.5 cc. The magnitude of the liver movements was evaluated based on differences of liver size Lave at the isocentric axial plane between the inspiratory and expiratory CT images. RESULTS The DD in almost all DVH metrics tended to increase when the liver moved away from the target during inhalation: For example, Mean ± $ \pm $ a standard deviation (SD) DD in PTV D95% for the treatment plan incorporating beam avoidance and those without beam avoidance was 0.5 ± $\pm$ 0.3 and 0.9 ± $ \pm $ 0.6 Gy, respectively. The spinal cord D0.035 cc for those shows 0.4 ± $ \pm $ 0.2 and 0.7 ± $ \pm $ 0.7 Gy, respectively. The treatment plans without beam avoidance also showed moderate or strong correlations between Lave and DD for almost all DVH metrics. No correlation was seen in the beam avoidance plan. The spinal cord D0.035 cc revealed approximately 1 Gy or +4% in DD when Lave was < -4 cm. CONCLUSIONS Respiratory motion of the liver dome can cause substantial dosimetric discrepancies in the dose delivered to the spinal cord, although the extent depends on patient variables. Dose assessment should be performed for determining the appropriate means of respiratory management, such as breath-hold. Alternatively, beam avoidance effectively mitigates the impact.
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Affiliation(s)
- Hiroyuki Okamoto
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
| | - Midori Nonaka
- Department of Radiological Technology, National Cancer Center Hospital, Tokyo, Japan
| | - Takahito Chiba
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
| | - Tomoya Kaneda
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yuta Kobayashi
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
| | - Satoshi Nakamura
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroki Nakayama
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
| | - Kotaro Iijima
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
- Department of Radiation Oncology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yasunori Shuto
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
- Department of Radiological Technology, National Cancer Center Hospital, Tokyo, Japan
| | - Miki Yonemura
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
| | - Riki Oshika
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hironori Kishida
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yuka Urago
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
| | - Masato Nishitani
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
- Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Shuka Nishina
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
- Department of Radiological Sciences, Komazawa University Graduate School, Tokyo, Japan
| | - Takumi Sakamoto
- Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, Tokyo, Japan
- Department of Radiological Sciences, Komazawa University Graduate School, Tokyo, Japan
| | - Yoshihiro Shibata
- Department of Radiological Technology, National Cancer Center Hospital, Tokyo, Japan
| | - Tomonori Goka
- Department of Radiological Technology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
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11
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Sanford NN, Timmerman RD. Optimizing Risk Vs. Reward in the Era of Ablative Radiotherapy Through Calculated Useful Trauma (CUT). Int J Radiat Oncol Biol Phys 2024; 119:721-723. [PMID: 38402476 DOI: 10.1016/j.ijrobp.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 02/26/2024]
Affiliation(s)
- Nina N Sanford
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Robert D Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
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12
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Wang J, Dong T, Meng X, Li W, Li N, Wang Y, Yang B, Qiu J. Application and dosimetric comparison of surface-guided deep inspiration breath-hold for lung stereotactic body radiotherapy. Med Dosim 2024:S0958-3947(24)00027-X. [PMID: 38910070 DOI: 10.1016/j.meddos.2024.05.003] [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: 04/08/2024] [Revised: 05/18/2024] [Accepted: 05/23/2024] [Indexed: 06/25/2024]
Abstract
Respiratory motion management is the crucial challenge for safe and effective application of lung stereotactic body radiotherapy (SBRT). The present study implemented lung SBRT treatment in voluntary deep inspiration breath-hold (DIBH) with surface-guided radiotherapy (SGRT) system and evaluated the geometric and dosimetric benefits of DIBH to organs-at-risk (OARs), aiming to advising the choice between DIBH technology and conventional free breathing 4 dimensions (FB-4D) technology. Five patients of lung SBRT treated in DIBH with SGRT at our institution were retrospectively analyzed. CT scans were acquired in DIBH and FB-4D, treatment plans were generated for both respiratory phases. The geometric and dosimetry of tumor, ipsilateral lung, double lungs and heart were compared between the DIBH and FB-4D treatment plans. In terms of target coverage, utilizing DIBH significantly reduced the mean plan target volume (PTV) by 21.9% (p = 0.09) compared to FB-4D, the conformity index (CI) of DIBH and FB-4D were comparable, but the dose gradient index (DGI) of DIBH was higher. With DIBH expanding lung, the volumes of ipsilateral lung and double lungs were 2535.1 ± 403.0cm3 and 4864.3 ± 900.2cm3, separately, 62.2% (p = 0.009) and 73.1% (p = 0.009) more than volumes of ipsilateral lung (1460.03 ± 146.60cm3) and double lungs (2811.25 ± 603.64cm3) in FB-4D. The heart volume in DIBH was 700.0 ± 146.1cm3, 11.6% (p = 0.021) less than that in FB-4D. As for OARs protection, the mean dose, percent of volume receiving > 20Gy (V20) and percent of volume receiving > 5Gy (V5) of ipsilateral lung in DIBH were significantly lower by 33.2% (p = 0.020), 44.0% (p = 0.022) and 24.5% (p = 0.037) on average, separately. Double lungs also showed significant decrease by 31.1% (p = 0.019), 45.5% (p = 0.024) and 20.9% (p = 0.048) on average for mean dose, V20 and V5 in DIBH. Different from the lung, the mean dose and V5 of heart showed no consistency between DIBH and FB-4D, but lower maximum dose of heart was achieved in DIBH for all patients in this study. Appling lung SBRT in DIBH with SGRT was feasibly performed with high patient compliance. DIBH brought significant dosimetric benefits to lung, however, it caused more or less irradiated heart dose that depend on the patients' individual differences which were unpredictable.
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Affiliation(s)
- Jiaxin Wang
- Department of Radiation Oncology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Tingting Dong
- Department of Radiation Oncology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Xiangyin Meng
- Department of Radiation Oncology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Wenbo Li
- Department of Radiation Oncology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Nan Li
- Department of Radiation Oncology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Yijun Wang
- Department of Radiation Oncology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Bo Yang
- Department of Radiation Oncology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China.
| | - Jie Qiu
- Department of Radiation Oncology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China.
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Hsu S, Chao Y, Hu Y, Zhang Y, Hong W, Chen Y, Chen R, Zeng Z, Du S. Radiotherapy enhances efficacy of PD-1 inhibitors in advanced hepatocellular carcinoma: A propensity-matched real-world study. Chin Med J (Engl) 2024; 137:1332-1342. [PMID: 38725345 PMCID: PMC11191029 DOI: 10.1097/cm9.0000000000003124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND To address the need for immunotherapy in patients with advanced primary hepatocellular carcinoma (HCC), combination with radiotherapy (RT) has emerged as a promising strategy. In preclinical studies, irradiated tumors released tumor antigens to synergistically increase the antitumor effect of immunotherapy. Hence, we investigated whether RT enhances the efficacy of anti-programmed death receptor-1 (PD-1) inhibitors in advanced HCC in real-world practice. METHODS Between August 2018 and June 2021, 172 patients with advanced primary HCC were enrolled in the tertiary center (Zhongshan Hospital of Fudan University); 95 were treated with a combination of RT and the inhibitor of PD-1 (RT-PD1 cohort), and 77 were administered anti-PD-1 therapy (PD1 cohort). The first cycle of PD-1 inhibitors was administered within 60 days or concurrently with RT. Propensity score matching for bias reduction was used to evaluate the clinical outcomes. RESULTS Among 71 propensity-matched pairs, median progression-free survival was 5.7 months in the RT-PD1 cohort vs. 2.9 months in the PD1 cohort ( P <0.001). Median overall survival was 20.9 months in the RT-PD1 cohort vs. 11.2 months in the PD1 cohort ( P = 0.018). Compared with patients in the PD1 cohort, patients in the RT-PD1 cohort had significantly higher objective response rates (40.8%, 29/71 vs. 19.7%, 14/71, P = 0.006) and disease control rates (62.0%, 44/71 vs. 31.0%, 22/71, P <0.001). The incidences of toxic effects were not significantly different between the two cohorts. CONCLUSIONS RT plus anti-PD-1 therapy is well tolerated. RT enhances the efficacy of anti-PD-1 therapy in patients with advanced primary HCC by improving survival outcomes without increased toxic effects.
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Affiliation(s)
- Shujung Hsu
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yencheng Chao
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yong Hu
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yang Zhang
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Weifeng Hong
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yixing Chen
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Rongxin Chen
- Department of Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zhaochong Zeng
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Shisuo Du
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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14
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Abuduxiku M, Chen X, Zhang S, Yang J, Liao W, Xiao J. Optimization of collimator angle combined island blocking with parked gap achieves superior normal tissue sparing in SBRT planning of multiple liver lesions. J Appl Clin Med Phys 2024; 25:e14267. [PMID: 38259201 PMCID: PMC11163495 DOI: 10.1002/acm2.14267] [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: 08/18/2023] [Revised: 09/20/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024] Open
Abstract
PURPOSE To propose an efficient collimator angle optimization method by combining island blocking (IB) and parked gap (PG) problem to reduce the radiotherapy dose for normal tissue. The reduction will be done with single-isocenter multi-lesion volumetric modulated arc therapy (VMAT) for the stereotactic body radiation therapy (SBRT) of liver cancer. METHODS A novel collimator angle optimization algorithm was developed based on the two-dimensional projection of targets on a beam's eye view (BEV) plane as a function of gantry and collimator angle. This optimization algorithm minimized the sum of the combined IB and PG (IB & PG) areas from all gantry angles for each arc. For comparison, two SBRT plans were respectively generated for each of the 20 retrospective liver cancer cases with multiple lesions. One plan was optimized using the IB & PG algorithm, and the other plan was optimized with a previously reported optimization algorithm that only considered the IB area. Plans were then evaluated and compared using typical dosimetric metrics. RESULTS With the comparable target coverage, IB & PG plans had significantly lower D500cc, D700cc, mean dose (Dmean), and V15 of normal liver tissues when compared to IB plans. The median percent reductions were 3.32% to 5.36%. The D1cc, D5cc, and Dmean for duodenum and small intestine in IB & PG plans were significantly reduced in a range from 7.60% up to 16.03%. Similarly, the median integral dose was reduced by 3.73%. Furthermore, the percentage of normal liver Dmean sparing when IB & PG plans compared to IB plans, was found to be positively correlated (ρ = 0.669, P = 0.001) with the inter-target distance. CONCLUSION The proposed IB & PG algorithm has been demonstrated to outperform the IB algorithm in almost all normal tissue sparing, and the magnitude of liver sparing was positively correlated with inter-target distance.
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Affiliation(s)
- Maidina Abuduxiku
- Radiotherapy Physics & Technology CenterCancer CenterWest China HospitalSichuan UniversityChengduSichuanChina
| | - Xiaoqiang Chen
- Radiotherapy Physics & Technology CenterCancer CenterWest China HospitalSichuan UniversityChengduSichuanChina
| | - Shu Zhang
- Head and Neck Oncology DepartmentCancer CenterWest China HospitalSichuan UniversityChengduSichuanChina
- Department of Radiation OncologyCancer CenterWest China HospitalSichuan UniversityChengduSichuanChina
| | - Jiangping Yang
- Head and Neck Oncology DepartmentCancer CenterWest China HospitalSichuan UniversityChengduSichuanChina
| | - Wenjun Liao
- Department of Radiation OncologyAffiliated Cancer Hospital of University of Electronic Science and Technology of ChinaChengduChina
| | - Jianghong Xiao
- Radiotherapy Physics & Technology CenterCancer CenterWest China HospitalSichuan UniversityChengduSichuanChina
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15
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Jaramillo-Jiménez E, Sandoval-Barrios J, Walsh FJ, Jaramillo-Jiménez MC, Echeverri-Sánchez JD, Rodríguez-Márquez IA, Barrientos-Montoya HD, Ascencio-Lancheros JL, Giraldo-Palacio JF, Sierra-Arrieta IM, Gómez-Duque DI, Pérez-López S, Bustamante MT. Epileptic encephalopathies secondary to hypothalamic hamartomas treated with radiosurgery: A case series. Epileptic Disord 2024. [PMID: 38804823 DOI: 10.1002/epd2.20246] [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: 05/05/2023] [Revised: 05/08/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE Hypothalamic hamartomas are congenital lesions that typically present with gelastic seizures, refractory epilepsy, neurodevelopmental delay, and severe cognitive impairment. Surgical procedures have been reported to be effective in removing the hamartomas, however, they are associated with significant morbidity. Therefore, it is not considered a safe therapeutic modality. Image-guided robotic radiosurgery (CyberKnife® Radiosurgery System) has been shown to provide good outcomes without lasting complications. METHODS This series of cases describes the clinical, radiological, radiotherapeutic, and postsurgical outcomes of five patients with epileptic encephalopathies secondary to hypothalamic hamartomas who were treated with CyberKnife®. RESULTS All patients exhibited refractory epilepsy with gelastic seizures and were unsuitable candidates for surgical resection The prescribed dose ranged between 16 and 25 Gy, delivered in a single fraction for four patients and five fractions for one patient while adhering strictly to visual pathway constraints. After radiosurgery, four patients maintained seizure control (one with an Engel class Ia, three with an Engel class 1d), and another presented sporadic, nondisabling gelastic seizures (with an Engel class IIa). After 24-26 months of follow-up, in three patients, their intelligence quotient scores increased. No complications were reported. SIGNIFICANCE This report suggests that Cyberknife may be a good option for treating hypothalamic hamartoma, particularly in cases where other noninvasive alternatives are unavailable. Nevertheless, additional studies are essential in order to evaluate the effectiveness of the technique in these cases.
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Affiliation(s)
| | | | - Fergus John Walsh
- School of Medicine, College of Health & Medicine, University of Tasmania, Hobart, Tasmania, Australia
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16
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Fu W, Zhang Y, Mehta K, Chen A, Musunuru HB, Pucci P, Kubis J, Huq MS. Evaluating intra-fractional tumor motion in lung stereotactic radiotherapy with deep inspiration breath-hold. J Appl Clin Med Phys 2024:e14414. [PMID: 38803045 DOI: 10.1002/acm2.14414] [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: 02/27/2024] [Revised: 04/19/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024] Open
Abstract
PURPOSE To evaluate the intra-fractional tumor motion in lung stereotactic body radiotherapy (SBRT) with deep inspiration breath-hold (DIBH), and to investigate the adequacy of the current planning target volume (PTV) margins. METHODS Twenty-eight lung SBRT patients with DIBH were selected in this study. Among the lesions, twenty-three were at right or left lower lobe, two at right middle lobe, and three at right or left upper lobe. Post-treatment gated cone-beam computed tomography (CBCT) was acquired to quantify the intra-fractional tumor shift at each treatment. These obtained shifts were then used to calculate the required PTV margin, which was compared with the current applied margin of 5 mm margin in anterior-posterior (AP) and right-left (RL) directions and 8 mm in superior-inferior (SI) direction. The beam delivery time was prolonged with DIBH. The actual beam delivery time with DIBH (Tbeam_DIBH) was compared with the beam delivery time without DIBH (Tbeam_wo_DIBH) for the corresponding SBRT plan. RESULTS A total of 113 treatments were analyzed. At six treatments (5.3%), the shifts exceeded the tolerance defined by the current PTV margin. The average shifts were 0.0 ± 1.9 mm, 0.1±1.5 mm, and -0.5 ± 3.7 mm in AP, RL, and SI directions, respectively. The required PTV margins were determined to be 4.5, 3.9, and 7.4 mm in AP, RL, and SI directions, respectively. The average Tbeam_wo_DIBH and Tbeam_DIBH were 2.4 ± 0.4 min and 3.6 ± 1.5 min, respectively. The average treatment slot for lung SBRT with DIBH was 25.3 ± 7.9 min. CONCLUSION Intra-fractional tumor motion is the predominant source of treatment uncertainties in CBCT-guided lung SBRT with DIBH. The required PTV margin should be determined based on data specific to each institute, considering different techniques and populations. Our data indicate that our current applied PTV margin is adequate, and it is possible to reduce further in the RL direction. The time increase of Tbeam_DIBH, relative to the treatment slot, is not clinically significant.
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Affiliation(s)
- Weihua Fu
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Yongqian Zhang
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Kiran Mehta
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Alex Chen
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Hima Bindu Musunuru
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Pietro Pucci
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Jason Kubis
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - M Saiful Huq
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
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Ehret F, Ebner DK, McComas KN, Gogineni E, Andraos T, Kim M, Lo S, Schulder M, Redmond KJ, Muacevic A, Shih HA, Kresl J. The Radiosurgery Society Case-Based Discussion of the Management of Head and Neck or Skull Base Paragangliomas with Stereotactic Radiosurgery and Radiotherapy. Pract Radiat Oncol 2024; 14:225-233. [PMID: 38237891 DOI: 10.1016/j.prro.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 02/17/2024]
Abstract
Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) have been used for the treatment of head and neck or skull base paraganglioma for a considerable time, demonstrating promising local control rates and a favorable safety profile compared with surgical approaches. Nevertheless, the choice of treatment must be carefully tailored to each patient's preferences, tumor location, and size, as well as anticipated treatment-related morbidity. This case-based review serves as a practical and concise guide for the use of SRS and FSRT in the management of head and neck or skull base paragangliomas, providing information on the diagnosis, treatment, follow-up considerations, and potential pitfalls.
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Affiliation(s)
- Felix Ehret
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Berlin, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany; European Radiosurgery Center Munich, Munich, Germany.
| | - Daniel K Ebner
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Kyra N McComas
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Emile Gogineni
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Therese Andraos
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Minsun Kim
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Simon Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Michael Schulder
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, New York, New York
| | - Kristin J Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | | | - Helen A Shih
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - John Kresl
- Radiation Oncology and Radiosurgery, Phoenix CyberKnife & Radiation Oncology Center, Phoenix, Arizona
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Deng L, Shayan G, Jiang W, Bi N, Wang L. Phase III, multicenter, randomized trial of 45 Gy versus 30 Gy thoracic radiation for extensive-stage small cell lung cancer (ES-SCLC): Study protocol. Thorac Cancer 2024; 15:938-943. [PMID: 38426233 PMCID: PMC11016412 DOI: 10.1111/1759-7714.15263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Consolidative thoracic radiotherapy (cTRT) has previously shown benefit to patients with extensive stage small cell lung cancer (ES-SCLC) who respond to chemotherapy. However, the optimum dose of cTRT is unknown. The purpose of this randomized trial is to compare the efficacy of 45 Gy in 15 fractions with 30 Gy in 10 fractions cTRT in ES-SCLC. METHODS This phase III, multicenter, randomized trial is designed to evaluate the safety and efficacy of different cTRT dose in ES-SCLC. Eligible patients with pathologically confirmed ES-SCLC who responded to 4-6 cycles of etoposide plus cisplatin (EP) or carboplatin (EC) chemotherapy were randomized 1:1 to receive either 30 Gy in 10 fractions (standard dose) or 45 Gy in 15 fractions (high dose) cTRT. The primary endpoint is 2-year overall survival (OS). Secondary endpoints include 2-year progression-free survival (PFS), 2-year local control (LC) and treatment related toxicity as measured by adverse events according to the Common Terminology Criteria for Adverse Events (version 4.0). DISCUSSION The present study is the first randomized phase III trial designed to evaluate the efficacy of higher versus lower dose cTRT in ES-SCLC, providing evidence for future clinical practice in prolonging survival of patients with ES-SCLC.
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Affiliation(s)
- Lei Deng
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijingChina
| | - Gulidanna Shayan
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijingChina
| | - Wei Jiang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital and Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Nan Bi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijingChina
| | - Luhua Wang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital and Shenzhen HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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19
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Lee J, Kim JH, Liu M, Bang A, Olson R, Chang JS. Five-Fraction High-Conformal Ultrahypofractionated Radiotherapy for Primary Tumors in Metastatic Breast Cancer. J Breast Cancer 2024; 27:91-104. [PMID: 38529591 PMCID: PMC11065499 DOI: 10.4048/jbc.2024.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/13/2024] [Accepted: 03/14/2024] [Indexed: 03/27/2024] Open
Abstract
PURPOSE To report on the local control and toxicity of 5-fraction, high-conformal ultrafractionated radiation therapy (RT) for primary tumors in patients with metastatic breast cancer (MBC) who did not undergo planned surgical intervention. METHODS We retrospectively reviewed 27 patients with MBC who underwent 5-fraction high-dose ultrafractionated intensity-modulated RT for their primary tumors between 2017 and 2022 at our institution. A median dose of 66.8 Gy (range, 51.8-83.6 Gy) was prescribed to the gross tumor, calculated in 2-Gy equivalents using an α/β ratio of 3.5, along with a simultaneous integrated boost of 81.5%. The primary endpoint of this study was local control. RESULTS The median tumor size and volume were 5.1 cm and 112.4 cm3, respectively. Treatment was generally well tolerated, with only 15% of the patients experiencing mild acute skin toxicity, which resolved spontaneously. The best infield response rate was 82%, with the objective response observed at a median time of 10.8 months post-RT (range, 1.4-29.2), until local progression or the last follow-up. At a median follow-up of 18.3 months, the 2-year local control rate was 77%. A higher number of prior lines of systemic therapy was significantly associated with poorer 2-year local control (one-two lines, 94% vs three or more lines, 34%; p = 0.004). Post-RT, 67% of the patients transitioned to the next line of systemic therapy, and the median duration of maintaining the same systemic therapy post-RT was 16.3 months (range, 1.9-40.3). CONCLUSION In our small dataset, 5-fraction, high-conformal ultrahypofractionated breast RT offered promising 2-year local control with minimal toxicity. Further studies are warranted to investigate the optimal dose and role in this setting.
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Affiliation(s)
- Jeongshim Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiation Oncology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Jee Hung Kim
- Division of Medical Oncology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mitchell Liu
- British Columbia Cancer Agency - Vancouver Centre, Vancouver, Canada
| | - Andrew Bang
- British Columbia Cancer Agency - Vancouver Centre, Vancouver, Canada
| | - Robert Olson
- British Columbia Cancer Agency - Centre for the North, Prince George, Canada
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
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20
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Liu M, Cygler JE, Tiberi D, Doody J, Malone S, Vandervoort E. Dosimetric impact of rotational errors in trigeminal neuralgia radiosurgery using CyberKnife. J Appl Clin Med Phys 2024; 25:e14238. [PMID: 38131465 PMCID: PMC11005971 DOI: 10.1002/acm2.14238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE Trigeminal neuralgia (TN) can be treated on the CyberKnife system using two different treatment delivery paths: the general-purpose full path corrects small rotations, while the dedicated trigeminal path improves dose fall-off but does not allow rotational corrections. The study evaluates the impact of uncorrected rotations on brainstem dose and the length of CN5 (denoted as Leff) covered by the prescription dose. METHODS AND MATERIALS A proposed model estimates the delivered dose considering translational and rotational delivery errors for TN treatments on the CyberKnife system. The model is validated using radiochromic film measurements with and without rotational setup error for both paths. Leff and the brainstem dose is retrospectively assessed for 24 cases planned using the trigeminal path. For 15 cases, plans generated using both paths are compared for the target coverage and toxicity to the brainstem. RESULTS In experimental validations, measured and estimated doses agree at 1%/1 mm level. For 24 cases, the treated Leff is 5.3 ± 1.7 mm, reduced from 5.9 ± 1.8 mm in the planned dose. Constraints for the brainstem are met in 23 cases for the treated dose but require frequent treatment interruption to maintain rotational corrections <0.5° using the trigeminal path. The treated length of CN5, and plan quality metrics are similar for the two paths, favoring the full path where rotations are corrected. CONCLUSIONS We validated an analytical model that can provide patient-specific tolerances on rotations to meet plan objectives. Treatment using the full path can reduce treatment time and allow for rotational corrections.
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Affiliation(s)
- Ming Liu
- Department of Medical PhysicsThe Ottawa Hospital Cancer CenterOttawaOntarioCanada
- Department of PhysicsCarleton UniversityOttawaOntarioCanada
| | - Joanna E Cygler
- Department of Medical PhysicsThe Ottawa Hospital Cancer CenterOttawaOntarioCanada
- Department of PhysicsCarleton UniversityOttawaOntarioCanada
- Department of RadiologyUniversity of OttawaOttawaOntarioCanada
| | - David Tiberi
- Department of Radiation OncologyThe Ottawa Hospital Cancer CentreOttawaOntarioCanada
- Department of Radiation OncologyUniversity of OttawaOttawaOntarioCanada
| | - Janice Doody
- Radiation Medicine ProgramThe Ottawa Hospital Cancer CentreOttawaOntarioCanada
| | - Shawn Malone
- Department of Radiation OncologyThe Ottawa Hospital Cancer CentreOttawaOntarioCanada
- Department of Radiation OncologyUniversity of OttawaOttawaOntarioCanada
| | - Eric Vandervoort
- Department of Medical PhysicsThe Ottawa Hospital Cancer CenterOttawaOntarioCanada
- Department of PhysicsCarleton UniversityOttawaOntarioCanada
- Department of RadiologyUniversity of OttawaOttawaOntarioCanada
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21
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Milano MT, Doucette C, Mavroidis P, Yorke E, Ryckman J, Mahadevan A, Kapitanova I, Kong FMS, Grimm J, Marks LB. Hypofractionated Stereotactic Radiation Therapy Dosimetric Tolerances for the Inferior Aspect of the Brachial Plexus: A Systematic Review. Int J Radiat Oncol Biol Phys 2024; 118:931-943. [PMID: 36682981 DOI: 10.1016/j.ijrobp.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/17/2022] [Accepted: 11/06/2022] [Indexed: 01/22/2023]
Abstract
We sought to systematically review and summarize dosimetric factors associated with radiation-induced brachial plexopathy (RIBP) after stereotactic body radiation therapy (SBRT) or hypofractionated image guided radiation therapy (HIGRT). From published studies identified from searches of PubMed and Embase databases, data quantifying risks of RIBP after 1- to 10-fraction SBRT/HIGRT were extracted and summarized. Published studies have reported <10% risks of RIBP with maximum doses (Dmax) to the inferior aspect of the brachial plexus of 32 Gy in 5 fractions and 25 Gy in 3 fractions. For 10-fraction HIGRT, risks of RIBP appear to be low with Dmax < 40 to 50 Gy. For a given dose value, greater risks are anticipated with point volume-based metrics (ie, D0.03-0.035cc: minimum dose to hottest 0.03-0.035 cc) versus Dmax. With SBRT/HIGRT, there were insufficient published data to predict risks of RIBP relative to brachial plexus dose-volume exposure. Minimizing maximum doses and possibly volume exposure of the brachial plexus can reduce risks of RIBP after SBRT/HIGRT. Further study is needed to better understand the effect of volume exposure on the brachial plexus and whether there are location-specific susceptibilities along or within the brachial plexus structure.
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Affiliation(s)
- Michael T Milano
- Department of Radiation Oncology, University of Rochester, Rochester, New York.
| | | | - Panayiotis Mavroidis
- Department of Radiation Oncology and Lineberger Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Jeff Ryckman
- Department of Radiation Oncology, West Virginia University, Parkersburg, West Virginia
| | - Anand Mahadevan
- Department of Radiation Oncology, Geisinger Cancer Institute, Danville, Pennsylvania
| | - Irina Kapitanova
- Department of Radiation Oncology, Geisinger Cancer Institute, Danville, Pennsylvania
| | - Feng-Ming Spring Kong
- Department of Clinical Oncology, University of Hong Kong-Shenzhen Hospital/Li Ka Shing School of Medicine, Shenzhen/Hong Kong, China
| | - Jimm Grimm
- Department of Radiation Oncology, Geisinger Cancer Institute, Danville, Pennsylvania
| | - Lawrence B Marks
- Department of Radiation Oncology and Lineberger Cancer Center, University of North Carolina, Chapel Hill, North Carolina
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22
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Li Y, Jiang J, Jiang Q, Lu W, Cui H, Song Y, Li W, Zhang T, Li L. Advanced navigation technology enables endobronchial brachytherapy for peripheral lung cancer: An old technique plays a new role. Brachytherapy 2024; 23:199-206. [PMID: 38161082 DOI: 10.1016/j.brachy.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/19/2023] [Accepted: 12/06/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE To investigate the feasibility of super-selectively endobronchial brachytherapy in the treatment of peripheral lung cancer guided by advanced navigation technology. METHODS AND MATERIALS Six patients with peripheral lung tumors successfully underwent treatment with super-selectively endobronchial brachytherapy guided by advanced navigation technology following pathway planning and were subsequently followed up to assess survival and treatment-related toxicities. RESULTS The endobronchial applicators were successfully placed inside the tumors of all patients using advanced navigation techniques according to the pretreatment plan, and brachytherapy was delivered at curative doses after evaluation using radiotherapy planning software. None of the patients showed local progression of the treated lesions during the follow-up for a duration ranging from 11 months to 35 months, with a median follow-up time of 23 months. The patient with the longest follow-up, nearly 3 years, exhibited a stable condition. After undergoing endobronchial brachytherapy, patients predominantly experienced localized fibrosis as indicated. No significant alterations in cardiopulmonary function were detected during the follow-up, and no other adverse effects were found. CONCLUSIONS The use of endobronchial brachytherapy for the curative treatment of peripheral lung cancers is feasible. Furthermore, the development of novel bronchial navigation techniques has the potential to broaden the application of endobronchial brachytherapy.
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Affiliation(s)
- Yishi Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Juan Jiang
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qingfeng Jiang
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenli Lu
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haixia Cui
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanbo Song
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wencong Li
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tao Zhang
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Longhao Li
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Hering S, Nieto A, Marschner S, Hofmaier J, Schmidt-Hegemann NS, da Silva Mendes V, Landry G, Niyazi M, Manapov F, Belka C, Corradini S, Eze C. The role of online MR-guided multi-fraction stereotactic ablative radiotherapy in lung tumours. Clin Transl Radiat Oncol 2024; 45:100736. [PMID: 38433949 PMCID: PMC10909605 DOI: 10.1016/j.ctro.2024.100736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 03/05/2024] Open
Abstract
Background The aim of this prospective observational study was to evaluate the dosimetry benefits, changes in pulmonary function, and clinical outcome of online adaptive MR-guided SBRT. Methods From 11/2020-07/2022, 45 consecutive patients with 59 lesions underwent multi-fraction SBRT (3-8 fractions) at our institution. Patients were eligible if they had biopsy-proven NSCLC or lung cancer/metastases diagnosed via clinical imaging. Endpoints were local control (LC) and overall survival (OS). We evaluated PTV/GTV dose coverage, organs at risk exposure, and changes in pulmonary function (PF). Acute toxicity was classified per the National Cancer Institute-Common Terminology Criteria for Adverse Events version 5.0. Results The median PTV was 14.4 cm3 (range: 3.4 - 96.5 cm3). In total 195/215 (91%) plans were reoptimised. In the reoptimised vs. predicted plans, PTV coverage by the prescribed dose increased in 94.6% of all fractions with a median increase in PTV VPD of 5.6% (range: -1.8 - 44.6%, p < 0.001), increasing the number of fractions with PTV VPD ≥ 95% from 33% to 98%. The PTV D95% and D98% (BED10) increased in 93% and 95% of all fractions with a median increase of 7.7% (p < 0.001) and 10.6% (p < 0.001). The PTV D95% (BED10) increased by a mean of 9.6 Gy (SD: 10.3 Gy, p < 0.001). At a median follow-up of 21.4 months (95% CI: 12.3-27.0 months), 1- and 2-year LC rates were 94.8% (95% CI: 87.6 - 100.0%) and 91.1% (95% CI: 81.3 - 100%); 1- and 2-year OS rates were 85.6% (95% CI: 75.0 - 96.3%) and 67.1 % (95% CI: 50.3 - 83.8%). One grade ≥ 3 toxicity and no significant reduction in short-term PF parameters were recorded. Conclusions Online adaptive MR-guided SBRT is an effective, safe and generally well tolerated treatment option for lung tumours achieving encouraging local control rates with significantly improved target volume coverage.
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Affiliation(s)
- Svenja Hering
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Alexander Nieto
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Marschner
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Jan Hofmaier
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | | | | | - Guillaume Landry
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- Department of Radiation Oncology, University of Tübingen, Tübingen, Germany
| | - Farkhad Manapov
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich; and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Chukwuka Eze
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
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Guo HL, Wu WW, Huan Y, Zhang HW. SGRT-based stereotactic body radiotherapy for lung cancer setup accuracy and margin of the PTV. J Appl Clin Med Phys 2024; 25:e14195. [PMID: 37915300 DOI: 10.1002/acm2.14195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/09/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE Surface-guided radiation therapy (SGRT, AlignRT) was used to analyze motion during stereotactic body radiotherapy (SBRT) in lung cancer patients and to explore the margin of the planning target volume (PTV). METHODS The residual errors of the AlignRT were evaluated based on grayscale cone-beam computed tomography registration results before each treatment. AlignRT log file was used to analyze the correlation between the frequency and longest duration of errors larger than 2 mm and lasting longer than 2 s and maximum error with age and treatment duration. The displacement value at the end of treatment, the average displacement value, and the 95% probability density displacement interval were defined as intrafraction errors, and PTV1, PTV2, PTV3 were calculated by Van Herk formula or Z score analysis. Organ dosimetric differences were compared after the experience-based margin was replaced with PTV3. RESULTS The interfraction residual errors were Vrt0 , 0.06 ± 0.18 cm; Lng0 , -0.03 ± 0.19 cm; Lat0 , 0.02 ± 0.15 cm; Pitch0 , 0.23 ± 0.7°; Roll0 , 0.1 ± 0.69°; Rtn0 , -0.02 ± 0.79°. The frequency, longest duration and maximum error in vertical direction were correlated with treatment duration (r = 0.404, 0.353, 0.283, p < 0.05, respectively). In the longitudinal direction, the frequency was correlated with age and treatment duration (r = 0.376, 0.283, p < 0.05, respectively), maximum error was correlated with age (r = 0.4, P < 0.05). Vertical, longitudinal, lateral margins of PTV1, PTV2, PTV3 were 2 mm, 4 mm, 2 mm; 2 mm, 2 mm, 2 mm, 3 mm, 5 mm, 3 mm, respectively. After replacing the original PTV, mean lung dose (MLD), 2-cm3 chest wall dose (CD), lung V20 decreased by 0.2 Gy, 2.1 Gy, 0.5%, respectively (p < 0.05). CONCLUSION AlignRT can be used for interfraction setup and monitoring intrafraction motion. It is more reasonable to use upper and lower limits of the 95% probability density interval as an intrafraction error.
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Affiliation(s)
- Hai-Liang Guo
- Department of Oncology, the First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Wei-Wei Wu
- Department of Radiotherapy, the Affiliated Cancer Hospital of Gannan Medical University, GanZhou Cancer Hospital, Ganzhou, China
| | - Yan Huan
- Department of Oncology, People's Hospital of Qianxinan Buyi and Miao Minority Autonomous Prefecture, Qian xinan, China
| | - Huai-Wen Zhang
- Department of Radiotherapy, Jiangxi Cancer Hospital, The Second Affiliated Hospital of Nanchang Medical College, NHC Key Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal Carcinoma, Nanchang, China
- Department of Oncology, The Third People's Hospital of Jingdezhen, Jingdezhen, China
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25
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De Leo AN, Shah A, Li J, Morris CG, Bova FJ, Friedman WA, Amdur RJ. Stereotactic Radiosurgery for Vestibular Schwannoma With Radiographic Brainstem Compression. Am J Clin Oncol 2024; 47:110-114. [PMID: 37981700 DOI: 10.1097/coc.0000000000001065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
OBJECTIVE The safety of single-treatment stereotactic radiosurgery (SRS) for vestibular schwannoma (VS) with radiographic evidence of brainstem compression but without motor deficit is controversial. Data on linear accelerator (linac)-based SRS in this setting are scarce. We address this with an outcomes report from an unselected series of patients with VS with radiographic brainstem compression treated with linac SRS. METHODS We included 139 patients with unilateral VS (any size) with radiographic brainstem compression (all without serious brainstem neurological deficits). The SRS prescription dose was 12.5 Gy (single fraction) using 6MV linac-produced photon beams, delivered with a multiple arc technique. Inclusion criteria required at least 1 year of radiographic follow-up with magnetic resonance imaging. The primary endpoint was freedom from serious brainstem toxicity (≥grade 3 Common Terminology Criteria for Adverse Events v5); the secondary was freedom from enlargement (tumor progression or any requiring intervention). We assessed serious cranial nerve complications, excluding hearing loss, defined as Common Terminology Criteria for Adverse Events v5 grade 3 toxicity. RESULTS Median magnetic resonance imaging follow-up time was 5 years, and median tumor size was 2.5 cm in greatest axial dimension and 5 ml in volume. The median brainstem D0.03 ml=12.6 Gy and median brainstem V10 Gy=0.4 ml. At 5 years, the actuarial freedom from serious brainstem toxicity was 100%, and freedom from tumor enlargement (requiring surgery and/or due to progression) was 90%. Severe facial nerve damage in patients without tumor enlargement was 0.9%. CONCLUSION Linac-based SRS, as delivered in our series for VS with radiographic brainstem compression, is safe and effective.
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Affiliation(s)
| | | | | | | | - Frank J Bova
- Neurosurgery, University of Florida College of Medicine, Gainesville, FL
| | - William A Friedman
- Neurosurgery, University of Florida College of Medicine, Gainesville, FL
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Salas B, Ferrera-Alayón L, Espinosa-López A, Vera-Rosas A, Salcedo E, Kannemann A, Alayon A, Chicas-Sett R, LLoret M, Lara P. Dose-escalated SBRT for borderline and locally advanced pancreatic cancer. Feasibility, safety and preliminary clinical results of a multicenter study. Clin Transl Radiat Oncol 2024; 45:100753. [PMID: 38433951 PMCID: PMC10907515 DOI: 10.1016/j.ctro.2024.100753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/16/2024] [Accepted: 02/18/2024] [Indexed: 03/05/2024] Open
Abstract
Background Pancreatic Stereotactic Body Radiotherapy (SBRT) allows for the administration of a higher biologically effective doses (BED), that would be essential to achieve durable tumor control. Escalating treatment doses need a very accurate tumor positioning and motion control during radiotherapy.The aim of this study to assess the feasibility and safety of a Simultaneous Integrated Boost (SIB) dose-escalated protocol at 45 Gy, 50 Gy and 55 Gy in 5 consecutive daily fractions, in Border Line Resectable Pancreatic Cancer (BRCP) /Locally Advanced Pancreatic Cancer (LAPC) by means of a standard LINAC platform. Methods Patients diagnosed of BRPC/LAPC, candidates for neoadjuvant chemotherapy and SBRT, in four university hospitals of the province of Las Palmas (Canary Islands, Spain) were included in this prospective study. Radiotherapy was administered using standard technology (LINACS) with advanced positioning (Lipiodol® and metallic stent used as fiducial markers) and tumor motion control (4D, DBH, Calypso®). There were 3 planned dose-escalated SIB groups, 45 Gy/5f (9 patients) 50 Gy/5f (9 + 9 patients) and 55 Gy/5f (9 patients). The defined primary end points of the study were the safety and feasibility of the proposed treatment protocol. Secondary endpoints included radiological tumor response after SBRT, local control and survival. Results From June 2017 to December 2022, sixty-two patients were initially assessed for eligibility in the study in the four participating centers, and 49 were candidates for chemotherapy (CHT). Forty-one were referred to radiotherapy after CHT and 33 finally were treated by escalated-dose SIB, 45 Gy (9 patients) 50 Gy (16 patients), 55 Gy(8 patients). All patients completed the scheduled treatment and no acute or late severe (≥grade3) gastrointestinal toxicity was observed.Local response was analyzed by CT/MRI two months after the end of SBRT. Ten patients (31,25 %) achieved objective response (2/9:45 Gy, 5/15:50 Gy, 3/8:55 Gy). Follow-up was closed as July 2023. Freedom from local progression at 1-2y were 89,3% (95 %CI:83,4-95,2%) and 66 % (95 %CI:54,6-77,4%) respectively. The 1-2y survival rates were 95,7% (95 %CI:91,4-100 % and 48,6% (95 %CI:37,7-59,5%) respectively. Conclusion These promising results should be confirmed by further studies with larger sample size and extended follow-up period.
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Affiliation(s)
- B. Salas
- Department of Radiation Oncology University Hospital Dr Negrín Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain
| | - L. Ferrera-Alayón
- Department of Radiation Oncology University Hospital Dr Negrín Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain
- Las Palmas de Gran Canaria University (ULPGC) ,C. Juan de Quesada, 30, 35001 Las Palmas de Gran Canaria,Spain
| | - A. Espinosa-López
- Department of Radiation Oncology, University Hospital Virgen de la Arrixaca, Carretera Madrid-Cartagena, S/N, 30120 El Palmar (Murcia), Spain
| | - A. Vera-Rosas
- Department of Radiation Oncology University Hospital Dr Negrín Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain
| | - E. Salcedo
- Department of Radiation Oncology University Hospital Dr Negrín Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain
| | - A. Kannemann
- Department of Radiation Oncology University Hospital Dr Negrín Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain
| | - A. Alayon
- Department of Radiation Oncology University Hospital Dr Negrín Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain
| | - R. Chicas-Sett
- Department of Radiation Oncology, ASCIRES GRUPO BIOMEDICO, Valencia, Spain
| | - M. LLoret
- Department of Radiation Oncology University Hospital Dr Negrín Las Palmas de Gran Canaria, Barranco de la Ballena s/n, 35010 Las Palmas de Gran Canaria, Spain
- Las Palmas de Gran Canaria University (ULPGC) ,C. Juan de Quesada, 30, 35001 Las Palmas de Gran Canaria,Spain
- Instituto Canario de Investigacion del Cáncer ICIC
| | - P.C. Lara
- Instituto Canario de Investigacion del Cáncer ICIC
- Canarian Comprehensive Cancer Center, Department of Oncology University Hospital San Roque, C. Dolores de la Rocha, 5, 35001 Las Palmas de Gran Canaria, Spain
- Fernando Pessoa Canarias University, Calle la Juventud, s/n, 35450 Guía, Las Palmas de Gran Canaria, Spain
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Jaksic N, Modesto A, Meillan N, Bordron A, Michalet M, Riou O, Lisbona A, Huguet F. Stereotactic body radiation therapy for liver metastases in oligometastatic disease. Cancer Radiother 2024; 28:75-82. [PMID: 37865603 DOI: 10.1016/j.canrad.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/07/2023] [Accepted: 04/25/2023] [Indexed: 10/23/2023]
Abstract
Oligometastatic cancers designate cancers in which the number of metastases is less than five, corresponding to a particular biological entity whose prognosis is situated between a localized and metastatic disease. The liver is one of the main sites of metastases. When patients are not suitable for surgery, stereotactic body radiotherapy provides high local control rate, although these data come mainly from retrospective studies, with no phase III study results. The need for a high therapeutic dose (biologically effective dose greater than 100Gy) while respecting the constraints on the organs at risk, and the management of respiratory movements require expertise and sufficient technical prerequisites. The emergence of new techniques such as MRI-guided radiotherapy could further increase the effectiveness of stereotactic radiotherapy of liver metastases, and thus improve the prognosis of these oligometastatic cancers.
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Affiliation(s)
- N Jaksic
- Institut de cancérologie et radiothérapie Brétillien, 35400 Saint-Malo, France.
| | - A Modesto
- Département de radiothérapie, institut régional du cancer, 31100 Toulouse, France
| | - N Meillan
- Département de radiothérapie, centre hospitalier d'Argenteuil, 95107 Argenteuil, France
| | - A Bordron
- Département de radiothérapie, centre hospitalier universitaire de Brest, 29200 Brest, France
| | - M Michalet
- Département de radiothérapie, institut régional du cancer, 34000 Montpellier, France
| | - O Riou
- Département de radiothérapie, institut régional du cancer, 34000 Montpellier, France
| | - A Lisbona
- Département de radiothérapie, institut régional du cancer, 44800 Saint-Herblain, France
| | - F Huguet
- Service d'oncologie radiothérapie, hôpital Tenon, hôpitaux universitaires Est Parisien, Sorbonne université, 75020 Paris, France
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Wen F, Lin T, Zhang P, Zeng H, Wei Q, Shen Y. Bladder sparing by short-course radiotherapy combined with toripalimab in high-risk/extremely high-risk non-muscle invasive bladder cancer (HOPE-04): study protocol for a single-arm, prospective, phase II trial. BMJ Open 2024; 14:e076663. [PMID: 38262639 PMCID: PMC10806730 DOI: 10.1136/bmjopen-2023-076663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION Radical cystectomy remains the standard treatment for intravesical Bacille Calmette-Guerin (BCG) unresponsive non-muscle invasive bladder cancer (NMIBC) because potential bladder-preserving therapies are not well established. Combination of radiotherapy with programmed death-1 (PD-1) antibody may offer an optional bladder preservation treatment for high-risk/extremely high risk NMIBC. Hence, the current study aims to investigate the safety and efficacy of short-course radiotherapy (5×5 Gy) and toripalimab (PD-1 antibody) as a novel bladder sparing treatment in this population. METHODS AND ANALYSIS HOPE-04 is an open-label, single-arm, phase II study, designed to evaluate the safety and efficacy of short-course radiotherapy and toripalimab in patients with high-risk/extremely high risk NMIBC. Fifty-five patients with pathological and imaging diagnosed NMIBC with or without BCG treatment will be recruited. Radiotherapy of 5×5 Gy will be given to the whole bladder followed by a focal tumour bed boost and concomitant administration of toripalimab of 240 mg intravenous infusion every 21 days for 12 cycles (about 1 year). The primary endpoints are disease-free survival and safety. The secondary endpoint is overall survival. Additional indicators include implementation rate of salvage surgery and quality of life. ETHICS AND DISSEMINATION This trial has been approved by the Ethics Committee of West China Hospital, Sichuan University. Trial findings will be disseminated via peer reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER Chinese Ethics Committee of Registering Clinical Trials (ChiCTR2200059970).
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Affiliation(s)
- Feng Wen
- Abdominal Oncology Ward, Division of Radiation Oncology, Cancer Center, West China Hospital Sichuan University, Chengdu, Sichuan, China
| | - Tianhai Lin
- Department of Urology, Institute of Urology, West China Hospital Sichuan University, Chengdu, China
| | - Peng Zhang
- Department of Urology, Institute of Urology, West China Hospital Sichuan University, Chengdu, China
| | - Hao Zeng
- Department of Urology, Institute of Urology, West China Hospital Sichuan University, Chengdu, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital Sichuan University, Chengdu, China
| | - Yali Shen
- Abdominal Oncology Ward, Division of Radiation Oncology, Cancer Center, West China Hospital Sichuan University, Chengdu, Sichuan, China
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Thaweerat W, Dankulchai P. Case report: Stereotactic MR-guided adaptive radiotherapy for inoperable urothelial carcinoma at the renal pelvis. Front Oncol 2024; 13:1284417. [PMID: 38260853 PMCID: PMC10800431 DOI: 10.3389/fonc.2023.1284417] [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: 08/28/2023] [Accepted: 12/05/2023] [Indexed: 01/24/2024] Open
Abstract
We report the case of an 87-year-old woman with upper tract urothelial carcinoma at the left renal pelvis. She received stereotactic body radiotherapy of 35 Gy in five fractions for palliative treatment of hematuria that was delivered by a 1.5-T magnetic resonance (MR) imaging-guided linear accelerator. Her symptom was relieved after treatment, and posttreatment imaging revealed a complete response of the primary tumor. Thus, this case showed that stereotactic MR-guided radiotherapy could be an appealing option for inoperable patients although radiotherapy is infrequently mentioned in the current treatment guideline of upper tract urothelial carcinoma. Daily adaptive planning from MR images obtained before treatment could improve the target dose and minimize the organ at risk dose. This may lead to a decrease in radiation adverse effects including worsening renal function due to the renal pelvis tumor's proximity to the kidney.
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Affiliation(s)
| | - Pittaya Dankulchai
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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30
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Niu GM, Gao MM, Wang XF, Dong Y, Zhang YF, Wang HH, Guan Y, Cheng ZY, Zhao SZ, Song YC, Tao Z, Zhao LJ, Meng MB, Spring Kong FM, Yuan ZY. Dosimetric analysis of brachial plexopathy after stereotactic body radiotherapy: Significance of organ delineation. Radiother Oncol 2024; 190:110023. [PMID: 37995850 DOI: 10.1016/j.radonc.2023.110023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES Examine the significance of contouring the brachial plexus (BP) for toxicity estimation and select metrics for predicting radiation-induced brachial plexopathy (RIBP) after stereotactic body radiotherapy. MATERIALS AND METHODS Patients with planning target volume (PTV) ≤ 2 cm from the BP were eligible. The BP was contoured primarily according to the RTOG 1106 atlas, while subclavian-axillary veins (SAV) were contoured according to RTOG 0236. Apical PTVs were classified as anterior (PTV-A) or posterior (PTV-B) PTVs. Variables predicting grade 2 or higher RIBP (RIBP2) were selected through least absolute shrinkage and selection operator regression and logistic regression. RESULTS Among 137 patients with 140 BPs (median follow-up, 32.1 months), 11 experienced RIBP2. For patients with RIBP2, the maximum physical dose to the BP (BP-Dmax) was 46.5 Gy (median; range, 35.7 to 60.7 Gy). Of these patients, 54.5 % (6/11) satisfied the RTOG limits when using SAV delineation; among them, 83.3 % (5/6) had PTV-B. For patients with PTV-B, the maximum physical dose to SAV (SAV-Dmax) was 11.2 Gy (median) lower than BP-Dmax. Maximum and 0.3 cc biologically effective doses to the BP based on the linear-quadratic-linear model (BP-BEDmax LQL and BP-BED0.3cc LQL, α/β = 3) were selected as predictive variables with thresholds of 118 and 73 Gy, respectively. CONCLUSION Contouring SAV may significantly underestimate the RIBP2 risk in dosimetry, especially for patients with PTV-B. BP contouring indicated BP-BED0.3cc LQL and BP-BEDmax LQL as potential predictors of RIBP2.
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Affiliation(s)
- Geng-Min Niu
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, China
| | - Miao-Miao Gao
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, China
| | - Xiao-Feng Wang
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, China
| | - Yang Dong
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, China
| | - Yi-Fan Zhang
- Department of Oncology, Institute of Integrative Oncology, Tianjin Union Medical Center, Nankai University School of Medicine, Tianjin, China
| | - Huan-Huan Wang
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, China
| | - Yong Guan
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, China
| | - Ze-Yuan Cheng
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, China
| | - Shu-Zhou Zhao
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, China
| | - Yong-Chun Song
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, China
| | - Zhen Tao
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, China
| | - Lu-Jun Zhao
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, China
| | - Mao-Bin Meng
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, China
| | - Feng-Ming Spring Kong
- Department of Clinical Oncology, HKU Shenzhen Hospital, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Shenzhen, Hong Kong, China.
| | - Zhi-Yong Yuan
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute & Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin, China.
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Tucker WW, Mazur TR, Schmidt MC, Hilliard J, Badiyan S, Spraker MB, Kavanaugh JA. Script-based implementation of automatic grid placement for lattice stereotactic body radiation therapy. Phys Imaging Radiat Oncol 2024; 29:100549. [PMID: 38380154 PMCID: PMC10876586 DOI: 10.1016/j.phro.2024.100549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/26/2024] [Accepted: 02/05/2024] [Indexed: 02/22/2024] Open
Abstract
Background and purpose Spatially fractionated radiation therapy (SFRT) has demonstrated promising clinical response in treating large tumors with heterogeneous dose distributions. Lattice stereotactic body radiation therapy (SBRT) is an SFRT technique that leverages inverse optimization to precisely localize regions of high and lose dose within disease. The aim of this study was to evaluate an automated heuristic approach to sphere placement in lattice SBRT treatment planning. Materials and methods A script-based algorithm for sphere placement in lattice SBRT based on rules described by protocol was implemented within a treatment planning system. The script was applied to 22 treated cases and sphere distributions were compared with manually placed spheres in terms of number of spheres, number of protocol violations, and time required to place spheres. All cases were re-planned using script-generated spheres and plan quality was compared with clinical plans. Results The mean number of spheres placed excluding those that violate rules was greater using the script (13.8) than that obtained by either dosimetrist (10.8 and 12.0, p < 0.001 and p = 0.003) or physicist (12.7, p = 0.061). The mean time required to generate spheres was significantly less using the script (2.5 min) compared to manual placement by dosimetrists (25.0 and 29.9 min) and physicist (19.3 min). Plan quality indices were similar in all cases with no significant differences, and OAR constraints remained met on all plans except two. Conclusion A script placed spheres for lattice SBRT according to institutional protocol rules. The script-produced placement was superior to that of manually-specified spheres, as characterized by sphere number and rule violations.
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Affiliation(s)
- Wesley W. Tucker
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO 63110 USA
| | - Thomas R. Mazur
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO 63110 USA
| | - Matthew C. Schmidt
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO 63110 USA
| | - Jessica Hilliard
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO 63110 USA
| | - Shahed Badiyan
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO 63110 USA
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Quashie EE, Li XA, Prior P, Awan M, Schultz C, Tai A. Obtaining organ-specific radiobiological parameters from clinical data for radiation therapy planning of head and neck cancers. Phys Med Biol 2023; 68:245015. [PMID: 37903437 DOI: 10.1088/1361-6560/ad07f5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/30/2023] [Indexed: 11/01/2023]
Abstract
Objective.Different radiation therapy (RT) strategies, e.g. conventional fractionation RT (CFRT), hypofractionation RT (HFRT), stereotactic body RT (SBRT), adaptive RT, and re-irradiation are often used to treat head and neck (HN) cancers. Combining and/or comparing these strategies requires calculating biological effective dose (BED). The purpose of this study is to develop a practical process to estimate organ-specific radiobiologic model parameters that may be used for BED calculations in individualized RT planning for HN cancers.Approach.Clinical dose constraint data for CFRT, HFRT and SBRT for 5 organs at risk (OARs) namely spinal cord, brainstem, brachial plexus, optic pathway, and esophagus obtained from literature were analyzed. These clinical data correspond to a particular endpoint. The linear-quadratic (LQ) and linear-quadratic-linear (LQ-L) models were used to fit these clinical data and extract relevant model parameters (alpha/beta ratio, gamma/alpha,dTand BED) from the iso-effective curve. The dose constraints in terms of equivalent physical dose in 2 Gy-fraction (EQD2) were calculated using the obtained parameters.Main results.The LQ-L and LQ models fitted clinical data well from the CFRT to SBRT with the LQ-L representing a better fit for most of the OARs. The alpha/beta values for LQ-L (LQ) were found to be 2.72 (2.11) Gy, 0.55 (0.30) Gy, 2.82 (2.90) Gy, 6.57 (3.86) Gy, 5.38 (4.71) Gy, and the dose constraint EQD2 were 55.91 (54.90) Gy, 57.35 (56.79) Gy, 57.54 (56.35) Gy, 60.13 (59.72) Gy and 65.66 (64.50) Gy for spinal cord, optic pathway, brainstem, brachial plexus, and esophagus, respectively. Additional two LQ-L parametersdTwere 5.24 Gy, 5.09 Gy, 7.00 Gy, 5.23 Gy, and 6.16 Gy, and gamma/alpha were 7.91, 34.02, 8.67, 5.62 and 4.95.Significance.A practical process was developed to extract organ-specific radiobiological model parameters from clinical data. The obtained parameters can be used for biologically based radiation planning such as calculating dose constraints of different fractionation regimens.
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Affiliation(s)
- Edwin E Quashie
- Department of Radiation Oncology, Medical College of Wisconsin, WI 53226, United States of America
- Department of Radiation Oncology, Brown University School of Medicine, Providence, RI 02903, United States of America
- Department of Radiation Oncology, Rhode Island Hospital, Providence, RI 02903, United States of America
| | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, WI 53226, United States of America
| | - Phillip Prior
- Department of Radiation Oncology, Medical College of Wisconsin, WI 53226, United States of America
| | - Musaddiq Awan
- Department of Radiation Oncology, Medical College of Wisconsin, WI 53226, United States of America
| | - Christopher Schultz
- Department of Radiation Oncology, Medical College of Wisconsin, WI 53226, United States of America
| | - An Tai
- Department of Radiation Oncology, Medical College of Wisconsin, WI 53226, United States of America
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Hernández KVD, Unterkirhers S, Schneider U. Quality assessment of automatically planned O-Ring linac SBRT plans for pelvic lymph node metastases, finding the optimal minimum target size by comparison with robotic SBRT. J Appl Clin Med Phys 2023; 24:e14143. [PMID: 37738649 PMCID: PMC10691630 DOI: 10.1002/acm2.14143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/24/2023] Open
Abstract
PURPOSE The purpose of this study is to assess the quality of automatic planned O-Ring Halcyon linac SBRT plans for pelvic lymph node metastases and to establish an absolute PTV volume threshold as a plan quality prediction criterion. Compliance of the plans to institutional SBRT plan evaluation criteria and differences in plan quality and treatment delivery times between Halcyon Linac and CyberKnife robotic SBRT were evaluated. METHODS Twenty-one CyberKnife treatment plans were replanned for Halcyon. Prescription doses range was 26-40 Gy in mean three fractions. The mean/median planning target volume was 4.0/3.6 cm3 . Institutional criteria for the plan evaluation were: New Conformity Index (NCI), Conformity Index (CI), Modified Gradient Index (MGI), selectivity index reciprocal (PIV/TVPIV ), and the target coverage by prescription isodose (%PIV). Statistical analysis based on the receiver operating characteristic (ROC) curve was used to determine a plan quality predictor threshold of the PTV volume. Comparative analysis of normal tissue complication probabilities (NTCP) was used to assess the risk of toxicity in healthy tissues. RESULTS Seventy-one percent (n = 15)/95% (n = 20) of Halcyon and 81% (n = 17)/100% (n = 21) of CK plans fulfilled all ideal/tolerance criteria. For PTVs above a found optimal threshold of 2.6 cm3 (71%, n = 15), no statistically significant difference was observed between the CI, NCI, PIV/TVPIV , and MGI indexes of both groups, while the coverage (%PIV) was statistically but not clinically significantly different between cohorts. Significantly shorter delivery times are expected with Halcyon. No significant differences in NTCP were observed. CONCLUSION All but one automatically optimized Halcyon treatment plans demonstrated ideal or acceptable performance. PTV threshold of 2.6 cm3 can be used as decision criteria in clinical settings. The results of our study demonstrated the promising performance of the Halcyon for pelvic SBRT, although plan-specific QA is required to verify machine performance during plan delivery.
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Affiliation(s)
| | | | - Uwe Schneider
- Science FacultyUniversity of ZürichZürichSwitzerland
- Medical PhysicsRadiotherapy HirslandenZürichSwitzerland
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Zhang S, Zhan W, Zeng N, Yang J, Xiong M, Liao W, Chen N, Xiao J. Dosimetric comparison in sparing normal tissue dosage by using auto-SBRT planning in oligo liver tumors. Front Oncol 2023; 13:1273042. [PMID: 38023203 PMCID: PMC10665725 DOI: 10.3389/fonc.2023.1273042] [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: 08/05/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose The study aimed to compare the dosimetric distribution of VMAT plans by increasing the number of half arcs in liver SBRT and investigate the effect by using automatic plan software in plan optimization. Method Thirty-one patients with oligo liver tumors were randomly selected. VMAT treatment plans with different numbers of coplanar half arcs were generated. Result Adding arcs significantly increased the PTV, D2%, D50%, and CI, but sacrificed the plan homogeneity. It also decreased the maximum dose of normal tissues such as the stomach, duodenum, and spinal cord and reduced Dmean, D500cc, and D700cc for the liver. Nevertheless, the diminishing effect gradually decayed into three arcs. Meanwhile, the addition of arcs substantially extended the beam-on time. Conclusion In the context of SBRT for oligo liver tumors, increasing the number of coplanar half arcs will improve PTV conformity and offer better protection for OARs, albeit at the expense of increased treatment duration. Considering the trade-off between plan quality and treatment efficiency, a three-arc plan may be more suitable for clinical implementation.
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Affiliation(s)
- Shu Zhang
- Head and Neck Oncology Department, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Weiyi Zhan
- Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ni Zeng
- Head and Neck Oncology Department, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jiangping Yang
- Head and Neck Oncology Department, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Maoqi Xiong
- West China Clinical Skills Training Center, West China School of Medicine/West China Hospital, Sichuan University, Chengdu, China
| | - Wenjun Liao
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
| | - Nianyong Chen
- Head and Neck Oncology Department, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jianghong Xiao
- Radiotherapy Physics and Technology Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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Roussot N, Fumet JD, Limagne E, Thibaudin M, Hervieu A, Hennequin A, Zanetta S, Dalens L, Fourrier T, Galland L, Jacob P, Bertaut A, Rederstorff E, Chevalier C, Ghirardi S, Gilbert E, Khoukaz A, Martin E, Nicolet C, Quivrin M, Thibouw D, Vulquin N, Truc G, Rouffiac M, Ghiringhelli F, Mirjolet C. A phase I study of the combination of atezolizumab, tiragolumab, and stereotactic body radiation therapy in patients with metastatic multiorgan cancer. BMC Cancer 2023; 23:1080. [PMID: 37946136 PMCID: PMC10633948 DOI: 10.1186/s12885-023-11534-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Immunotherapy targeting the PD-1/PD-L1 pathway is a standard of care in a number of metastatic malignancies, but less than a fifth of patients are expected to respond to ICIs (Immune Checkpoint Inhibitors). In a clinical trial, combining the anti-TIGIT (T cell immunoreceptor with Ig and ITIM domains) Mab (monoclonal antibody) tiragolumab with atezolizumab improved outcomes in non-small cell lung cancer. In preclinical models, SBRT (Stereotactic Body Radiation Therapy) could increase expression levels of the inhibitory co-receptors TIGIT and PD-L1. We aim to assess the combination of tiragolumab with atezolizumab and SBRT in metastatic, previously treated by ICIs, non-small cell lung cancer, head and neck cancer, bladder cancer, and renal cell cancer. METHODS This phase I study (ClinicalTrials.gov NCT05259319) will assess the efficacy and safety of the combination of atezolizumab with tiragolumab and stereotactic body radiation therapy in patients with histologically proven metastatic non-small cell lung cancer, renal cell cancer, bladder cancer, and head and neck cancer previously treated. First part: 2 different schedules of SBRT in association with a fixed dose of atezolizumab and tiragolumab will be investigated only with metastatic non-small cell lung cancer patients (cohort 1). The expansion cohorts phase will be a multicentric, open-label study at the recommended scheme of administration and enroll additional patients with metastatic bladder cancer, renal cell cancer, and head and neck cancer (cohort 2, 3 and 4). Patients will be treated until disease progression, unacceptable toxicity, intercurrent conditions that preclude continuation of treatment, or patient refusal in the absence of progression or intolerance. The primary endpoint of the first phase is the safety of the combination in a sequential or concomitant scheme and to determine the expansion cohorts phase recommended scheme of administration. The primary endpoint of phase II is to evaluate the efficacy of tiragolumab + atezolizumab + SBRT in terms of 6-month PFS (Progression-Free Survival). Ancillary analyses will be performed with peripheral and intratumoral immune biomarker assessments. TRIAL REGISTRATION This study is registered on ClinicalTrials.gov: NCT05259319, since February 28th, 2022.
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Affiliation(s)
- Nicolas Roussot
- Department of Medical Oncology, Center Georges François Leclerc, 1 rue du Professeur Marion, Dijon, 21000, France
- Cancer Biology Transfer Platform, Dijon, France
- University of Burgundy-Franche Comté, Dijon, France
- UMR INSERM 1231, Dijon, France
| | - Jean-David Fumet
- Department of Medical Oncology, Center Georges François Leclerc, 1 rue du Professeur Marion, Dijon, 21000, France.
- Cancer Biology Transfer Platform, Dijon, France.
| | - Emeric Limagne
- Cancer Biology Transfer Platform, Dijon, France
- GIMI Genetic and Immunology Medical Institute, Dijon, France
- University of Burgundy-Franche Comté, Dijon, France
- UMR INSERM 1231, Dijon, France
| | - Marion Thibaudin
- Cancer Biology Transfer Platform, Dijon, France
- GIMI Genetic and Immunology Medical Institute, Dijon, France
- UMR INSERM 1231, Dijon, France
| | - Alice Hervieu
- Department of Medical Oncology, Center Georges François Leclerc, 1 rue du Professeur Marion, Dijon, 21000, France
| | - Audrey Hennequin
- Department of Medical Oncology, Center Georges François Leclerc, 1 rue du Professeur Marion, Dijon, 21000, France
| | - Sylvie Zanetta
- Department of Medical Oncology, Center Georges François Leclerc, 1 rue du Professeur Marion, Dijon, 21000, France
| | - Lorraine Dalens
- Department of Medical Oncology, Center Georges François Leclerc, 1 rue du Professeur Marion, Dijon, 21000, France
| | - Théo Fourrier
- Department of Medical Oncology, Center Georges François Leclerc, 1 rue du Professeur Marion, Dijon, 21000, France
| | - Loick Galland
- Department of Medical Oncology, Center Georges François Leclerc, 1 rue du Professeur Marion, Dijon, 21000, France
| | - Pierre Jacob
- Department of Medical Oncology, Center Georges François Leclerc, 1 rue du Professeur Marion, Dijon, 21000, France
| | - Aurélie Bertaut
- Department of Epidemiology and Biostatistics, Center GF Leclerc, Dijon, France
| | - Emilie Rederstorff
- Department of Epidemiology and Biostatistics, Center GF Leclerc, Dijon, France
| | | | - Sarah Ghirardi
- Department of Radiotherapy, Center GF Leclerc, Dijon, France
| | - Elodie Gilbert
- Department of Radiotherapy, Center GF Leclerc, Dijon, France
| | - Azzat Khoukaz
- Department of Radiotherapy, Center GF Leclerc, Dijon, France
| | - Etienne Martin
- Department of Radiotherapy, Center GF Leclerc, Dijon, France
| | | | - Magali Quivrin
- Department of Radiotherapy, Center GF Leclerc, Dijon, France
| | - David Thibouw
- Department of Radiotherapy, Center GF Leclerc, Dijon, France
| | - Noémie Vulquin
- Department of Radiotherapy, Center GF Leclerc, Dijon, France
| | - Gilles Truc
- Department of Radiotherapy, Center GF Leclerc, Dijon, France
| | - Magali Rouffiac
- Department of Radiotherapy, Center GF Leclerc, Dijon, France
| | - Francois Ghiringhelli
- Department of Medical Oncology, Center Georges François Leclerc, 1 rue du Professeur Marion, Dijon, 21000, France
- Cancer Biology Transfer Platform, Dijon, France
- GIMI Genetic and Immunology Medical Institute, Dijon, France
- University of Burgundy-Franche Comté, Dijon, France
- UMR INSERM 1231, Dijon, France
| | - Céline Mirjolet
- UMR INSERM 1231, Dijon, France
- Radiation Oncology Department, Preclinical Radiation Therapy and Radiobiology Unit, Center GF Leclerc, Unicancer, Dijon, France
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Mohamad I, Karam I, El-Sehemy A, Abu-Gheida I, Al-Ibraheem A, AL-Assaf H, Aldehaim M, Alghamdi M, Alotain I, Ashour M, Bushehri A, ElHaddad M, Hosni A. The Evolving Role of Stereotactic Body Radiation Therapy for Head and Neck Cancer: Where Do We Stand? Cancers (Basel) 2023; 15:5010. [PMID: 37894377 PMCID: PMC10605184 DOI: 10.3390/cancers15205010] [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: 08/29/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Stereotactic body radiation therapy (SBRT) is a precise and conformal radiation therapy (RT) that aims to deliver a high dose of radiation to the tumor whilst sparing surrounding normal tissue, making it an attractive option for head and neck cancer (HNC) patients who are not suitable for the traditional long course of RT with comprehensive RT target volume. Definitive SBRT for HNC has been investigated in different settings, including early stage glottis cancer, and as an alternative to brachytherapy boost after external beam RT. It is also used as a primary treatment option for elderly or medically unfit patients. More recently, an SBRT combination with immunotherapy in the neoadjuvant setting for HNC showed promising results. Salvage or adjuvant SBRT for HNC can be used in appropriately selected cases. Future studies are warranted to determine the optimum dose and fractionation schedules in any of these indications.
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Affiliation(s)
- Issa Mohamad
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11941, Jordan;
| | - Irene Karam
- Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, ON M4N3M5, Canada;
| | - Ahmed El-Sehemy
- Faculty of Medicine, University of Toronto, Toronto, ON M5S1A1, Canada;
| | - Ibrahim Abu-Gheida
- Department of Radiation Oncology, Burjeel Medical City, Abu Dhabi 7400, United Arab Emirates;
- Emirates Oncology Society, Dubai 2299, United Arab Emirates
| | - Akram Al-Ibraheem
- Department of Nuclear Medicine, King Hussein Cancer Center, Amman 11941, Jordan;
| | - Hossam AL-Assaf
- Department of Radiation Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh 11525, Saudi Arabia
| | - Mohammed Aldehaim
- Department of Radiation Oncology, King Faisal Specialist Hospital and Research Center Riyadh, Riyadh 11211, Saudi Arabia;
| | - Majed Alghamdi
- Radiation Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region, Jeddah 21556, Saudi Arabia;
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 11481, Saudi Arabia
| | - Ibrahim Alotain
- Department of Radiation Oncology, King Fahad Specialist, Dammam 31444, Saudi Arabia;
| | - May Ashour
- Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo 11796, Egypt;
| | - Ahmad Bushehri
- Department of Radiation Oncology, Kuwait Cancer Control Center, Kuwait 42262, Kuwait;
| | - Mostafa ElHaddad
- Clinical Oncology Department, Kasr Al-Ainy Center of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy School of Medicine, Cairo University, Cairo 12613, Egypt
| | - Ali Hosni
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G2M9, Canada
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Liu C, Cho Y, Magnelli A, Angelov L, Balagamwala EH, Chao ST, Xia P. The dosimetric impact of titanium implants in spinal SBRT using four commercial treatment planning algorithms. J Appl Clin Med Phys 2023; 24:e14070. [PMID: 37540084 PMCID: PMC10562029 DOI: 10.1002/acm2.14070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/03/2023] [Accepted: 05/29/2023] [Indexed: 08/05/2023] Open
Abstract
To evaluate the dosimetric impact of titanium implants in spine SBRT using four dose calculation algorithms. Twenty patients with titanium implants in the spine treated with SBRT without density override (DO) were selected. The clinical plan for each patient was created in Pinnacle and subsequently imported into Eclipse (AAA and AcurosXB) and Raystation (CC) for dose evaluation with and without DO to the titanium implant. We renormalized all plans such that 90% of the tumor volume received the prescription dose and subsequently evaluated the following dose metrics: (1) the maximum dose to 0.03 cc (Dmax), dose to 99% (D99%) and 90% (D90%) of the tumor volume; (2) Dmax and volumetric metrics of the spinal cord. For the same algorithm, plans with and without DO had similar dose distributions. Differences in Dmax, D99% and D90% of the tumor were on average <2% with slightly larger variations up to 5.58% in Dmax using AcurosXB. Dmax of the spinal cord for plans calculated with DO increased but the differences were clinically insignificant for all algorithms (mean: 0.36% ± 0.7%). Comparing to the clinical plans, the relative differences for all algorithms had an average of 1.73% (-10.36%-13.21%) for the tumor metrics and -0.93% (-9.87%-10.95%) for Dmax of the spinal cord. A few cases with small tumor and spinal cord volumes, dose differences of >10% in both D99% and Dmax of the tumor, and Dmax of the spinal cord were observed. For all algorithms, the presence of titanium implants in the spine for most patients had minimal impact on dose distributions with and without DO. For the same plan calculated with different algorithms, larger differences in volumetric metrics of >10% could be observed, impacted by dose gradient at the plan normalization volume, tumor volumes, plan complexity, and partial voxel volume interpolation.
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Affiliation(s)
- Chieh‐Wen Liu
- Department of Radiation Oncology, Taussig Cancer InstituteCleveland ClinicClevelandOhioUSA
| | - Young‐Bin Cho
- Department of Radiation Oncology, Taussig Cancer InstituteCleveland ClinicClevelandOhioUSA
| | - Anthony Magnelli
- Department of Radiation Oncology, Taussig Cancer InstituteCleveland ClinicClevelandOhioUSA
| | - Lilyana Angelov
- Department of Radiation Oncology, Taussig Cancer InstituteCleveland ClinicClevelandOhioUSA
| | - Ehsan H. Balagamwala
- Department of Radiation Oncology, Taussig Cancer InstituteCleveland ClinicClevelandOhioUSA
| | - Samuel T. Chao
- Department of Radiation Oncology, Taussig Cancer InstituteCleveland ClinicClevelandOhioUSA
| | - Ping Xia
- Department of Radiation Oncology, Taussig Cancer InstituteCleveland ClinicClevelandOhioUSA
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Hannan R, McLaughlin MF, Pop LM, Pedrosa I, Kapur P, Garant A, Ahn C, Christie A, Zhu J, Wang T, Robles L, Durakoglugil D, Woldu S, Margulis V, Gahan J, Brugarolas J, Timmerman R, Cadeddu J. Phase 2 Trial of Stereotactic Ablative Radiotherapy for Patients with Primary Renal Cancer. Eur Urol 2023; 84:275-286. [PMID: 36898872 PMCID: PMC10440291 DOI: 10.1016/j.eururo.2023.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/17/2023] [Accepted: 02/15/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Most renal cell carcinomas (RCCs) are localized and managed by active surveillance, surgery, or minimally invasive techniques. Stereotactic ablative radiation (SAbR) may provide an innovative non-invasive alternative although prospective data are limited. OBJECTIVE To investigate whether SAbR is effective in the management of primary RCCs. DESIGN, SETTING, AND PARTICIPANTS Patients with biopsy-confirmed radiographically enlarging primary RCC (≤5 cm) were enrolled. SAbR was delivered in either three (12 Gy) or five (8 Gy) fractions. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was local control (LC) defined as a reduction in tumor growth rate (compared with a benchmark of 4 mm/yr on active surveillance) and pathologic evidence of tumor response at 1 yr. Secondary endpoints included LC by the Response Evaluation Criteria in Solid Tumors (RECIST 1.1), safety, and preservation of kidney function. Exploratory tumor cell-enriched spatial protein and gene expression analysis were conducted on pre- and post-treatment biopsy samples. RESULTS AND LIMITATIONS Target accrual was reached with the enrollment of 16 ethnically diverse patients. Radiographic LC at 1 yr was observed in 94% of patients (15/16; 95% confidence interval: 70, 100), and this was accompanied by pathologic evidence of tumor response (hyalinization, necrosis, and reduced tumor cellularity) in all patients. By RECIST, 100% of the sites remained without progression at 1 yr. The median pretreatment growth rate was 0.8 cm/yr (interquartile range [IQR]: 0.3, 1.4), and the median post-treatment growth rate was 0.0 cm/yr (IQR: -0.4, 0.1, p < 0.002). Tumor cell viability decreased from 4.6% to 0.7% at 1 yr (p = 0.004). With a median follow-up of 36 mo for censored patients, the disease control rate was 94%. SAbR was well tolerated with no grade ≥2 (acute or late) toxicities. The average glomerular filtration rate declined from a baseline of 65.6 to 55.4 ml/min at 1 yr (p = 0.003). Spatial protein and gene expression analyses were consistent with the induction of cellular senescence by radiation. CONCLUSIONS This clinical trial adds to the growing body of evidence suggesting that SAbR is effective for primary RCC supporting its evaluation in comparative phase 3 clinical trials. PATIENT SUMMARY In this clinical trial, we investigated a noninvasive treatment option of stereotactic radiation therapy for the treatment of primary kidney cancer and found that it was safe and effective.
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Affiliation(s)
- Raquibul Hannan
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA; Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Mark F McLaughlin
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA
| | - Laurentiu M Pop
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA
| | - Ivan Pedrosa
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Radiology, University of Texas Southwestern, Dallas, TX, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Payal Kapur
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Department of Pathology, University of Texas Southwestern, Dallas, TX, USA
| | - Aurelie Garant
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA; Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Chul Ahn
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Population and Data Sciences, University of Texas Southwestern, Dallas, TX, USA
| | - Alana Christie
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - James Zhu
- Quantitative Biomedical Research Center, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tao Wang
- Quantitative Biomedical Research Center, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Liliana Robles
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA
| | - Deniz Durakoglugil
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA
| | - Solomon Woldu
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Vitaly Margulis
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - Jeffrey Gahan
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA
| | - James Brugarolas
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Internal Medicine, University of Texas Southwestern, Dallas, TX, USA
| | - Robert Timmerman
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX, USA; Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey Cadeddu
- Kidney Cancer Program, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA
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De Pietro R, Zaccaro L, Marampon F, Tini P, De Felice F, Minniti G. The evolving role of reirradiation in the management of recurrent brain tumors. J Neurooncol 2023; 164:271-286. [PMID: 37624529 PMCID: PMC10522742 DOI: 10.1007/s11060-023-04407-2] [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: 07/01/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023]
Abstract
Despite aggressive management consisting of surgery, radiation therapy (RT), and systemic therapy given alone or in combination, a significant proportion of patients with brain tumors will experience tumor recurrence. For these patients, no standard of care exists and management of either primary or metastatic recurrent tumors remains challenging.Advances in imaging and RT technology have enabled more precise tumor localization and dose delivery, leading to a reduction in the volume of health brain tissue exposed to high radiation doses. Radiation techniques have evolved from three-dimensional (3-D) conformal RT to the development of sophisticated techniques, including intensity modulated radiation therapy (IMRT), volumetric arc therapy (VMAT), and stereotactic techniques, either stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT). Several studies have suggested that a second course of RT is a feasible treatment option in patients with a recurrent tumor; however, survival benefit and treatment related toxicity of reirradiation, given alone or in combination with other focal or systemic therapies, remain a controversial issue.We provide a critical overview of the current clinical status and technical challenges of reirradiation in patients with both recurrent primary brain tumors, such as gliomas, ependymomas, medulloblastomas, and meningiomas, and brain metastases. Relevant clinical questions such as the appropriate radiation technique and patient selection, the optimal radiation dose and fractionation, tolerance of the brain to a second course of RT, and the risk of adverse radiation effects have been critically discussed.
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Affiliation(s)
- Raffaella De Pietro
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Lucy Zaccaro
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Francesco Marampon
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Paolo Tini
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Francesca De Felice
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Giuseppe Minniti
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.
- IRCCS Neuromed, Pozzilli (IS), Isernia, Italy.
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Puckett LL, Titi M, Kujundzic K, Dawes SL, Gore EM, Katsoulakis E, Park JH, Solanki AA, Kapoor R, Kelly M, Palta J, Chetty IJ, Jabbour SK, Liao Z, Movsas B, Thomas CR, Timmerman RD, Werner-Wasik M, Kudner R, Wilson E, Simone CB. Consensus Quality Measures and Dose Constraints for Lung Cancer From the Veterans Affairs Radiation Oncology Quality Surveillance Program and ASTRO Expert Panel. Pract Radiat Oncol 2023; 13:413-428. [PMID: 37075838 DOI: 10.1016/j.prro.2023.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE For patients with lung cancer, it is critical to provide evidence-based radiation therapy to ensure high-quality care. The US Department of Veterans Affairs (VA) National Radiation Oncology Program partnered with the American Society for Radiation Oncology (ASTRO) as part of the VA Radiation Oncology Quality Surveillance to develop lung cancer quality metrics and assess quality of care as a pilot program in 2016. This article presents recently updated consensus quality measures and dose-volume histogram (DVH) constraints. METHODS AND MATERIALS A series of measures and performance standards were reviewed and developed by a Blue-Ribbon Panel of lung cancer experts in conjunction with ASTRO in 2022. As part of this initiative, quality, surveillance, and aspirational metrics were developed for (1) initial consultation and workup; (2) simulation, treatment planning, and treatment delivery; and (3) follow-up. The DVH metrics for target and organ-at-risk treatment planning dose constraints were also reviewed and defined. RESULTS Altogether, a total of 19 lung cancer quality metrics were developed. There were 121 DVH constraints developed for various fractionation regimens, including ultrahypofractionated (1, 3, 4, or 5 fractions), hypofractionated (10 and 15 fractionations), and conventional fractionation (30-35 fractions). CONCLUSIONS The devised measures will be implemented for quality surveillance for veterans both inside and outside of the VA system and will provide a resource for lung cancer-specific quality metrics. The recommended DVH constraints serve as a unique, comprehensive resource for evidence- and expert consensus-based constraints across multiple fractionation schemas.
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Affiliation(s)
- Lindsay L Puckett
- Department of Radiation Oncology, Medical College of Wisconsin and Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin.
| | - Mohammad Titi
- Department of Radiation Oncology, Medical College of Wisconsin and Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
| | | | | | - Elizabeth M Gore
- Department of Radiation Oncology, Medical College of Wisconsin and Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin
| | - Evangelia Katsoulakis
- Department of Radiation Oncology, James A. Haley Veterans Affairs Healthcare System, Tampa, Florida
| | - John H Park
- Department of Radiation Oncology, Kansas City VA Medical Center, Kansas City, Missouri; Department of Radiology, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Abhishek A Solanki
- Department of Radiation Oncology, Loyola University and Hines VA Medical Center, Chicago, Illinois
| | - Rishabh Kapoor
- Department of Radiation Oncology, Virginia Commonwealth University and Hunter Holmes McGuire VA Medical Center, Richmond, Virginia
| | - Maria Kelly
- Department of Radiation Oncology, VHA National Radiation Oncology Program Office, Richmond, Virginia
| | - Jatinder Palta
- Department of Radiation Oncology, Virginia Commonwealth University and Hunter Holmes McGuire VA Medical Center, Richmond, Virginia; Department of Radiation Oncology, VHA National Radiation Oncology Program Office, Richmond, Virginia
| | - Indrin J Chetty
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Michigan
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Zhongxing Liao
- Division of Radiation Oncology, Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Michigan
| | - Charles R Thomas
- Radiation Oncology, Dartmouth Cancer Institute, Hanover, New Hampshire
| | - Robert D Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical School, Dallas, Texas
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Sydney Kimmel Cancer Center of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Randi Kudner
- American Society for Radiation Oncology, Arlington, Virginia
| | - Emily Wilson
- American Society for Radiation Oncology, Arlington, Virginia
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, New York
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Ma MW, Wang ZS, Li HZ, Gao XS, Liu C, Ren XY, Zhang WL, Yang KW. Breaking barriers: Stereotactic ablative proton and photon radiation therapy for renal cell carcinoma with extensive metastases: A case report. Med Dosim 2023; 49:41-45. [PMID: 37563017 DOI: 10.1016/j.meddos.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/19/2023] [Accepted: 06/27/2023] [Indexed: 08/12/2023]
Abstract
Patients with advanced renal cancer (RCC) often have limited success with systemic therapy due to tumor heterogeneity. However, stereotactic ablative radiotherapy (SABR) has been shown to have a beneficial therapeutic effect for oligometastatic disease when used early. Despite this, current guidelines recommend the use of tyrosine kinase inhibitors (TKIs) as the first-line therapeutic agent for patients with recurrent or metastatic kidney cancer. Additionally, there is limited data on the combination of systemic treatment and SABR for extensive metastatic RCC due to concerns about high toxicity. Proton therapy offers a promising treatment option as it emits energy at a specific depth, generating high target doses while minimizing damage to normal tissue. This allows for precise treatment of various tumor lesions. In this case report, we describe a high-risk 65-year-old male with extensive pleural and thoracic lymph node metastases and 2 bone metastases of clear cell renal cancer. While the targeted therapy and immunotherapy effectively treated the bone metastases, it was not effective in treating the chest metastases, including the pleural and lymph node metastases. Thus, the patient received full-coverage radiotherapy with photon for primary renal tumor and intensity-modulated proton therapy (IMPT) for thoracic metastases. The patient showed no evidence of disease for 1 year after the initial radiotherapy, and no severe SABR-related adverse effects were observed until now. The combination of targeted therapy and immunotherapy with full-coverage radiotherapy may be a promising treatment option for selected patients with extensive metastatic renal cancer, especially as proton therapy allows for more precise control of the beam and minimal damage to normal tissue. This case has motivated us to investigate the potential advantages of administering proton therapy concurrently with systemic therapy in the management of metastatic renal cell carcinoma patients.
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Affiliation(s)
- Ming-Wei Ma
- Department of Radiation Oncology, Peking University First Hospital, Beijing 100034, China
| | - Zi-Shen Wang
- Department of Radiation Oncology, Hebei Yizhou Proton Center, Zhuozhou, Hebei Province, 072750, China.
| | - Hong-Zhen Li
- Department of Radiation Oncology, Peking University First Hospital, Beijing 100034, China.
| | - Xian-Shu Gao
- Department of Radiation Oncology, Peking University First Hospital, Beijing 100034, China.
| | - Chao Liu
- Department of Radiation Oncology, Hebei Yizhou Proton Center, Zhuozhou, Hebei Province, 072750, China
| | - Xue-Ying Ren
- Department of Radiation Oncology, Peking University First Hospital, Beijing 100034, China
| | - Wei-Li Zhang
- Department of Radiation Oncology, Hebei Yizhou Proton Center, Zhuozhou, Hebei Province, 072750, China
| | - Kai-Wei Yang
- Department of Urology, Peking University First Hospital, Beijing 100034, China
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Barbour AB, Kirste S, Grosu AL, Siva S, Louie AV, Onishi H, Swaminath A, Teh BS, Psutka SP, Weg ES, Chen JJ, Zeng J, Gore JL, Hall E, Liao JJ, Correa RJM, Lo SS. The Judicious Use of Stereotactic Ablative Radiotherapy in the Primary Management of Localized Renal Cell Carcinoma. Cancers (Basel) 2023; 15:3672. [PMID: 37509333 PMCID: PMC10377531 DOI: 10.3390/cancers15143672] [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: 06/16/2023] [Revised: 07/11/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Localized renal cell carcinoma is primarily managed surgically, but this disease commonly presents in highly comorbid patients who are poor operative candidates. Less invasive techniques, such as cryoablation and radiofrequency ablation, are effective, but require percutaneous or laparoscopic access, while generally being limited to cT1a tumors without proximity to the renal pelvis or ureter. Active surveillance is another management option for small renal masses, but many patients desire treatment or are poor candidates for active surveillance. For poor surgical candidates, a growing body of evidence supports stereotactic ablative radiotherapy (SABR) as a safe and effective non-invasive treatment modality. For example, a recent multi-institution individual patient data meta-analysis of 190 patients managed with SABR estimated a 5.5% five-year cumulative incidence of local failure with one patient experiencing grade 4 toxicity, and no other grade ≥3 toxic events. Here, we discuss the recent developments in SABR for the management of localized renal cell carcinoma, highlighting key concepts of appropriate patient selection, treatment design, treatment delivery, and response assessment.
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Affiliation(s)
- Andrew B Barbour
- Department of Radiation Oncology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA 98195, USA
| | - Simon Kirste
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK) Partner Site Freiburg, 79085 Freiburg, Germany
| | - Anca-Liga Grosu
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, German Cancer Consortium (DKTK) Partner Site Freiburg, 79085 Freiburg, Germany
| | - Shankar Siva
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Center, University of Melbourne, Parkville, VIC 3052, Australia
| | - Alexander V Louie
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Hiroshi Onishi
- Department of Radiology, School of Medicine, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Anand Swaminath
- Division of Radiation Oncology, Juravinski Cancer Centre, McMaster University, Hamilton, ON L8V 5C2, Canada
| | - Bin S Teh
- Department of Radiation Oncology, Cancer Center and Research Institute, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Sarah P Psutka
- Department of Urology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA 98195, USA
| | - Emily S Weg
- Department of Radiation Oncology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA 98195, USA
| | - Jonathan J Chen
- Department of Radiation Oncology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA 98195, USA
| | - Jing Zeng
- Department of Radiation Oncology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA 98195, USA
| | - John L Gore
- Department of Urology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA 98195, USA
| | - Evan Hall
- Department of Medical Oncology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA 98195, USA
| | - Jay J Liao
- Department of Radiation Oncology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA 98195, USA
| | - Rohann J M Correa
- Department of Radiation Oncology, London Health Sciences Centre, London, ON N6A 5W9, Canada
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington, Fred Hutchinson Cancer Center, Seattle, WA 98195, USA
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Pedroso Partichelli F, de Arruda Botelho M. Evaluation of the applicability of the lattice radiotherapy technique at the National Cancer Institute - INCA. Med Dosim 2023; 48:245-248. [PMID: 37414713 DOI: 10.1016/j.meddos.2023.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/07/2023] [Accepted: 05/24/2023] [Indexed: 07/08/2023]
Abstract
Lattice is a 3-dimensional spatially fractionated radiotherapy that uses a distribution of high-doses, similar to spheres at vertices of a 3D network or matrix. These vertices that receive the high-dose are called peaks, while the rest of the target volume that receives a lower dose, is called the valley. This study aims to verify the technical feasibility for Spatially Fractionated Radiation Therapy treatment using the Lattice technique performed with VMAT at the National Cancer Institute José Alencar Gomes da Silva - INCA, Unit I. Ten patient cases were selected, with gross tumor volumes ranging from 90 to 1734 cc. A literature review was carried out to determine the geometry, the distribution of peaks and the peak to valley dose ratio that will be used in the Lattice technique plans. The dose distributions in the targets and organs at risk of the Lattice plans were clinically compared with the plans without the peaks. A configuration of spheres with diameter of 1.2 cm, separated center-to-center by 3 cm and with a prescription of 14 Gy in a single dose at these peaks was estabilished, while the valley had a prescription of 25 Gy in 5 fractions. Despite the increase in the prescribed equivalent dose in 2 Gy fractions from 40 Gy to 79.3 Gy, the median increase in doses to the OARs was 2.7%, with a maximum increase of 14.7%. The quality control of the plans was approved through the gamma analysis of the measurements performed with the Varian EPID. These findings demonstrate the technical feasibility of SFRT using the lattice technique with VMAT, and suggest that it may provide an effective delivery of high radiation therapy doses to tumors while minimizing the damage to surrounding healthy tissues.
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Affiliation(s)
- Fernanda Pedroso Partichelli
- Medical Phisics/Radiotherapy, Medical Physics Resident, National Cancer Institute, Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Marina de Arruda Botelho
- Medical Phisics/Radiotherapy, Senior Medical Physics, National Cancer Institute, Rio de Janeiro, Rio de Janeiro, Brazil
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Walther E, Griffin L, Randall E, Sandmeyer L, Osinchuk S, Sukut S, Hansen K, Keyerleber M, Lawrence J, Parker S, Mayer M. Contouring in the optic plane improves the accuracy of computed tomography-based segmentation of the optic pathway. Vet Radiol Ultrasound 2023. [PMID: 37335283 DOI: 10.1111/vru.13261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/08/2023] [Accepted: 05/08/2023] [Indexed: 06/21/2023] Open
Abstract
Canine optic pathway structures are often contoured on CT images, despite the difficulty of visualizing the optic pathway with CT using standard planes. The purpose of this prospective, analytical, diagnostic accuracy study was to examine the accuracy of optic pathway contouring by veterinary radiation oncologists (ROs) before and after training on optic plane contouring. Optic pathway contours used as the gold standard for comparison were created based on expert consensus from registered CT and MRI for eight dogs. Twenty-one ROs contoured the optic pathway on CT using their preferred method, and again following atlas and video training demonstrating contouring on the optic plane. The Dice similarity coefficient (DSC) was used to assess contour accuracy. A multilevel mixed model with random effects to account for repeated measures was used to examine DSC differences. The median DSC (5th and 95th percentile) before and after training was 0.31 (0.06, 0.48) and 0.41 (0.18, 0.53), respectively. The mean DSC was significantly higher after training compared with before training (mean difference = 0.10; 95% CI, 0.08-0.12; P < 0.001) across all observers and patients. DSC values were comparable to those reported (0.4-0.5) for segmentation of the optic chiasm and nerves in human patients. Contour accuracy improved after training but remained low, potentially due to the small optic pathway volumes. When registered CT-MRI images are not available, our study supports routine addition of an optic plane with specific window settings to improve segmentation accuracy in mesaticephalic dogs ≥11 kg.
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Affiliation(s)
- Eric Walther
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lynn Griffin
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Elissa Randall
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Lynne Sandmeyer
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Stephanie Osinchuk
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sally Sukut
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Katherine Hansen
- Surgical and Radiological Sciences, Davis Veterinary Medicine, University of California, Davis, California, USA
| | - Michele Keyerleber
- Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts, USA
| | - Jessica Lawrence
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, USA
| | - Sarah Parker
- Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Monique Mayer
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Breslin T, Paino J, Wegner M, Engels E, Fiedler S, Forrester H, Rennau H, Bustillo J, Cameron M, Häusermann D, Hall C, Krause D, Hildebrandt G, Lerch M, Schültke E. A Novel Anthropomorphic Phantom Composed of Tissue-Equivalent Materials for Use in Experimental Radiotherapy: Design, Dosimetry and Biological Pilot Study. Biomimetics (Basel) 2023; 8:230. [PMID: 37366825 DOI: 10.3390/biomimetics8020230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 06/28/2023] Open
Abstract
The production of anthropomorphic phantoms generated from tissue-equivalent materials is challenging but offers an excellent copy of the typical environment encountered in typical patients. High-quality dosimetry measurements and the correlation of the measured dose with the biological effects elicited by it are a prerequisite in preparation of clinical trials with novel radiotherapy approaches. We designed and produced a partial upper arm phantom from tissue-equivalent materials for use in experimental high-dose-rate radiotherapy. The phantom was compared to original patient data using density values and Hounsfield units obtained from CT scans. Dose simulations were conducted for broad-beam irradiation and microbeam radiotherapy (MRT) and compared to values measured in a synchrotron radiation experiment. Finally, we validated the phantom in a pilot experiment with human primary melanoma cells.
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Affiliation(s)
- Thomas Breslin
- Department of Oncology, Clinical Sciences, Lund University, 22185 Lund, Sweden
| | - Jason Paino
- Centre of Medical Radiation Physics, University of Wollongong, Wollongong 2522, Australia
| | - Marie Wegner
- Institute of Product Development and Mechanical Engineering Design, Hamburg University of Technology, 21073 Hamburg, Germany
| | - Elette Engels
- Centre of Medical Radiation Physics, University of Wollongong, Wollongong 2522, Australia
- Australian Synchrotron/ANSTO, Clayton 3168, Australia
| | - Stefan Fiedler
- European Molecular Biology Laboratory (EMBL), Hamburg Outstation, 22607 Hamburg, Germany
| | - Helen Forrester
- School of Science, Royal Melbourne Institute of Technology (RMIT) University, Melbourne 3001, Australia
| | - Hannes Rennau
- Department of Radiooncology, Rostock University Medical Center, 18059 Rostock, Germany
| | - John Bustillo
- Centre of Medical Radiation Physics, University of Wollongong, Wollongong 2522, Australia
| | | | | | | | - Dieter Krause
- Institute of Product Development and Mechanical Engineering Design, Hamburg University of Technology, 21073 Hamburg, Germany
| | - Guido Hildebrandt
- Department of Radiooncology, Rostock University Medical Center, 18059 Rostock, Germany
| | - Michael Lerch
- Centre of Medical Radiation Physics, University of Wollongong, Wollongong 2522, Australia
| | - Elisabeth Schültke
- Department of Radiooncology, Rostock University Medical Center, 18059 Rostock, Germany
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Regnery S, Leiner L, Buchele C, Hoegen P, Sandrini E, Held T, Deng M, Eichkorn T, Rippke C, Renkamp CK, König L, Lang K, Adeberg S, Debus J, Klüter S, Hörner-Rieber J. Comparison of different dose accumulation strategies to estimate organ doses after stereotactic magnetic resonance-guided adaptive radiotherapy. Radiat Oncol 2023; 18:92. [PMID: 37248504 DOI: 10.1186/s13014-023-02284-7] [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: 01/23/2023] [Accepted: 05/17/2023] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION Re-irradiation is frequently performed in the era of precision oncology, but previous doses to organs-at-risk (OAR) must be assessed to avoid cumulative overdoses. Stereotactic magnetic resonance-guided online adaptive radiotherapy (SMART) enables highly precise ablation of tumors close to OAR. However, OAR doses may change considerably during adaptive treatment, which complicates potential re-irradiation. We aimed to compare the baseline plan with different dose accumulation techniques to inform re-irradiation. PATIENTS & METHODS We analyzed 18 patients who received SMART to lung or liver tumors inside prospective databases. Cumulative doses were calculated inside the planning target volumes (PTV) and OAR for the adapted plans and theoretical non-adapted plans via (1) cumulative dose volume histograms (DVH sum plan) and (2) deformable image registration (DIR)-based dose accumulation to planning images (DIR sum plan). We compared cumulative dose parameters between the baseline plan, DVH sum plan and DIR sum plan using equivalent doses in 2 Gy fractions (EQD2). RESULTS Individual patients presented relevant increases of near-maximum doses inside the proximal bronchial tree, spinal cord, heart and gastrointestinal OAR when comparing adaptive treatment to the baseline plans. The spinal cord near-maximum doses were significantly increased in the liver patients (D2% median: baseline 6.1 Gy, DIR sum 8.1 Gy, DVH sum 8.4 Gy, p = 0.04; D0.1 cm³ median: baseline 6.1 Gy, DIR sum 8.1 Gy, DVH sum 8.5 Gy, p = 0.04). Three OAR overdoses occurred during adaptive treatment (DIR sum: 1, DVH sum: 2), and four more intense OAR overdoses would have occurred during non-adaptive treatment (DIR sum: 4, DVH sum: 3). Adaptive treatment maintained similar PTV coverages to the baseline plans, while non-adaptive treatment yielded significantly worse PTV coverages in the lung (D95% median: baseline 86.4 Gy, DIR sum 82.4 Gy, DVH sum 82.2 Gy, p = 0.006) and liver patients (D95% median: baseline 87.4 Gy, DIR sum 82.1 Gy, DVH sum 81.1 Gy, p = 0.04). CONCLUSION OAR doses can increase during SMART, so that re-irradiation should be planned based on dose accumulations of the adapted plans instead of the baseline plan. Cumulative dose volume histograms represent a simple and conservative dose accumulation strategy.
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Affiliation(s)
- Sebastian Regnery
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Lukas Leiner
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Carolin Buchele
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Philipp Hoegen
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elisabetta Sandrini
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Thomas Held
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Maximilian Deng
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Tanja Eichkorn
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Carolin Rippke
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - C Katharina Renkamp
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Kristin Lang
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Klüter
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
- National Center for Tumor diseases (NCT), Heidelberg, Germany.
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Lee BM, Lee SJ, Kim N, Byun HK, Kim YB. Radiotherapy in recurrent ovarian cancer: updated results of involved-field radiation therapy. Int J Gynecol Cancer 2023:ijgc-2022-004200. [PMID: 37217239 DOI: 10.1136/ijgc-2022-004200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
OBJECTIVE This study aimed to update the possible clinical benefits of radiation therapy in recurrent ovarian cancer. METHODS The medical records of 495 patients with recurrent ovarian cancer after initially undergoing maximal cytoreductive surgery and adjuvant platinum-based chemotherapy based on the pathologic stage between January 2010 and December 2020 were analyzed: 309 and 186 patients were treated without and with involved-field radiation therapy, respectively. Involved-field radiation therapy is defined as radiation therapy only to the areas of the body involved by tumor. The prescribed doses were ≥45 Gy (equivalent dose in 2 Gy/fraction). Overall survival was compared between patients treated with and without involved-field radiation therapy. The favorable group was defined as patients who satisfied at least four of the following factors: good performance, no ascites, normal CA-125, platinum-sensitive tumor, and nodal recurrence. RESULTS The median age of the patients was 56 years (range 49-63) and median time to recurrence was 11.1 months (range 6.1-15.5). 217 patients (43.8%) were treated at a single site. Radiation therapy, performance status, CA-125, platinum sensitivity, residual disease, and ascites were all significant prognostic factors. The 3-year overall survival of all patients, patients treated without radiation therapy, and patients treated with radiation therapy was 54.0%, 44.8%, and 69.3%, respectively. Radiation therapy was associated with higher overall survival rates in the unfavorable and favorable patient groups. Patient characteristics showed higher rates of normal CA-125, lymph node metastasis only, lower platinum sensitivity, and higher rates of ascites in the radiation therapy group. After propensity score matching, the radiation therapy group showed superior overall survival to the non-radiation therapy group. Normal CA-125, good performance status, and platinum sensitivity were associated with a good prognosis in patients treated with radiation therapy. CONCLUSION Our study showed that higher overall survival was observed in patients treated with radiation therapy in recurrent ovarian cancer.
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Affiliation(s)
- Byung Min Lee
- Radiation Oncology, Uijeongbu St Mary's Hospital, Seoul, Korea (the Republic of)
- Department of Radiation Oncology, Yonsei University College of Medicine, Seodaemun-gu, Korea (the Republic of)
| | - Seo Jin Lee
- Department of Radiation Oncology, Yonsei University College of Medicine, Seodaemun-gu, Korea (the Republic of)
| | - Nalee Kim
- Radiation Oncology, Samsung Seoul Hospital, Gangnam-gu, Seoul, Korea (the Republic of)
| | - Hwa Kyung Byun
- Department of Radiation Oncology, Yonsei University College of Medicine, Seodaemun-gu, Korea (the Republic of)
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seodaemun-gu, Korea (the Republic of)
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Iramina H, Nakamura M, Nakamura K, Fujimoto T, Mizowaki T. Quantification of six-degree-of-freedom motion during beam delivery in spine stereotactic body radiotherapy using intra-irradiation cone-beam computed tomography imaging technique. Phys Med 2023; 110:102605. [PMID: 37167776 DOI: 10.1016/j.ejmp.2023.102605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/22/2023] [Accepted: 05/04/2023] [Indexed: 05/13/2023] Open
Abstract
PURPOSE Quantifying intra-fractional six-degree-of-freedom (6DoF) residual errors or motion from approved patient setups is necessary for accurate beam delivery in spine stereotactic body radiotherapy. However, previously reported errors were not acquired during beam delivery. Therefore, we aimed to quantify the 6DoF residual errors and motions during arc beam delivery using a concurrent cone-beam computed tomography (CBCT) imaging technique, intra-irradiation CBCT. METHODS Consecutive 15 patients, 19 plans for various treatment sites, and 199 CBCT images were analyzed. Pre-irradiation CBCT was performed to verify shifts from the initial patient setup using the ExacTrac system. During beam delivery by two or three co-planar full-arc rotations, CBCT imaging was performed concurrently. Subsequently, an intra-irradiation CBCT image was reconstructed. Pre- and intra-irradiation CBCT images were rigidly registered to a planning CT image based on the bone to quantify 6DoF residual errors. RESULTS 6DoF residual errors quantified using pre- and intra-irradiation CBCTs were within 2.0 mm/2.0°, except for one measurement. The mean elapsed time (mean ± standard deviation [min:sec]) after pre-irradiation CBCT to the end of the last arc beam delivery was 6:08 ± 1:25 and 7:54 ± 2:14 for the 2- and 3-arc plans, respectively. Root mean squares of residual errors for several directions showed significant differences; however, they were within 1.0 mm/1.0°. Time-dependent analysis revealed that the residual errors tended to increase with elapsed time. CONCLUSION The errors represent the optimal intra-fractional error compared with those acquired using the pre-, inter-beam, and post-6DoF image guidance and can be acquired within a standard treatment timeslot.
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Affiliation(s)
- Hiraku Iramina
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Mitsuhiro Nakamura
- Department of Advanced Medical Physics, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Kiyonao Nakamura
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Takahiro Fujimoto
- Division of Clinical Radiology Service, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
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Cao B, Zhang L, Wu C, Liu X, Wang Q, Tong F, Yang W, Wang J. Survival Outcomes and Failure Patterns in Patients with Inoperable Non-Metastatic Pancreatic Cancer Treated with Definitive Radiotherapy. Cancers (Basel) 2023; 15:cancers15082213. [PMID: 37190142 DOI: 10.3390/cancers15082213] [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: 02/13/2023] [Revised: 03/19/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023] Open
Abstract
This study investigated the long-term results, failure patterns, and prognostic factors of patients with initially inoperable non-metastatic pancreatic cancer (PC) receiving definitive radiotherapy (RT). Between January 2016 and December 2020, a total of 168 non-metastatic PC patients, who were surgically unresectable or medically inoperable, were enrolled to receive definitive RT, with or without chemotherapy. Overall survival (OS) and progression-free survival (PFS) were evaluated using the Kaplan-Meier method with a log-rank test. The cumulative incidence of locoregional and distant progression was estimated using the competing risks model. The Cox proportional-hazards model was used to determine the influence of prognostic variables on OS. With a median follow-up of 20.2 months, the median OS (mOS) and median PFS (mPFS) from diagnosis were 18.0 months [95% confidence interval (CI), 16.5-21.7 months] and 12.3 months (95% CI, 10.2-14.3 months), respectively. The mOS and mPFS from RT were 14.3 months (95% CI, 12.7-18.3 months) and 7.7 months (95% CI, 5.5-12.0 months), respectively. The corresponding 1-year, 2-year, and 3-year OS from diagnosis and RT were 72.1%, 36.6%, and 21.5% as well as 59.0%, 28.8%, and 19.0%, respectively. In a multivariate analysis, stage I-II (p = 0.032), pre-RT CA19-9 ≤ 130 U/mL (p = 0.011), receiving chemotherapy (p = 0.003), and a biologically effective dose (BED10) > 80 Gy (p = 0.014) showed a significant favorable influence on OS. Among the 59 available patients with definite progression sites, the recurrences of local, regional, and distant progression were 33.9% (20/59), 18.6% (11/59), and 59.3% (35/59), respectively. The 1-year and 2-year cumulative incidences of locoregional progression after RT were 19.5% (95% CI, 11.5-27.5%) and 32.8% (95% CI, 20.8-44.8%), respectively. Definitive RT was associated with long-term primary tumor control, resulting in superior survival in patients with inoperable non-metastatic PC. Further prospective randomized trials are warranted to validate our results in these patients.
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Affiliation(s)
- Biyang Cao
- Chinese PLA Medical School, Beijing 100853, China
- Department of Radiation Oncology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Letian Zhang
- Chinese PLA Medical School, Beijing 100853, China
- Department of Radiation Oncology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Chenchen Wu
- Chinese PLA Medical School, Beijing 100853, China
- Department of Radiation Oncology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiaoliang Liu
- Department of Radiation Oncology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Qianqian Wang
- Department of Radiation Oncology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Fang Tong
- Department of Radiation Oncology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Wei Yang
- Department of Radiation Oncology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
| | - Jing Wang
- Department of Radiation Oncology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
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50
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Castelnau-Marchand P, Scher N, Bollet M, Chargari C, Toledano A. Stereotactic ablative radiotherapy for unresectable inferior vena cava tumor thrombus in a patient with renal cell carcinoma: a case report. Strahlenther Onkol 2023; 199:420-424. [PMID: 36862154 DOI: 10.1007/s00066-023-02054-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/29/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE Treatment options for renal cell carcinoma (RCC) with inferior vena cava tumor thrombus (IVC-TT) are limited and carry substantial risks. Currently, there are no standard treatment options in the setting of recurrent or unresectable RCC with IVC-TT. METHODS We report our experience of treating an IVC-TT RCC patient with stereotactic body radiation therapy (SBRT). RESULTS This 62-year-old gentleman presented renal cell carcinoma with IVC-TT and liver metastases. Initial treatment consisted of radical nephrectomy and thrombectomy followed by continuous sunitinib. At 3 months, he developed an unresectable IVC-TT recurrence. A fiducial marker was implanted into the IVC-TT by catheterization. New biopsies were performed at the same time, demonstrating a recurrence of the RCC. SBRT consisted of 5 fractions of 7 Gy to the IVC-TT with excellent initial tolerance. He subsequently received anti-PD1 therapy (nivolumab). At 4 years follow-up, he is doing well with no IVC-TT recurrence and no late toxicity. CONCLUSION SBRT appears to be a feasible and safe treatment for IVC-TT secondary to RCC in patients who are not candidates for surgery.
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Affiliation(s)
- Pauline Castelnau-Marchand
- Hartmann Radiotherapy and Radiosurgery Institute, 4 rue Kleber, 92200, Levallois Perret, Ile de France, France
| | - Nathaniel Scher
- Hartmann Radiotherapy and Radiosurgery Institute, 4 rue Kleber, 92200, Levallois Perret, Ile de France, France.
| | - Marc Bollet
- Hartmann Radiotherapy and Radiosurgery Institute, 4 rue Kleber, 92200, Levallois Perret, Ile de France, France
- Integrative medecine department, Rafael Institute, Levallois Perret, France
| | | | - Alain Toledano
- Hartmann Radiotherapy and Radiosurgery Institute, 4 rue Kleber, 92200, Levallois Perret, Ile de France, France
- Integrative medecine department, Rafael Institute, Levallois Perret, France
- Integrative health chair, National Conservatory of Arts and Crafts, Paris, France
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