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Haskova J, Sramko M, Cvek J, Kautzner J. Stereotactic Radiotherapy in the Management of Ventricular Tachycardias: More Questions than Answers? Card Electrophysiol Clin 2022; 14:779-792. [PMID: 36396193 DOI: 10.1016/j.ccep.2022.06.010] [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] [Indexed: 06/16/2023]
Abstract
Stereotactic body radiotherapy is a recent promising therapeutic alternative in cases of failed catheter ablation for recurrent ventricular tachycardias (VTs) in patients with structural heart disease. Initial clinical experience with a single radiation dose of 25 Gy shows reasonable efficacy in the reduction of VT recurrences with acceptable acute toxicity. Many unanswered questions remain, including unknown mechanism of action, variable time to effect, optimal method of substrate targeting, long-term safety, and definition of an optimal candidate for this treatment."
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Affiliation(s)
- Jana Haskova
- Department of Cardiology, IKEM, Vídeňská 1958/9, Prague 140 21, Czech Republic.
| | - Marek Sramko
- Department of Cardiology, IKEM, Vídeňská 1958/9, Prague 140 21, Czech Republic
| | - Jakub Cvek
- Department of Oncology, University Hospital Ostrava and Ostrava University Medical School, 17 listopadu 1790/5, Ostrava-Poruba 708 00 Czech Republic
| | - Josef Kautzner
- Department of Cardiology, IKEM, Vídeňská 1958/9, Prague 140 21, Czech Republic; Palacky University Medical School, Olomouc, Czech Republic
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2
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Savanović M, Loi M, Rivin Del Campo E, Huguet F, Foulquier JN. Assessment of Organ Dose Reduction Using Dynamic Conformal Arc and Static Field with FFF Beams for SBRT in Lung Cancer. Cancer Invest 2022; 40:868-878. [DOI: 10.1080/07357907.2022.2103705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Milovan Savanović
- Faculty of Medicine, University of Paris-Saclay, Le Kremlin-Bicetre, France
- Department of Radiotherapy, Tenon Hospital, APHP, Sorbonne University, Paris, France
| | - Mauro Loi
- Department of Radiotherapy, Tenon Hospital, APHP, Sorbonne University, Paris, France
| | - Eleonor Rivin Del Campo
- Department of Radiotherapy, Tenon Hospital, APHP, Sorbonne University, Paris, France
- Faculty of Medicine, Sorbonne University Medical Faculty, Paris, France
| | - Florence Huguet
- Department of Radiotherapy, Tenon Hospital, APHP, Sorbonne University, Paris, France
- Faculty of Medicine, Sorbonne University Medical Faculty, Paris, France
| | - Jean-Noël Foulquier
- Department of Radiotherapy, Tenon Hospital, APHP, Sorbonne University, Paris, France
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3
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Falcinelli L, Menichelli C, Casamassima F, Aristei C, Borghesi S, Ingrosso G, Draghini L, Tagliagambe A, Badellino S, di Monale E Bastia MB. Stereotactic radiotherapy for lung oligometastases. Rep Pract Oncol Radiother 2022; 27:23-31. [PMID: 35402023 PMCID: PMC8989443 DOI: 10.5603/rpor.a2022.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 12/27/2021] [Indexed: 11/25/2022] Open
Abstract
30–60% of cancer patients develop lung metastases, mostly from primary tumors in the colon-rectum, lung, head and neck area, breast and kidney. Nowadays, stereotactic radiotherapy (SRT ) is considered the ideal modality for treating pulmonary metastases. When lung metastases are suspected, complete disease staging includes a total body computed tomography (CT ) and/or positron emission tomography-computed tomography (PET -CT ) scan. PET -CT has higher specificity and sensitivity than a CT scan when investigating mediastinal lymph nodes, diagnosing a solitary lung lesion and detecting distant metastases. For treatment planning, a multi-detector planning CT scan of the entire chest is usually performed, with or without intravenous contrast media or esophageal lumen opacification, especially when central lesions have to be irradiated. Respiratory management is recommended in lung SRT, taking the breath cycle into account in planning and delivery. For contouring, co-registration and/or matching planning CT and diagnostic images (as provided by contrast enhanced CT or PET-CT ) are useful, particularly for central tumors. Doses and fractionation schedules are heterogeneous, ranging from 33 to 60 Gy in 3–6 fractions. Independently of fractionation schedule, a BED10 > 100 Gy is recommended for high local control rates. Single fraction SRT (ranges 15–30 Gy) is occasionally administered, particularly for small lesions. SRT provides tumor control rates of up to 91% at 3 years, with limited toxicities. The present overview focuses on technical and clinical aspects related to treatment planning, dose constraints, outcome and toxicity of SRT for lung metastases.
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Affiliation(s)
- Lorenzo Falcinelli
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Italy
| | | | | | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Italy
| | - Simona Borghesi
- Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, Italy
| | - Gianluca Ingrosso
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Italy
| | | | | | - Serena Badellino
- Radiation Oncology Department, A.O.U. Città della Salute e della Scienza, Turin, Italy
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4
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Borghesi S, Aristei C, Marampon F. Doses, fractionations, constraints for stereotactic radiotherapy. Rep Pract Oncol Radiother 2022; 27:10-14. [PMID: 35402033 PMCID: PMC8989440 DOI: 10.5603/rpor.a2021.0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/07/2021] [Indexed: 11/25/2022] Open
Abstract
This paper describes how to select the most appropriate stereotactic radiotherapy (SRT ) dose and fractionation scheme according to lesion size and site, organs at risk (OARs) proximity and the biological effective dose. In single-dose SRT, 15-34 Gy are generally used while in fractionated SRT 30 and 75 Gy in 2-5 fractions are administered. The ICRU Report No. 91, which is specifically dedicated to SRT treatments, provided indications for dose prescription (with its definition and essential steps), dose delivery and optimal coverage which was defined as the best planning target volume coverage that can be obtained in the irradiated district. Calculation algorithms and OAR s dose constraints are provided as well as treatment planning system characteristics, suggested beam energy and multileaf collimator leaf size. Finally, parameters for irradiation geometry and plan quality are also reported.
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Affiliation(s)
- Simona Borghesi
- Radiation Oncology Unit of Arezzo-Valdarno, Azienda USL Toscana Sud Est, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Italy
| | - Francesco Marampon
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Italy
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5
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Sodji QH, Ko R, von Eyben R, Owen SG, Capaldi DPI, Bush K, Binkley MS, Alrowais F, Pickthorn B, Maxim PG, Gensheimer MF, Diehn M, Loo BW. Acute and Late Esophageal Toxicity Following Stereotactic Ablative Radiotherapy to Thoracic Tumors near or Abutting the Esophagus. Int J Radiat Oncol Biol Phys 2021; 112:1144-1153. [PMID: 34942312 DOI: 10.1016/j.ijrobp.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/29/2021] [Accepted: 12/08/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the incidence of acute and late esophageal toxicity in patients with thoracic tumors near or abutting the esophagus treated with stereotactic ablative radiotherapy (SABR). METHODS AND MATERIALS Among patients with thoracic tumors treated with SABR, we identified those with tumors near or abutting the esophagus. Using the linear-quadratic model with an α/ß ratio of 10, we determined the correlation between dosimetric parameters and esophageal toxicity graded using the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0. RESULTS Out of 2200 patients treated with thoracic SABR, 767 patients were analyzable for esophageal dosimetry. We identified 55 patients with tumors near the esophagus (52 evaluable for esophagitis grade), 28 with PTV overlapping the esophagus. Median follow-up and overall survival were 16 and 23 months respectively. Thirteen patients (25%) developed temporary grade 2 acute esophageal toxicity, 11 (85%) of whom had PTV overlapping the esophagus. Symptoms resolved within 1-3 months in 12 patients, and 6 months in all patients. No grade 3-5 toxicity was observed. Only 3 patients (6%) developed late or persistent grade 2 dysphagia or dyspepsia of uncertain relationship to SABR. Cumulative incidence of acute esophagitis was 15% and 25% at 14 days and 60 days respectively. Acute toxicity correlated on univariate analysis with esophageal Dmax, D1cc, D2cc, Dmax/Dprescription and whether the PTV was overlapping the esophagus. Esophageal Dmax (BED10) < 62 Gy, D1cc (BED10) < 48 Gy, D2cc (BED10) < 43 Gy, and Dmax/Dprescription < 85% was associated with <20% risk of grade 2 acute esophagitis. Only 2 local recurrences occurred. CONCLUSIONS Although 25% of patients with tumors near the esophagus developed acute esophagitis (39% of those with PTV overlapping the esophagus), these toxicities were all grade 2 and all temporary. This suggests the safety and efficacy of thoracic SABR for tumors near or abutting the esophagus when treating with high conformity and sharp dose gradients.
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Affiliation(s)
- Quaovi H Sodji
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, U.S.A.; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Ryan Ko
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Rie von Eyben
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, U.S.A..
| | - Susie G Owen
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Dante P I Capaldi
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Karl Bush
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Michael S Binkley
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, U.S.A.; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Fahad Alrowais
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Bill Pickthorn
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Peter G Maxim
- Department of Radiation Oncology, University of California Irvine, CA, U.S.A
| | - Michael F Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, U.S.A.; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, U.S.A.; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, U.S.A.; Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, U.S.A.
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Potential Morbidity Reduction for Lung Stereotactic Body Radiation Therapy Using Respiratory Gating. Cancers (Basel) 2021; 13:cancers13205092. [PMID: 34680240 PMCID: PMC8533802 DOI: 10.3390/cancers13205092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/08/2021] [Accepted: 10/08/2021] [Indexed: 12/25/2022] Open
Abstract
Simple Summary Lung stereotactic body radiotherapy (SBRT) is the standard of care for early-stage lung cancer and oligometastases. For SBRT, motion has to be considered to avoid misdosage. Respiratory phase gating, meaning to irradiate the target volume only in a predefined gating motion phase window, can be applied to mitigate motion-induced effects. The aim of this study was to exploit the clinical benefit of gating for lung SBRT. For the majority of 14 lung tumor patients and various gating windows, we could prove a reduced dose to normal tissue by gating simulation. A normal tissue complication probability (NTCP) model analysis revealed a major reduction of normal tissue toxicity for moderate gating window sizes. The most beneficial effect of gating was found for those patients with the highest prior toxicity risk. The presented results are useful for personalized risk assessment prior to treatment and may help to select patients and optimal gating windows. Abstract We investigated the potential of respiratory gating to mitigate the motion-caused misdosage in lung stereotactic body radiotherapy (SBRT). For fourteen patients with lung tumors, we investigated treatment plans for a gating window (GW) including three breathing phases around the maximum exhalation phase, GW40–60. For a subset of six patients, we also assessed a preceding three-phase GW20–40 and six-phase GW20–70. We analyzed the target volume, lung, esophagus, and heart doses. Using normal tissue complication probability (NTCP) models, we estimated radiation pneumonitis and esophagitis risks. Compared to plans without gating, GW40–60 significantly reduced doses to organs at risk without impairing the tumor doses. On average, the mean lung dose decreased by 0.6 Gy (p < 0.001), treated lung V20Gy by 2.4% (p = 0.003), esophageal dose to 5cc by 2.0 Gy (p = 0.003), and maximum heart dose by 3.2 Gy (p = 0.009). The model-estimated mean risks of 11% for pneumonitis and 12% for esophagitis without gating decreased upon GW40–60 to 7% and 9%, respectively. For the highest-risk patient, gating reduced the pneumonitis risk from 43% to 32%. Gating is most beneficial for patients with high-toxicity risks. Pre-treatment toxicity risk assessment may help optimize patient selection for gating, as well as GW selection for individual patients.
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Wei Z, Peng X, Wang Y, Yang L, He L, Liu Z, Wang J, Mu X, Li R, Xiao J. Influence of target dose heterogeneity on dose sparing of normal tissue in peripheral lung tumor stereotactic body radiation therapy. Radiat Oncol 2021; 16:167. [PMID: 34461954 PMCID: PMC8404286 DOI: 10.1186/s13014-021-01891-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/17/2021] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To evaluate the influence of target dose heterogeneity on normal tissue dose sparing for peripheral lung tumor stereotactic body radiation therapy (SBRT). METHODS Based on the volumetric-modulated arc therapy (VMAT) technique, three SBRT plans with homogeneous, moderate heterogeneous, and heterogeneous (HO, MHE, and HE) target doses were compared in 30 peripheral lung tumor patients. The prescription dose was 48 Gy in 4 fractions. Ten rings outside the PTV were created to limit normal tissue dosage and evaluate dose falloff. RESULTS When MHE and HE plans were compared to HO plans, the conformity index of the PTV was increased by approximately 0.08. The median mean lung dose (MLD), V5, V10, V20 of whole lung, D2%, D1cc, D2cc of the rib, V30 of the rib, D2% and the maximum dose (Dmax) of the skin, and D2% and Dmax of most mediastinal organs at risk (OARs) and spinal cord were reduced by up to 4.51 Gy or 2.8%. Analogously, the median Dmax, D2% and mean dose of rings were reduced by 0.71 to 8.46 Gy; and the median R50% and D2cm were reduced by 2.1 to 2.3 and 7.4% to 8.0%, respectively. Between MHE and HE plans there was little to no difference in OARs dose and dose falloff beyond the target. Furthermore, the dose sparing of rib V30 and the mean dose of rings were negatively correlated with the rib and rings distance from tumor, respectively. CONCLUSIONS For peripheral lung tumor SBRT, target conformity, normal tissue dose, and dose falloff around the target could be improved by loosening or abandoning homogeneity. While there was negligible further dose benefit for the maximum target dose above 125% of the prescription, dose sparing of normal tissue derived from a heterogeneous target decreased as the distance from the tumor increased.
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Affiliation(s)
- Zhigong Wei
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingchen Peng
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Wang
- School of Computer Science, Sichuan University, Chengdu, 610000, China
| | - Lianlian Yang
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ling He
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zheran Liu
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jingjing Wang
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoli Mu
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ruidan Li
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jianghong Xiao
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China.
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8
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Kapitanova I, Biswas S, Divekar S, Kemmerer EJ, Rostock RA, Forster KM, Grimm RJ, Scofield CJ, Grimm J, Emami B, Mahadevan A. Estimating the tolerance of brachial plexus to hypofractionated stereotactic body radiotherapy: a modelling-based approach from clinical experience. Radiat Oncol 2021; 16:98. [PMID: 34098991 PMCID: PMC8186142 DOI: 10.1186/s13014-021-01822-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 05/19/2021] [Indexed: 12/01/2022] Open
Abstract
Background Brachial plexopathy is a potentially serious complication from stereotactic body radiation therapy (SBRT) that has not been widely studied. Therefore, we compared datasets from two different institutions and generated a brachial plexus dose–response model, to quantify what dose constraints would be needed to minimize the effect on normal tissue while still enabling potent therapy for the tumor.
Methods Two published SBRT datasets were pooled and modeled from patients at Indiana University and the Richard L. Roudebush Veterans Administration Medical Center from 1998 to 2007, as well as the Karolinska Institute from 2008 to 2013. All patients in both studies were treated with SBRT for apically located lung tumors localized superior to the aortic arch. Toxicities were graded according to Common Terminology Criteria for Adverse Events, and a probit dose response model was created with maximum likelihood parameter fitting. Results This analysis includes a total of 89 brachial plexus maximum point dose (Dmax) values from both institutions. Among the 14 patients who developed brachial plexopathy, the most common complications were grade 2, comprising 7 patients. The median follow-up was 30 months (range 6.1–72.2) in the Karolinska dataset, and the Indiana dataset had a median of 13 months (range 1–71). Both studies had a median range of 3 fractions, but in the Indiana dataset, 9 patients were treated in 4 fractions, and the paper did not differentiate between the two, so our analysis is considered to be in 3–4 fractions, one of the main limitations. The probit model showed that the risk of brachial plexopathy with Dmax of 26 Gy in 3–4 fractions is 10%, and 50% with Dmax of 70 Gy in 3–4 fractions. Conclusions This analysis is only a preliminary result because more details are needed as well as additional comprehensive datasets from a much broader cross-section of clinical practices. When more institutions join the QUANTEC and HyTEC methodology of reporting sufficient details to enable data pooling, our field will finally reach an improved understanding of human dose tolerance.
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Affiliation(s)
- Irina Kapitanova
- Department of Psychiatry, Mount Sinai St. Luke's Hospital, New York, NY, USA
| | - Sharmi Biswas
- Department of Pediatric Nephrology, Weill Cornell Medicine, New York, NY, USA
| | - Sabrina Divekar
- Sackler School of Medicine, Tel Aviv University, New York, NY, USA
| | - Eric J Kemmerer
- Department of Radiation Oncology, Geisinger Cancer Institute, 100 N Academy Ave, Danville, PA, 17822, USA
| | - Robert A Rostock
- Department of Radiation Oncology, Geisinger Cancer Institute, 100 N Academy Ave, Danville, PA, 17822, USA
| | - Kenneth M Forster
- Department of Radiation Oncology, Geisinger Cancer Institute, 100 N Academy Ave, Danville, PA, 17822, USA
| | - Rachel J Grimm
- Department of Radiation Oncology, Thomas Jefferson Hospital, Philadelphia, PA, USA
| | - Carla J Scofield
- Department of Radiation Oncology, Geisinger Cancer Institute, 100 N Academy Ave, Danville, PA, 17822, USA
| | - Jimm Grimm
- Department of Radiation Oncology, Geisinger Cancer Institute, 100 N Academy Ave, Danville, PA, 17822, USA. .,Department of Medical Imaging and Radiation Sciences, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Bahman Emami
- Department of Radiation Oncology, Loyola University Medical Center, Chicago, IL, USA
| | - Anand Mahadevan
- Department of Radiation Oncology, Geisinger Cancer Institute, 100 N Academy Ave, Danville, PA, 17822, USA
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Moraes FY, Chen X, Yan M, Spratt DE, Redmond K, Jackson WC, Yamada YJ. Evolving Role of Stereotactic Body Radiation Therapy in the Management of Spine Metastases: Defining Dose and Dose Constraints. Neurosurg Clin N Am 2020; 31:167-189. [PMID: 32147009 DOI: 10.1016/j.nec.2019.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
When treating solid tumor spine metastases, stereotactic high-dose-per-fraction radiation, given in a single fraction or in a hypofractionated approach, has proved to be a highly effective and safe therapeutic option for any tumor histology, in the setting of de novo therapy, as salvage treatment of local progression after previous radiation, and in the postoperative setting. There are variations in practice based on the clinical presentation, goals of therapy, as well as institutional preferences. As a biologically potent therapy, a thoughtful and careful attention to detail with patient selection, treatment planning, and delivery is crucial for treatment success.
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Affiliation(s)
- Fabio Y Moraes
- Department of Oncology, Division of Radiation Oncology, Queen's University, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Xuguang Chen
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Yan
- Department of Oncology, Division of Radiation Oncology, Queen's University, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Kristen Redmond
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - William C Jackson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Yoshiya Josh Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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10
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Loi M, Nuyttens JJ, Desideri I, Greto D, Livi L. Single-Fraction Radiotherapy (SFRT) For Bone Metastases: Patient Selection And Perspectives. Cancer Manag Res 2019; 11:9397-9408. [PMID: 31807069 PMCID: PMC6842277 DOI: 10.2147/cmar.s186630] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/22/2019] [Indexed: 01/02/2023] Open
Abstract
Bone metastases are a frequent and important source of morbidity in cancer patients. Stereotactic body radiation therapy (SBRT) is an established treatment option for local control and pain relief of bone metastases, and it is increasingly used as upfront treatment, postoperative consolidation or salvage treatment after prior RT. However, heterogeneity of dose schedules described in literature represents a severe limitation in the definition of the role of SBRT as a standard of care. No consensus is available on the use of single versus multiple fraction SBRT for bone metastases. Advantages of single-fraction SBRT include shorter overall duration of treatment, absence of inter-fraction uncertainty, improved compliance, theoretical increased efficacy, and lower costs. However, caution has been advised due to reports of severe late toxicities, in particular, vertebral collapse fracture (VCF). The aim of this paper is to review dose fractionation and indications for the management of bone metastases using SBRT.
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Affiliation(s)
- Mauro Loi
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Joost J Nuyttens
- Radiotherapy Department, Erasmus MC Cancer Center, Rotterdam, The Netherlands
| | - Isacco Desideri
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Daniela Greto
- Radiotherapy Department, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Radiotherapy Department, University of Florence, Florence, Italy
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11
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Milano MT, Mihai A, Kang J, Singh DP, Verma V, Qiu H, Chen Y, Kong FM(S. Stereotactic body radiotherapy in patients with multiple lung tumors: a focus on lung dosimetric constraints. Expert Rev Anticancer Ther 2019; 19:959-969. [DOI: 10.1080/14737140.2019.1686980] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Michael T. Milano
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Alina Mihai
- Department of Radiation Oncology, Beacon Hospital, Beacon Court, Dublin, Ireland
| | - John Kang
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Deepinder P Singh
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Vivek Verma
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Haoming Qiu
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Yuhchyau Chen
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
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12
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Duijm M, van der Voort van Zyp NC, van de Vaart P, Oomen-de Hoop E, Mast ME, Hoogeman MS, Nuyttens JJ. Predicting High-Grade Esophagus Toxicity After Treating Central Lung Tumors With Stereotactic Radiation Therapy Using a Normal Tissue Complication Probability Model. Int J Radiat Oncol Biol Phys 2019; 106:73-81. [PMID: 31499137 DOI: 10.1016/j.ijrobp.2019.08.059] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE The treatment of central lung tumors with stereotactic body radiation therapy (SBRT) is challenged by the risk of excessive esophageal toxicity. To improve clinical decision making, we aimed to derive normal tissue complication probability (NTCP) models in a patient cohort with central lung tumors treated with SBRT and to evaluate the currently used esophagus dose constraints. METHODS AND MATERIALS Patients with a central lung tumor who received SBRT (8 fractions of 7.5 Gy or 12 fractions of 5 Gy) were included. Doses were recalculated to an equivalent dose of 2 Gy with an α/β-ratio of 10 Gy for acute and 3 Gy for late toxicity (the cut-off was 3 months). The esophagus was manually delineated. NTCP modeling based on logistic regression was used to relate dose-volume histogram parameters (Dmax, D1cc, D2cc, D5cc) to acute and late toxicity. Parameters with a P < .05 were included in the model. Based on the NTCP models, we determined the probability of toxicity for the currently used dose constraints: D1cc ≤40 Gy for 8 fractions and D1cc ≤48 Gy for 12 fractions. RESULTS For this study, 188 patients with 203 tumors were eligible. Esophagus toxicity occurred in 33 patients (18%). Late high-grade toxicity consisted of 2 possible treatment-related deaths (grade 5) and 2 patients with grade 3 toxicity. Acute toxicity consisted of only grade 1 (n = 19) and grade 2 toxicity (n = 10). All investigated dose-volume histogram parameters were significantly correlated to acute and late toxicity. The probability of late high-grade toxicity is 1.1% for 8 fractions and 1.4% for 12 fractions when applying the current dose constraints. CONCLUSIONS High-grade esophageal toxicity occurred in 2.1% of the patients, including 2 possible treatment-related deaths. The currently used dose constraints correspond to a low risk of high-grade toxicity.
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Affiliation(s)
- Marloes Duijm
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | | | - Paul van de Vaart
- Department of Radiation Oncology, Haaglanden MC, The Hague, The Netherlands
| | - Esther Oomen-de Hoop
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Mirjam E Mast
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Mischa S Hoogeman
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Joost J Nuyttens
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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13
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Kong FMS, Moiseenko V, Zhao J, Milano MT, Li L, Rimner A, Das S, Li XA, Miften M, Liao Z, Martel M, Bentzen SM, Jackson A, Grimm J, Marks LB, Yorke E. Organs at Risk Considerations for Thoracic Stereotactic Body Radiation Therapy: What Is Safe for Lung Parenchyma? Int J Radiat Oncol Biol Phys 2018; 110:172-187. [PMID: 30496880 DOI: 10.1016/j.ijrobp.2018.11.028] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 11/09/2018] [Accepted: 11/14/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Stereotactic body radiation therapy (SBRT) has become the standard of care for inoperable early-stage non-small cell lung cancer and is often used for recurrent lung cancer and pulmonary metastases. Radiation-induced lung toxicity (RILT), including radiation pneumonitis and pulmonary fibrosis, is a major concern for which it is important to understand dosimetric and clinical predictors. METHODS AND MATERIALS This study was undertaken through the American Association of Physicists in Medicine's Working Group on Biological Effects of Stereotactic Body Radiotherapy. Data from studies of lung SBRT published through the summer of 2016 that provided detailed information about RILT were analyzed. RESULTS Ninety-seven studies were ultimately considered. Definitions of the risk organ and complication endpoints as well as dose-volume information presented varied among studies. The risk of RILT, including radiation pneumonitis and pulmonary fibrosis, was reported to be associated with the size and location of the tumor. Patients with interstitial lung disease appear to be especially susceptible to severe RILT. A variety of dosimetric parameters were reported to be associated with RILT. There was no apparent threshold "tolerance dose-volume" level. However, most studies noted safe treatment with a rate of symptomatic RILT of <10% to 15% after lung SBRT with a mean lung dose (MLD) of the combined lungs ≤8 Gy in 3 to 5 fractions and the percent of total lung volume receiving more than 20 Gy (V20) <10% to 15%. CONCLUSIONS To allow more rigorous analysis of this complication, future studies should standardize reporting by including standardized endpoint and volume definitions and providing dose-volume information for all patients, with and without RILT.
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Affiliation(s)
- Feng-Ming Spring Kong
- University Hospitals/Seidman Cancer Center and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio.
| | | | - Jing Zhao
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Ling Li
- Fudan University Cancer Hospital, Shanghai, China
| | - Andreas Rimner
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shiva Das
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - X Allen Li
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | | | - Soren M Bentzen
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Andrew Jackson
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jimm Grimm
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Lawrence B Marks
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ellen Yorke
- Memorial Sloan Kettering Cancer Center, New York, New York
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14
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Yau V, Lindsay P, Le L, Lau A, Wong O, Glick D, Bezjak A, Cho BJ, Hope A, Sun A, Giuliani M. Low Incidence of Esophageal Toxicity After Lung Stereotactic Body Radiation Therapy: Are Current Esophageal Dose Constraints Too Conservative? Int J Radiat Oncol Biol Phys 2018; 101:574-580. [DOI: 10.1016/j.ijrobp.2018.02.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/08/2018] [Accepted: 02/14/2018] [Indexed: 01/15/2023]
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15
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Esophagus toxicity after stereotactic and hypofractionated radiotherapy for central lung tumors: Normal tissue complication probability modeling. Radiother Oncol 2018; 127:233-238. [PMID: 29478763 DOI: 10.1016/j.radonc.2018.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/26/2018] [Accepted: 02/05/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE To correlate esophagus toxicity and dose-volume histogram (DVH) parameters in order to assess risks, and derive a Normal Tissue Complication Probability (NTCP) model. METHODS AND MATERIALS Patients with a central lung tumor from 2 centers, who underwent stereotactic or hypofractionated radiotherapy (≤12 fractions), were analyzed. Doses were recalculated to an equivalent dose of 2 Gy with an α/β ratio of 10 (EQD210). The esophagus was manually delineated and DVH-parameters (Dmax,EQD2, D1cc,EQD2, D2cc,EQD2, D5cc,EQD2) were analyzed and used for NTCP modeling based on logistic regression analysis. RESULTS Two-hundred-and-thirty-one patients with 252 tumors were eligible. No acute or late grade 3-5 esophageal toxicity was reported. Acute grade 1-2 esophagus toxicity was recorded in 38 patients (17%). All DVH-parameters were significantly higher in patients with toxicity. NTCP models showed a 50% probability of acute grade 1-2 toxicity at a Dmax of 67 Gy EQD210 and D1cc of 42 Gy EQD210. No difference in overall survival was observed between patients with and without toxicity (p = 0.428). CONCLUSION As no grade 3-5 esophageal toxicity was observed in our cohort, a Dmax of 56 Gy EQD210 and a D5cc of 35.5 Gy EQD210 could be delivered without high risks of severe toxicity. The NTCP models of this study might be used as practical guidelines for the treatment of central lung tumors with stereotactic radiotherapy.
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16
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Bang A, Bezjak A. Stereotactic body radiotherapy for centrally located stage I non-small cell lung cancer. Transl Lung Cancer Res 2018; 8:58-69. [PMID: 30788235 DOI: 10.21037/tlcr.2018.10.07] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Stereotactic body radiotherapy (SBRT) has become the standard of care for the treatment of early stage non-small cell lung cancer in high risk or medically inoperable patients. It is very well tolerated when given to peripherally located tumors and is associated with high rates of local control. Centrally located tumors represent a bigger challenge as they are closer to a number of critical structures, namely the major bronchi, esophagus, large vessels and brachial plexus, that can be damaged by the high ablative doses of SBRT needed for optimal tumor control. Thus, the fractionation schedule for centrally located tumors needs to balance the need for tumor control while minimizing the risk of significant radiotherapy toxicity. In this article, we review the current evidence, summarize the prospective and retrospective studies of SBRT for centrally located tumors, and highlight several practical considerations.
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Affiliation(s)
- Andrew Bang
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Andrea Bezjak
- Department of Radiation Oncology, University of Toronto, Toronto, Canada.,Radiation Medicine Program, Princess Margaret Cancer Centre/University Health Network, Toronto, Canada
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17
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D'Andrea M, Strolin S, Ungania S, Cacciatore A, Bruzzaniti V, Marconi R, Benassi M, Strigari L. Radiobiological Optimization in Lung Stereotactic Body Radiation Therapy: Are We Ready to Apply Radiobiological Models? Front Oncol 2018; 7:321. [PMID: 29359121 PMCID: PMC5766682 DOI: 10.3389/fonc.2017.00321] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 12/11/2017] [Indexed: 12/25/2022] Open
Abstract
Lung tumors are often associated with a poor prognosis although different schedules and treatment modalities have been extensively tested in the clinical practice. The complexity of this disease and the use of combined therapeutic approaches have been investigated and the use of high dose-rates is emerging as effective strategy. Technological improvements of clinical linear accelerators allow combining high dose-rate and a more conformal dose delivery with accurate imaging modalities pre- and during therapy. This paper aims at reporting the state of the art and future direction in the use of radiobiological models and radiobiological-based optimizations in the clinical practice for the treatment of lung cancer. To address this issue, a search was carried out on PubMed database to identify potential papers reporting tumor control probability and normal tissue complication probability for lung tumors. Full articles were retrieved when the abstract was considered relevant, and only papers published in English language were considered. The bibliographies of retrieved papers were also searched and relevant articles included. At the state of the art, dose–response relationships have been reported in literature for local tumor control and survival in stage III non-small cell lung cancer. Due to the lack of published radiobiological models for SBRT, several authors used dose constraints and models derived for conventional fractionation schemes. Recently, several radiobiological models and parameters for SBRT have been published and could be used in prospective trials although external validations are recommended to improve the robustness of model predictive capability. Moreover, radiobiological-based functions have been used within treatment planning systems for plan optimization but the advantages of using this strategy in the clinical practice are still under discussion. Future research should be directed toward combined regimens, in order to potentially improve both local tumor control and survival. Indeed, accurate knowledge of the relevant parameters describing tumor biology and normal tissue response is mandatory to correctly address this issue. In this context, the role of medical physicists and the AAPM in the development of radiobiological models is crucial for the progress of developing specific tool for radiobiological-based optimization treatment planning.
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Affiliation(s)
- Marco D'Andrea
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome, Italy
| | - Silvia Strolin
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome, Italy
| | - Sara Ungania
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome, Italy
| | - Alessandra Cacciatore
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome, Italy
| | - Vicente Bruzzaniti
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome, Italy
| | - Raffaella Marconi
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome, Italy
| | - Marcello Benassi
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome, Italy
| | - Lidia Strigari
- Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome, Italy
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18
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De Rose F, Franceschini D, Reggiori G, Stravato A, Navarria P, Ascolese AM, Tomatis S, Mancosu P, Scorsetti M. Organs at risk in lung SBRT. Phys Med 2017; 44:131-138. [PMID: 28433508 DOI: 10.1016/j.ejmp.2017.04.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 03/24/2017] [Accepted: 04/09/2017] [Indexed: 12/23/2022] Open
Abstract
Lung stereotactic body radiotherapy (SBRT) is an accurate and precise technique to treat lung tumors with high 'ablative' doses. Given the encouraging data in terms of local control and toxicity profile, SBRT has currently become a treatment option for both early stage lung cancer and lung oligometastatic disease in patients who are medically inoperable or refuse surgical resection. Dose-adapted fractionation schedules and ongoing prospective trials should provide further evidence of SBRT safety trying to reduce toxicities and complications. In this heterogeneous scenario, a non-systematic review of dose constraints for lung SBRT was performed, including the main organs at risk in the thorax.
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Affiliation(s)
- F De Rose
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Milan, Italy
| | - D Franceschini
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Milan, Italy
| | - G Reggiori
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Milan, Italy
| | - A Stravato
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Milan, Italy.
| | - P Navarria
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Milan, Italy
| | - A M Ascolese
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Milan, Italy
| | - S Tomatis
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Milan, Italy
| | - P Mancosu
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Milan, Italy
| | - M Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Center and Research Hospital, Milan, Italy; Depart ment of Biomedical Sciences, Humanitas University, Milan, Italy
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19
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Cardenas ML, Mazur TR, Tsien CI, Green OL. A rapid, computational approach for assessing interfraction esophageal motion for use in stereotactic body radiation therapy planning. Adv Radiat Oncol 2017; 3:209-215. [PMID: 29904747 PMCID: PMC6000025 DOI: 10.1016/j.adro.2017.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 08/30/2017] [Accepted: 10/03/2017] [Indexed: 01/15/2023] Open
Abstract
Purpose We present a rapid computational method for quantifying interfraction motion of the esophagus in patients undergoing stereotactic body radiation therapy on a magnetic resonance (MR) guided radiation therapy system. Methods and materials Patients who underwent stereotactic body radiation therapy had simulation computed tomography (CT) and on-treatment MR scans performed. The esophagus was contoured on each scan. CT contours were transferred to MR volumes via rigid registration. Digital Imaging and Communications in Medicine files containing contour points were exported to MATLAB. In-plane CT and MR contour points were spline interpolated, yielding boundaries with centroid positions, CCT and CMR. MR contour points lying outside of the CT contour were extracted. For each such point, BMR(j), a segment from CCT intersecting BMR(j), was produced; its intersection with the CT contour, BCT(i), was calculated. The length of the segment Sij, between BCT(i) and BMR(j), was found. The orientation θ was calculated from Sij vector components: θ = arctan[(Sij)y / (Sij)x] A set of segments {Sij} was produced for each slice and binned by quadrant with 0° < θ ≤ 90°, 90° < θ ≤ 180°, 180° < θ ≤ 270°, and 270° < θ ≤ 360° for the left anterior, right anterior, right posterior, and left posterior quadrants, respectively. Slices were binned into upper, middle, and lower esophageal (LE) segments. Results Seven patients, each having 3 MR scans, were evaluated, yielding 1629 axial slices and 84,716 measurements. The LE segment exhibited the greatest magnitude of motion. The mean LE measurements in the left anterior, left posterior, right anterior, and right posterior were 5.2 ± 0.07 mm, 6.0 ± 0.09 mm, 4.8 ± 0.08 mm, and 5.1 ± 0.08 mm, respectively. There was considerable interpatient variability. Conclusions The LE segment exhibited the greatest magnitude of mobility compared with the middle and upper esophageal segments. A novel computational method enables personalized, nonuniform esophageal margins to be tailored to individual patients.
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Affiliation(s)
| | | | | | - Olga L Green
- Washington University in St. Louis, St. Louis, Missouri
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20
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Lacornerie T, Rio E, Mahé MA. [Stereotactic body radiation therapy for hepatic malignancies: Organs at risk, uncertainties margins, doses]. Cancer Radiother 2017; 21:574-579. [PMID: 28844506 DOI: 10.1016/j.canrad.2017.07.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 07/20/2017] [Accepted: 07/22/2017] [Indexed: 11/30/2022]
Abstract
Stereotactic body radiation therapy for primary and metastatic hepatic malignancies can be performed in association and/or as an alternative to surgery and radiofrequency. The consequences of the great number of techniques available are heterogeneity in contouring, dose prescription and in determination of dose constraints for organs at risk. The objective of this paper is to improve the quality and safety and to help the diffusion of this technique for a majority of patients. In 2016, the French Society of Radiation Oncology (SFRO) published guidelines for external radiotherapy and brachytherapy ("Recorad"). This paper is an update of these recommendations considering recent publications.
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Affiliation(s)
- T Lacornerie
- Service de physique médicale, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59020 Lille, France.
| | - E Rio
- Service de radiothérapie, institut de cancérologie de l'Ouest René-Gauducheau, boulevard Professeur-Jacques-Monod, 44805 Saint-Herblain, France
| | - M-A Mahé
- Service de radiothérapie, institut de cancérologie de l'Ouest René-Gauducheau, boulevard Professeur-Jacques-Monod, 44805 Saint-Herblain, France
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21
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Pham AHN, Yorke E, Rimner A, Wu AJC. Potential for Interfraction Motion to Increase Esophageal Toxicity in Lung SBRT. Technol Cancer Res Treat 2017; 16:935-943. [PMID: 28573929 PMCID: PMC5640496 DOI: 10.1177/1533034617711353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Purpose: To characterize the effect of the relative motion of esophagus and tumor on radiation doses to the esophagus in patients treated with stereotactic body radiation therapy for central lung tumors. Methods and Materials: Fifty fractions of stereotactic body radiation therapy in 10 patients with lung tumors within 2.5 cm of the esophagus were reviewed. The esophagus was delineated on each treatment’s cone-beam computed tomography scan and compared to its position on the planning scan. Dose–volume histograms were calculated using the original treatment beams to determine the actual dose delivered to the esophagus for each fraction of stereotactic body radiation therapy. Results: Median interfraction right–left shift of the esophagus was 0.9 mm (range, −5.4 to 3.3 mm) toward the left. Median interfraction anteroposterior shift was 0.7 mm (range, −3.7 to 11.5 mm) posteriorly. The median percentage increase in dose to 1 cm3, dose to 3.5 cm3, and dose to 5 cm3 was 1.7%, 5.6%, and 6.6%, respectively. Two cases of significant late esophageal toxicity were observed, with change in esophageal position relative to the planning target volume resulting in significantly higher D5cc values than anticipated. Conclusion: Interfraction shifts between the internal target volume and esophagus can lead to unanticipated increases in the volume of esophagus receiving high doses when treating central lung tumors with stereotactic body radiation therapy. Certain practical steps, such as considering deep breath hold for internal target volume reduction, using a planning risk volume for esophagus, and carefully visualizing and considering esophageal position at the time of stereotactic body radiation therapy, can be taken to minimize unanticipated dose increases that could cause unexpected esophageal toxicity.
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Affiliation(s)
- Anthony Hoai-Nam Pham
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Ellen Yorke
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Andreas Rimner
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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22
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Pollom EL, Chin AL, Diehn M, Loo BW, Chang DT. Normal Tissue Constraints for Abdominal and Thoracic Stereotactic Body Radiotherapy. Semin Radiat Oncol 2017; 27:197-208. [PMID: 28577827 DOI: 10.1016/j.semradonc.2017.02.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Although stereotactic body radiotherapy (SBRT) or stereotactic ablative radiotherapy has become an established standard of care for the treatment of a variety of malignancies, our understanding of normal tissue dose tolerance with extreme hypofractionation remains immature. Since Timmerman initially proposed normal tissue dose constraints for SBRT in the 2008 issue of Seminars of Radiation Oncology, experience with SBRT has grown, and more long-term clinical outcome data have been reported. This article reviews the modern toxicity literature and provides updated clinically practical and useful recommendations of SBRT dose constraints for extracranial sites. We focus on the major organs of the thoracic and upper abdomen, specifically the liver and the lung.
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Affiliation(s)
- Erqi L Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Alexander L Chin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Daniel T Chang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA.
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23
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Pasquier D, Martinage G, Mirabel X, Lacornerie T, Makhloufi S, Faivre JC, Thureau S, Lartigau É. Radiothérapie stéréotaxique des métastases osseuses vertébrales. Cancer Radiother 2016; 20:500-7. [DOI: 10.1016/j.canrad.2016.07.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 07/13/2016] [Indexed: 12/11/2022]
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24
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Adebahr S, Schimek-Jasch T, Nestle U, Brunner TB. Oesophagus side effects related to the treatment of oesophageal cancer or radiotherapy of other thoracic malignancies. Best Pract Res Clin Gastroenterol 2016; 30:565-80. [PMID: 27644905 DOI: 10.1016/j.bpg.2016.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 07/20/2016] [Indexed: 01/31/2023]
Abstract
The oesophagus as a serial organ located in the central chest is frequent subject to "incidental" dose application in radiotherapy for several thoracic malignancies including oesophageal cancer itself. Especially due to the radiosensitive mucosa severe radiotherapy induced sequelae can occur, acute oesophagitis and strictures as late toxicity being the most frequent side-effects. In this review we focus on oesophageal side effects derived from treatment of gastrointestinal cancer and secondly provide an overview on oesophageal toxicity from conventional and stereotactic fractionated radiotherapy to the thoracic area in general. Available data on pathogenesis, frequency, onset, and severity of oesophageal side effects are summarized. Whereas for conventional radiotherapy the associations of applied doses to certain volumes of the oesophagus are well described, the tolerance dose to the mediastinal structures for hypofractionated therapy is unknown. The review provides available attempts to predict the risk of oesophageal side effects from dosimetric parameters of SBRT.
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Affiliation(s)
- Sonja Adebahr
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Germany.
| | - Tanja Schimek-Jasch
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Ursula Nestle
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Germany
| | - Thomas B Brunner
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Germany.
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25
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Blanck O, Ipsen S, Chan MK, Bauer R, Kerl M, Hunold P, Jacobi V, Bruder R, Schweikard A, Rades D, Vogl TJ, Kleine P, Bode F, Dunst J. Treatment Planning Considerations for Robotic Guided Cardiac Radiosurgery for Atrial Fibrillation. Cureus 2016; 8:e705. [PMID: 27588226 PMCID: PMC4999353 DOI: 10.7759/cureus.705] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose Robotic guided stereotactic radiosurgery has recently been investigated for the treatment of atrial fibrillation (AF). Before moving into human treatments, multiple implications for treatment planning given a potential target tracking approach have to be considered. Materials & Methods Theoretical AF radiosurgery treatment plans for twenty-four patients were generated for baseline comparison. Eighteen patients were investigated under ideal tracking conditions, twelve patients under regional dose rate (RDR = applied dose over a certain time window) optimized conditions (beam delivery sequence sorting according to regional beam targeting), four patients under ultrasound tracking conditions (beam block of the ultrasound probe) and four patients with temporary single fiducial tracking conditions (differential surrogate-to-target respiratory and cardiac motion). Results With currently known guidelines on dose limitations of critical structures, treatment planning for AF radiosurgery with 25 Gy under ideal tracking conditions with a 3 mm safety margin may only be feasible in less than 40% of the patients due to the unfavorable esophagus and bronchial tree location relative to the left atrial antrum (target area). Beam delivery sequence sorting showed a large increase in RDR coverage (% of voxels having a larger dose rate for a given time window) of 10.8-92.4% (median, 38.0%) for a 40-50 min time window, which may be significant for non-malignant targets. For ultrasound tracking, blocking beams through the ultrasound probe was found to have no visible impact on plan quality given previous optimal ultrasound window estimation for the planning CT. For fiducial tracking in the right atrial septum, the differential motion may reduce target coverage by up to -24.9% which could be reduced to a median of -0.8% (maximum, -12.0%) by using 4D dose optimization. The cardiac motion was also found to have an impact on the dose distribution, at the anterior left atrial wall; however, the results need to be verified. Conclusion Robotic AF radiosurgery with 25 Gy may be feasible in a subgroup of patients under ideal tracking conditions. Ultrasound tracking was found to have the lowest impact on treatment planning and given its real-time imaging capability should be considered for AF robotic radiosurgery. Nevertheless, advanced treatment planning using RDR or 4D respiratory and cardiac dose optimization may be still advised despite using ideal tracking methods.
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Affiliation(s)
- Oliver Blanck
- Department for Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany ; Saphir Radiosurgery Center, Frankfurt and Güstrow, Germany
| | - Svenja Ipsen
- Robotics and Cognitive Systems, University of Lübeck
| | - Mark K Chan
- Department for Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany ; Department for Radiation Oncology, Tuen Mun Hospital, Hong Kong, Hong Kong
| | - Ralf Bauer
- Institute for Diagnostics and Interventional Radiology, University Clinic Frankfurt, Germany ; Department for Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Switzerland
| | - Matthias Kerl
- Institute for Diagnostics and Interventional Radiology, University Clinic Frankfurt, Germany ; Radiology, Darmstadt, Germany
| | - Peter Hunold
- Clinic for Radiology and Nuclear Medicine, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| | - Volkmar Jacobi
- Institute for Diagnostics and Interventional Radiology, University Clinic Frankfurt, Germany
| | - Ralf Bruder
- Institute for Robotics and Cognitive Systems, University of Lubeck
| | - Achim Schweikard
- Institute for Robotics and Cognitive Systems, University of Luebeck, Institute for Robotics and Cognitive Systems, University of Lubeck
| | - Dirk Rades
- Department for Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany
| | - Thomas J Vogl
- Institute for Diagnostics and Interventional Radiology, University Clinic Frankfurt, Germany
| | - Peter Kleine
- Department for Thoracic, Cardiac and Thoracic Vascular Surgery, University Clinic Frankfurt, Germany
| | - Frank Bode
- Cardiology Department, Sana Clinic Oldenburg in Holstein
| | - Jürgen Dunst
- Department for Radiation Oncology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany ; Department for Radiation Oncology, University Medical Center Copenhagen, Denmark
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