1
|
Torelli N, Papp D, Unkelbach J. Spatiotemporal fractionation schemes for stereotactic radiosurgery of multiple brain metastases. Med Phys 2023; 50:5095-5114. [PMID: 37318898 DOI: 10.1002/mp.16457] [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: 07/05/2022] [Revised: 04/03/2023] [Accepted: 04/13/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) is an established treatment for patients with brain metastases (BMs). However, damage to the healthy brain may limit the tumor dose for patients with multiple lesions. PURPOSE In this study, we investigate the potential of spatiotemporal fractionation schemes to reduce the biological dose received by the healthy brain in SRS of multiple BMs, and also demonstrate a novel concept of spatiotemporal fractionation for polymetastatic cancer patients that faces less hurdles for clinical implementation. METHODS Spatiotemporal fractionation (STF) schemes aim at partial hypofractionation in the metastases along with more uniform fractionation in the healthy brain. This is achieved by delivering distinct dose distributions in different fractions, which are designed based on their cumulative biologically effective dose (BED α / β ${\rm{BED}}_{{{\alpha}}/{{\beta}}}$ ) such that each fraction contributes with high doses to complementary parts of the target volume, while similar dose baths are delivered to the normal tissue. For patients with multiple brain metastases, a novel constrained approach to spatiotemporal fractionation (cSTF) is proposed, which is more robust against setup and biological uncertainties. The approach aims at irradiating entire metastases with possibly different doses, but spatially similar dose distributions in every fraction, where the optimal dose contribution of every fraction to each metastasis is determined using a new planning objective to be added to the BED-based treatment plan optimization problem. The benefits of spatiotemporal fractionation schemes are evaluated for three patients, each with >25 BMs. RESULTS For the same tumor BED10 and the same brain volume exposed to high doses in all plans, the mean brain BED2 can be reduced compared to uniformly fractionated plans by 9%-12% with the cSTF plans and by 13%-19% with the STF plans. In contrast to the STF plans, the cSTF plans avoid partial irradiation of the individual metastases and are less sensitive to misalignments of the fractional dose distributions when setup errors occur. CONCLUSION Spatiotemporal fractionation schemes represent an approach to lower the biological dose to the healthy brain in SRS-based treatments of multiple BMs. Although cSTF cannot achieve the full BED reduction of STF, it improves on uniform fractionation and is more robust against both setup errors and biological uncertainties related to partial tumor irradiation.
Collapse
Affiliation(s)
- Nathan Torelli
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Dávid Papp
- Department of Mathematics, North Carolina State University, North Carolina, Raleigh, USA
| | - Jan Unkelbach
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| |
Collapse
|
2
|
Mohamed Yoosuf AB, Alshehri S, Abdul Aziz MZ, Mansor S, Appalanaido GK, Alqathami M. Effectiveness of Robotic Stereotactic Radiotherapy in Patients Undergoing Re-irradiation: A Review. Cureus 2023; 15:e43500. [PMID: 37719625 PMCID: PMC10500384 DOI: 10.7759/cureus.43500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Stereotactic ablative radiotherapy (SABR) is a possible treatment option for patients who develop recurrence within or at the edge of a previously irradiated volume. Robotic stereotactic radiotherapy is the result of technological advances in robotic precision, real-time imaging, non-invasive, highly customizable treatment plan, and delivery with sub-millimeter accuracy. This article reviews the radiobiologic, technical, and clinical aspects of robotic-based SABR re-irradiation for various anatomical sites. An extensive literature search was performed to identify articles on the utilization of robotic stereotactic radiotherapy for patients undergoing re-irradiation. The reported prescription dose and fractionation data along with outcomes such as overall survival, local control rates, and toxicities were qualitatively reviewed. The findings consistently indicate that re-irradiation using robotic SABR provides encouraging survival rates with minimal toxicity in the clinical setting of various anatomical sites delivered using locally non-invasive means where other treatment options are scarce.
Collapse
Affiliation(s)
- Ahamed Badusha Mohamed Yoosuf
- Oncology, King Abdullah International Medical Research Center, Riyadh, SAU
- Oncology/Radiation Oncology, King Abdulaziz Medical City, Riyadh, SAU
| | - Salem Alshehri
- Radiation Oncology, King Abdulaziz Medical City, Riyadh, SAU
- Oncology, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Mohd Zahri Abdul Aziz
- Advanced Management of Liver Malignancies Program, Universiti Sains Malaysia, Advanced Medical and Dental Institute, Penang, MYS
| | - Syahir Mansor
- Advanced Management of Liver Malignancies Program, Universiti Sains Malaysia, Advanced Medical and Dental Institute, Penang, MYS
- Nuclear Medicine Unit, Pusat Perubatan Universiti Sains Malaysia, Advanced Medical and Dental Institute, Penang, MYS
| | - Gokula Kumar Appalanaido
- Advanced Management of Liver Malignancies Program, Universiti Sains Malaysia, Advanced Medical and Dental Institute, Penang, MYS
- Radiotherapy Unit, Pusat Perubatan Universiti Sains Malaysia, Advanced Medical and Dental Institute, Penang, MYS
| | - Mamdouh Alqathami
- Department of Oncology, Ministry of National Guard, Health Affairs, Riyadh, SAU
- Clinical Research, King Abdullah International Medical Research Center, Riyadh, SAU
- Radiological Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| |
Collapse
|
3
|
Mohamed Yoosuf AB, Ajmal Khan M, Abdul Aziz MZ, Mansor S, Appalanaido GK, Alshehri S, Alqathami M. Re-irradiation Using Stereotactic Radiotherapy: A Bibliometric Analysis of Research Trends. Cureus 2023; 15:e39600. [PMID: 37384098 PMCID: PMC10297819 DOI: 10.7759/cureus.39600] [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] [Accepted: 05/27/2023] [Indexed: 06/30/2023] Open
Abstract
The objective of this research is to conduct a comprehensive bibliometric analysis using the Web of Science Core Collection (WoSCC) to examine the current research topics and trends pertaining to stereotactic-based re-irradiation. A bibliometric search was conducted for re-irradiation-related literature published in English from the WoSCC database from 1991 to 2022, using VOSviewer to visualize the results. The extracted information comprises the publication year, overall citation count, average citation rate, keywords, and research domains. We conducted a literature review to identify trends in research on re-irradiation. A total of 19,891 citations were found in 924 qualifying papers that came from 48 different nations. The number of publications and citations has grown steadily since 2008 with the highest number of publications in the year 2018. Similarly, a substantial increase in the number of citations has increased since 2004 and the citation growth rate has been positive between 2004 and 2019 with a peak in 2013. The top authorship patterns were six authors (111 publications and 2498 citations), whereas the highest number of citations per publication was attained with an authorship pattern of 17 authors (C/P = 41.1). The collaboration patterns analysis showed that the largest proportion of publications emanated from the United States with 363 publications (30.9%), followed by Germany with 102 publications (8.7%), and France with 92 publications (7.8%). The majority of the analyzed studies were focused on the brain (30%), head and neck (13%), lung (12%), and spine (10%) and there have been emerging studies on the use of re-irradiation for lung, prostate, pelvic and liver utilizing stereotactic radiotherapy. The main areas of interest have changed over time and are now based on a multidisciplinary approach that integrates advanced imaging techniques, stereotactic treatment delivery, the toxicity of organs at risk, quality of life, and treatment outcomes.
Collapse
Affiliation(s)
- Ahamed Badusha Mohamed Yoosuf
- Oncology, King Abdullah International Medical Research Center, Riyadh, SAU
- Department of Radiation Oncology, Ministry of National Guard-Health Affairs, Riyadh, SAU
| | - Muhammad Ajmal Khan
- Library and Health Science, Imam Abdulrehman Bin Faisal University, Dammam, SAU
| | - Mohd Zahri Abdul Aziz
- Advanced Management of Liver Malignancies Program, Universiti Sains Malaysia/Advanced Medical and Dental Institute, Penang, MYS
| | - Syahir Mansor
- Advanced Management of Liver Malignancies Program, Universiti Sains Malaysia/Advanced Medical and Dental Institute, Penang, MYS
- Nuclear Medicine Unit, Pusat Perubatan Universiti Sains Malaysia/Advanced Medical and Dental Institute, Penang, MYS
| | - Gokula Kumar Appalanaido
- Advanced Management of Liver Malignancies Program, Universiti Sains Malaysia/Advanced Medical and Dental Institute, Penang, MYS
- Radiotherapy Unit, Pusat Perubatan Universiti Sains Malaysia/Advanced Medical and Dental Institute, Penang, MYS
| | - Salem Alshehri
- Department of Radiation Oncology, Ministry of National Guard-Health Affairs, Riyadh, SAU
- Oncology, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Mamdouh Alqathami
- Department of Radiation Oncology, Ministry of National Guard-Health Affairs, Riyadh, SAU
- Oncology, King Abdullah International Medical Research Center, Riyadh, SAU
- Medical Physics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| |
Collapse
|
4
|
Nieder C, Aanes SG, Haukland E. Primary systemic therapy for patients with brain metastases from lung cancer ineligible for targeted agents. J Cancer Res Clin Oncol 2022; 148:3109-3116. [PMID: 35020043 PMCID: PMC9508211 DOI: 10.1007/s00432-022-03919-0] [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: 11/07/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022]
Abstract
Purpose The purpose of this study was to evaluate overall survival after systemic therapy, largely chemotherapy, in patients with small cell or non-small cell lung cancer and brain metastases. After completion of systemic therapy, some patients received planned brain irradiation, while others were followed. Methods Retrospective cohort study. Results Thirty-eight patients were included (28 small cell, 20 followed with imaging). Six of these 20 patients (30%) received delayed radiotherapy during follow-up. Planned radiotherapy (n = 18, intention-to-treat) was associated with longer survival from diagnosis of brain metastases, median 10.8 versus 6.1 months, p = 0.025. Delayed radiotherapy still resulted in numerically better survival than no radiotherapy at all (median 8.8 versus 5.3 months, not significant). If calculated from the start of delayed radiotherapy, median survival was only 2.7 months. In a multivariable analysis, both Karnofsky performance status ≥ 70 (p = 0.03) and planned radiotherapy (p = 0.05) were associated with better survival. Conclusion In patients ineligible for targeted agents, planned radiotherapy in a modern treatment setting was associated with longer survival compared to no radiotherapy. Timing and type of radiotherapy in such patients should be evaluated in prospective trials to identify patients who might not need planned radiotherapy.
Collapse
Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, 8092, Bodø, Norway. .,Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, 9037, Tromsø, Norway.
| | - Siv G Aanes
- Department of Oncology and Palliative Medicine, Nordland Hospital, 8092, Bodø, Norway
| | - Ellinor Haukland
- Department of Oncology and Palliative Medicine, Nordland Hospital, 8092, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT-The Arctic University of Norway, 9037, Tromsø, Norway.,SHARE-Center for Resilience in Healthcare, Faculty of Health Sciences, Department of Quality and Health Technology, University of Stavanger, 4036, Stavanger, Norway
| |
Collapse
|
5
|
Gordon K, Gulidov I, Gogolin D, Lepilina O, Golovanova O, Semenov A, Dujenko S, Medvedeva K, Koryakin S, Ivanov S, Kaprin A. A Clinical Case of 5 Times Irradiated Recurrent Orbital Hemangiopericytoma. Case Rep Oncol 2021; 14:78-84. [PMID: 33776686 PMCID: PMC7983647 DOI: 10.1159/000513030] [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: 11/10/2020] [Accepted: 11/13/2020] [Indexed: 11/19/2022] Open
Abstract
Orbital hemangiopericytomas (HPCs) are rare mesenchymal tumors with a high tendency to recur. Treatment options are quite limited in case of a relapse, but re-irradiation can be useful. Most of the available data limit the possibility of re-irradiation, while novel techniques (e.g., pencil beam proton therapy [PT]) open new approaches for the safe repeating of treatment. To the best of our knowledge, this is the first well-documented case of multi-times (>3) irradiation of tumors located intracranially. The case reported here describes orbital HPCs with proton irradiation performed two times since 1999 in a 30-year-old woman with a medical history as well as surgery followed by conventional radiotherapy (RT) and chemotherapy, and two times stereotactic RT (in 2009 and 2013). In 2016 the patient came to our hospital with the 3rd relapse of the tumor, located in the left orbit, with an intracranial part, involving cavernous sinus, which was close to the temporal lobe. The 4th course of irradiation was done in May to June 2016 by pencil beam PT. Radiation necrosis occurred after 2 years and was treated with bevacizumab (BVZ). Three years later, another relapse was treated with PT and BVZ. The 9-month follow-up showed complete tumor response without signs of brain toxicity. The patient died due to a brain abscess 1 year after the 5th irradiation. This case shows a possibility of irradiation, applied 5 times to the same location, with promising results and manageable toxicity.
Collapse
Affiliation(s)
- Konstantin Gordon
- Department of Proton Therapy, A. Tsyb Medical Radiological Research Center, Obninsk, Russian Federation
| | - Igor Gulidov
- Department of Proton Therapy, A. Tsyb Medical Radiological Research Center, Obninsk, Russian Federation
| | - Danil Gogolin
- Department of Proton Therapy, A. Tsyb Medical Radiological Research Center, Obninsk, Russian Federation
| | - Olga Lepilina
- Department of Dosimetry, A. Tsyb Medical Radiological Research Center, Obninsk, Russian Federation
| | - Olga Golovanova
- Department of Radiophysics, A. Tsyb Medical Radiological Research Center, Obninsk, Russian Federation
| | - Alexey Semenov
- Department of Proton Therapy, A. Tsyb Medical Radiological Research Center, Obninsk, Russian Federation
| | - Sergey Dujenko
- Department of Radiophysics, A. Tsyb Medical Radiological Research Center, Obninsk, Russian Federation
| | - Kira Medvedeva
- Department of Proton Therapy, A. Tsyb Medical Radiological Research Center, Obninsk, Russian Federation
| | - Sergey Koryakin
- Department of Radiophysics, A. Tsyb Medical Radiological Research Center, Obninsk, Russian Federation
| | - Sergey Ivanov
- A. Tsyb Medical Radiological Research Center, Obninsk, Russian Federation
| | - Andrey Kaprin
- National Medical Research Radiological Center, Moscow, Russian Federation
| |
Collapse
|
6
|
Holub K, Louvel G. Efficacy of salvage stereotactic radiotherapy (SRT) for locally recurrent brain metastases after initial SRT and characteristics of target population. Clin Transl Oncol 2021; 23:1463-1473. [PMID: 33464481 DOI: 10.1007/s12094-020-02544-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/15/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Due to a steadily growing use of stereotactic radiotherapy (SRT) for treatment of brain metastases (BMs), the in-field failure after an initial stereotaxy is an increasingly frequent problem. Repeat stereotactic radiotherapy (re-SRT) shows encouraging results in terms of local control. However, the evidence on prognostic factors limiting the overall survival (OS) of re-treated patients is scarce. Here, we sought to analyze the patients' and treatment characteristics influencing the survival outcomes after re-SRT. METHODS Data of all patients with local failure of initial SRT treated from 2012 to 2019 were retrospectively reviewed and cases treated with salvage SRT were analyzed. We analyzed the impact of patients' and treatment characteristics on overall survival after re-SRT by Kaplan-Meier method and Cox regression models. Local and distant brain control, cause of death, and radionecrosis rate were also assessed. RESULTS Forty-seven patients with 55 BMs treated with re-SRT were evaluated. Median OS after re-SRT was 9.2 months and the overall local control was 83.6%. Nine BMs (16.4%) presented local relapse (LR), 12 (21.8%) radionecrosis, while 21 patients (44.7%) developed new BMs. Only absence of extracranial metastases at BMs diagnosis (HR 0.42, CI 95%; 0.18-0.97), extracranial disease progression (HR 2.39, CI 95%; 1.06-5.38) and distant brain failure (HR 3.94, CI 95%; 1.68-9.24) after re-SRT were significantly associated with patients' survival. Extracranial progression following re-SRT was an independent prognosticator of worse OS. CONCLUSION Re-SRT after LR presented excellent local control with acceptable RN rate and improved patients' survival, limited mainly by extracranial and distant brain progression.
Collapse
Affiliation(s)
- K Holub
- Radiotherapy Department, Gustave Roussy Cancer Campus, Villejuif, France.
| | - G Louvel
- Radiotherapy Department, Gustave Roussy Cancer Campus, Villejuif, France.
| |
Collapse
|