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Sample records for stereotactic body radiation

  1. Stereotactic body radiation therapy

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    Lo, Simon S. [Univ. Hospitals Seidman Cancer Center, Cleveland, OH (United States). Dept. of Radiation Oncology; Case Western Reserve Univ., Cleveland, OH (United States). Case Comprehensive Cancer Center; Teh, Bin S. [The Methodist Hospital Cancer Center and Research Institute, Houston, TX (United States). Weill Cornell Medical College; Lu, Jiade J. [National Univ. of Singapore (Singapore). Dept. of Radiation Oncology; Schefter, Tracey E. (eds.) [Colorado Univ., Aurora, CO (United States). Dept. of Radiation Oncology

    2012-11-01

    Comprehensive an up-to-date account of the physical/technological, biological, and clinical aspects of SBRT. Examines in detail retrospective studies and prospective clinical trials for various organ sites from around the world. Written by world-renowned experts in SBRT from North America, Asia and Europe. Stereotactic body radiation therapy (SBRT) has emerged as an innovative treatment for various primary and metastatic cancers, and the past five years have witnessed a quantum leap in its use. This book provides a comprehensive and up-to-date account of the physical/technological, biological, and clinical aspects of SBRT. It will serve as a detailed resource for this rapidly developing treatment modality. The organ sites covered include lung, liver, spine, pancreas, prostate, adrenal, head and neck, and female reproductive tract. Retrospective studies and prospective clinical trials on SBRT for various organ sites from around the world are examined, and toxicities and normal tissue constraints are discussed. This book features unique insights from world-renowned experts in SBRT from North America, Asia, and Europe. It will be necessary reading for radiation oncologists, radiation oncology residents and fellows, medical physicists, medical physics residents, medical oncologists, surgical oncologists, and cancer scientists.

  2. [Stereotactic body radiation therapy for spinal metastases].

    Science.gov (United States)

    Pasquier, D; Martinage, G; Mirabel, X; Lacornerie, T; Makhloufi, S; Faivre, J-C; Thureau, S; Lartigau, É

    2016-10-01

    After the liver and lungs, bones are the third most common sites of cancer metastasis. Palliative radiotherapy for secondary bone tumours helps relieve pain, improve the quality of life and reduce the risk of fractures. Stereotactic body radiotherapy can deliver high radiation doses with very tight margins, which has significant advantages when treating tumours close to the spinal cord. Strict quality control is essential as dose gradient at the edge of the spinal cord is important. Optimal schedule is not defined. A range of dose-fractionation schedules have been used. Pain relief and local control are seen in over 80%. Toxicity rates are low, although vertebral fracture may occur. Ongoing prospective studies will help clarify its role in the management of oligometastatic patients. Copyright © 2016 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  3. Stereotactic Body Radiation Therapy in Spinal Metastases

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    Ahmed, Kamran A. [Mayo Medical School, College of Medicine, Mayo Clinic, Rochester, MN (United States); Stauder, Michael C.; Miller, Robert C.; Bauer, Heather J. [Department of Radiation Oncology, Mayo Clinic, Rochester, MN (United States); Rose, Peter S. [Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN (United States); Olivier, Kenneth R. [Department of Radiation Oncology, Mayo Clinic, Rochester, MN (United States); Brown, Paul D. [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Brinkmann, Debra H. [Department of Radiation Oncology, Mayo Clinic, Rochester, MN (United States); Laack, Nadia N., E-mail: laack.nadia@mayo.edu [Department of Radiation Oncology, Mayo Clinic, Rochester, MN (United States)

    2012-04-01

    Purpose: Based on reports of safety and efficacy, stereotactic body radiotherapy (SBRT) for treatment of malignant spinal tumors was initiated at our institution. We report prospective results of this population at Mayo Clinic. Materials and Methods: Between April 2008 and December 2010, 85 lesions in 66 patients were treated with SBRT for spinal metastases. Twenty-two lesions (25.8%) were treated for recurrence after prior radiotherapy (RT). The mean age of patients was 56.8 {+-} 13.4 years. Patients were treated to a median dose of 24 Gy (range, 10-40 Gy) in a median of three fractions (range, 1-5). Radiation was delivered with intensity-modulated radiotherapy (IMRT) and prescribed to cover 80% of the planning target volume (PTV) with organs at risk such as the spinal cord taking priority over PTV coverage. Results: Tumor sites included 48, 22, 12, and 3 in the thoracic, lumbar, cervical, and sacral spine, respectively. The mean actuarial survival at 12 months was 52.2%. A total of 7 patients had both local and marginal failure, 1 patient experienced marginal but not local failure, and 1 patient had local failure only. Actuarial local control at 1 year was 83.3% and 91.2% in patients with and without prior RT. The median dose delivered to patients who experienced local/marginal failure was 24 Gy (range, 18-30 Gy) in a median of three fractions (range, 1-5). No cases of Grade 4 toxicity were reported. In 1 of 2 patients experiencing Grade 3 toxicity, SBRT was given after previous radiation. Conclusion: The results indicate SBRT to be an effective measure to achieve local control in spinal metastases. Toxicity of treatment was rare, including those previously irradiated. Our results appear comparable to previous reports analyzing spine SBRT. Further research is needed to determine optimum dose and fractionation to further improve local control and prevent toxicity.

  4. Stereotactic Body Radiation Therapy in Spinal Metastases

    International Nuclear Information System (INIS)

    Ahmed, Kamran A.; Stauder, Michael C.; Miller, Robert C.; Bauer, Heather J.; Rose, Peter S.; Olivier, Kenneth R.; Brown, Paul D.; Brinkmann, Debra H.; Laack, Nadia N.

    2012-01-01

    Purpose: Based on reports of safety and efficacy, stereotactic body radiotherapy (SBRT) for treatment of malignant spinal tumors was initiated at our institution. We report prospective results of this population at Mayo Clinic. Materials and Methods: Between April 2008 and December 2010, 85 lesions in 66 patients were treated with SBRT for spinal metastases. Twenty-two lesions (25.8%) were treated for recurrence after prior radiotherapy (RT). The mean age of patients was 56.8 ± 13.4 years. Patients were treated to a median dose of 24 Gy (range, 10–40 Gy) in a median of three fractions (range, 1–5). Radiation was delivered with intensity-modulated radiotherapy (IMRT) and prescribed to cover 80% of the planning target volume (PTV) with organs at risk such as the spinal cord taking priority over PTV coverage. Results: Tumor sites included 48, 22, 12, and 3 in the thoracic, lumbar, cervical, and sacral spine, respectively. The mean actuarial survival at 12 months was 52.2%. A total of 7 patients had both local and marginal failure, 1 patient experienced marginal but not local failure, and 1 patient had local failure only. Actuarial local control at 1 year was 83.3% and 91.2% in patients with and without prior RT. The median dose delivered to patients who experienced local/marginal failure was 24 Gy (range, 18–30 Gy) in a median of three fractions (range, 1–5). No cases of Grade 4 toxicity were reported. In 1 of 2 patients experiencing Grade 3 toxicity, SBRT was given after previous radiation. Conclusion: The results indicate SBRT to be an effective measure to achieve local control in spinal metastases. Toxicity of treatment was rare, including those previously irradiated. Our results appear comparable to previous reports analyzing spine SBRT. Further research is needed to determine optimum dose and fractionation to further improve local control and prevent toxicity.

  5. Radiobiological mechanisms of stereotactic body radiation therapy and stereotactic radiation surgery

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    Kim, Mi Sook; Kim, Won Woo; Park, In Hwan; Kim, Hee Jong; Lee, Eun Jin; Jung, Jae Hoon [Research Center for Radiotherapy, Korea Institute of Radiological and Medical Sciences, Seoul (Korea, Republic of); Cho, Lawrence Chin Soo; Song, Chang W. [Dept. of Radiation Oncology, University of Minnesota Medical School, Minneapolis (United States)

    2015-12-15

    Despite the increasing use of stereotactic body radiation therapy (SBRT) and stereotactic radiation surgery (SRS) in recent years, the biological base of these high-dose hypo-fractionated radiotherapy modalities has been elusive. Given that most human tumors contain radioresistant hypoxic tumor cells, the radiobiological principles for the conventional multiple-fractionated radiotherapy cannot account for the high efficacy of SBRT and SRS. Recent emerging evidence strongly indicates that SBRT and SRS not only directly kill tumor cells, but also destroy the tumor vascular beds, thereby deteriorating intratumor microenvironment leading to indirect tumor cell death. Furthermore, indications are that the massive release of tumor antigens from the tumor cells directly and indirectly killed by SBRT and SRS stimulate anti-tumor immunity, thereby suppressing recurrence and metastatic tumor growth. The reoxygenation, repair, repopulation, and redistribution, which are important components in the response of tumors to conventional fractionated radiotherapy, play relatively little role in SBRT and SRS. The linear-quadratic model, which accounts for only direct cell death has been suggested to overestimate the cell death by high dose per fraction irradiation. However, the model may in some clinical cases incidentally do not overestimate total cell death because high-dose irradiation causes additional cell death through indirect mechanisms. For the improvement of the efficacy of SBRT and SRS, further investigation is warranted to gain detailed insights into the mechanisms underlying the SBRT and SRS.

  6. Guidelines for safe practice of stereotactic body (ablative) radiation therapy

    International Nuclear Information System (INIS)

    Foote, Matthew; Barry, Tamara; Bailey, Michael; Smith, Leigh; Seeley, Anna; Siva, Shankar; Hegi-Johnson, Fiona; Booth, Jeremy; Ball, David; Thwaites, David

    2015-01-01

    The uptake of stereotactic ablative body radiation therapy (SABR) / stereotactic body radiation therapy (SBRT) worldwide has been rapid. The Australian and New Zealand Faculty of Radiation Oncology (FRO) assembled an expert panel of radiation oncologists, radiation oncology medical physicists and radiation therapists to establish guidelines for safe practice of SABR. Draft guidelines were reviewed by a number of international experts in the field and then distributed through the membership of the FRO. Members of the Australian Institute of Radiography and the Australasian College of Physical Scientists and Engineers in Medicine were also asked to comment on the draft. Evidence-based recommendations (where applicable) address aspects of departmental staffing, procedures and equipment, quality assurance measures, as well as organisational considerations for delivery of SABR treatments. Central to the guidelines is a set of key recommendations for departments undertaking SABR. These guidelines were developed collaboratively to provide an educational guide and reference for radiation therapy service providers to ensure appropriate care of patients receiving SABR.

  7. Stereotactic Body Radiation Therapy for Oligometastatic Prostate Cancer

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    Muldermans, Jonathan L. [F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland (United States); Romak, Lindsay B. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Kwon, Eugene D. [Department of Urology, Mayo Clinic, Rochester, Minnesota (United States); Department of Immunology, Mayo Clinic, Rochester, Minnesota (United States); Park, Sean S. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Olivier, Kenneth R., E-mail: olivier.kenneth@mayo.edu [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States)

    2016-06-01

    Purpose: To review outcomes of patients with oligometastatic prostate cancer (PCa) treated with stereotactic body radiation therapy (SBRT) and to identify variables associated with local failure. Methods and Materials: We retrospectively reviewed records of patients treated with SBRT for oligometastatic PCa. Metastasis control (ie, control of the treated lesion, MC), biochemical progression-free survival, distant progression-free survival, and overall survival were estimated with the Kaplan-Meier method. Results: Sixty-six men with 81 metastatic PCa lesions, 50 of which were castrate-resistant, were included in the analysis. Lesions were in bone (n=74), lymph nodes (n=6), or liver (n=1). Stereotactic body radiation therapy was delivered in 1 fraction to 71 lesions (88%), at a median dose of 16 Gy (range, 16-24 Gy). The remaining lesions received 30 Gy in 3 fractions (n=6) or 50 Gy in 5 fractions (n=4). Median follow-up was 16 months (range, 3-49 months). Estimated MC at 2 years was 82%. Biochemical progression-free survival, distant progression-free survival, and overall survival were 54%, 45%, and 83%, respectively. On multivariate analysis, only the dose of SBRT was significantly associated with MC; lesions treated with 16 Gy had 58% MC, and those treated with ≥18 Gy had 95% MC at 2 years (P≤.001). At 2 years, MC for lesions treated with 18 Gy (n=21) was 88%. No patient treated with ≥18 Gy in a single fraction or with any multifraction regimen had local failure. Six patients (9%) had grade 1 pain flare, and 2 (3%) had grade 2 pain flare. No grade 2 or greater late toxicities were reported. Conclusions: Stereotactic body radiation therapy for patients with oligometastatic prostate cancer provided optimal metastasis control and acceptable toxicity with doses ≥18 Gy. Biochemical progression-free survival was 54% at 16 months with the inclusion of SBRT in the treatment regimen. Stereotactic body radiation therapy should be considered in

  8. Stereotactic Body Radiation Therapy for Oligometastatic Prostate Cancer

    International Nuclear Information System (INIS)

    Muldermans, Jonathan L.; Romak, Lindsay B.; Kwon, Eugene D.; Park, Sean S.; Olivier, Kenneth R.

    2016-01-01

    Purpose: To review outcomes of patients with oligometastatic prostate cancer (PCa) treated with stereotactic body radiation therapy (SBRT) and to identify variables associated with local failure. Methods and Materials: We retrospectively reviewed records of patients treated with SBRT for oligometastatic PCa. Metastasis control (ie, control of the treated lesion, MC), biochemical progression-free survival, distant progression-free survival, and overall survival were estimated with the Kaplan-Meier method. Results: Sixty-six men with 81 metastatic PCa lesions, 50 of which were castrate-resistant, were included in the analysis. Lesions were in bone (n=74), lymph nodes (n=6), or liver (n=1). Stereotactic body radiation therapy was delivered in 1 fraction to 71 lesions (88%), at a median dose of 16 Gy (range, 16-24 Gy). The remaining lesions received 30 Gy in 3 fractions (n=6) or 50 Gy in 5 fractions (n=4). Median follow-up was 16 months (range, 3-49 months). Estimated MC at 2 years was 82%. Biochemical progression-free survival, distant progression-free survival, and overall survival were 54%, 45%, and 83%, respectively. On multivariate analysis, only the dose of SBRT was significantly associated with MC; lesions treated with 16 Gy had 58% MC, and those treated with ≥18 Gy had 95% MC at 2 years (P≤.001). At 2 years, MC for lesions treated with 18 Gy (n=21) was 88%. No patient treated with ≥18 Gy in a single fraction or with any multifraction regimen had local failure. Six patients (9%) had grade 1 pain flare, and 2 (3%) had grade 2 pain flare. No grade 2 or greater late toxicities were reported. Conclusions: Stereotactic body radiation therapy for patients with oligometastatic prostate cancer provided optimal metastasis control and acceptable toxicity with doses ≥18 Gy. Biochemical progression-free survival was 54% at 16 months with the inclusion of SBRT in the treatment regimen. Stereotactic body radiation therapy should be considered in

  9. Gastrointestinal Toxicities With Combined Antiangiogenic and Stereotactic Body Radiation Therapy

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    Pollom, Erqi L.; Deng, Lei [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Pai, Reetesh K. [Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States); Brown, J. Martin; Giaccia, Amato; Loo, Billy W.; Shultz, David B.; Le, Quynh Thu; Koong, Albert C. [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Chang, Daniel T., E-mail: dtchang@stanford.edu [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States)

    2015-07-01

    Combining the latest targeted biologic agents with the most advanced radiation technologies has been an exciting development in the treatment of cancer patients. Stereotactic body radiation therapy (SBRT) is an ablative radiation approach that has become established for the treatment of a variety of malignancies, and it has been increasingly used in combination with biologic agents, including those targeting angiogenesis-specific pathways. Multiple reports have emerged describing unanticipated toxicities arising from the combination of SBRT and angiogenesis-targeting agents, particularly of late luminal gastrointestinal toxicities. In this review, we summarize the literature describing these toxicities, explore the biological mechanism of action of toxicity with the combined use of antiangiogenic therapies, and discuss areas of future research, so that this combination of treatment modalities can continue to be used in broader clinical contexts.

  10. A Study of Pseudoprogression After Spine Stereotactic Body Radiation Therapy

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    Bahig, Houda; Simard, Dany [Department of Radiation Oncology, Centre Hospitalier de l' Université de Montréal, Montreal, Quebec (Canada); Létourneau, Laurent [Department of Radiology, Centre Hospitalier de l' Université de Montréal, Montreal, Quebec (Canada); Wong, Philip; Roberge, David; Filion, Edith; Donath, David [Department of Radiation Oncology, Centre Hospitalier de l' Université de Montréal, Montreal, Quebec (Canada); Sahgal, Arjun [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Masucci, Laura, E-mail: g.laura.masucci.chum@ssss.gouv.qc.ca [Department of Radiation Oncology, Centre Hospitalier de l' Université de Montréal, Montreal, Quebec (Canada)

    2016-11-15

    Purpose: To determine the incidence of pseudoprogression (PP) after spine stereotactic body radiation therapy based on a detailed and quantitative assessment of magnetic resonance imaging (MRI) morphologic tumor alterations, and to identify predictive factors distinguishing PP from local recurrence (LR). Methods and Materials: A retrospective analysis of 35 patients with 49 spinal segments treated with spine stereotactic body radiation therapy, from 2009 to 2014, was conducted. The median number of follow-up MRI studies was 4 (range, 2-7). The gross tumor volumes (GTVs) within each of the 49 spinal segments were contoured on the pretreatment and each subsequent follow-up T1- and T2-weighted MRI sagittal sequence. T2 signal intensity was reported as the mean intensity of voxels constituting each volume. LR was defined as persistent GTV enlargement on ≥2 serial MRI studies for ≥6 months or on pathologic confirmation. PP was defined as a GTV enlargement followed by stability or regression on subsequent imaging within 6 months. Kaplan-Meier analysis was used for estimation of actuarial local control, disease-free survival, and overall survival. Results: The median follow-up was 23 months (range, 1-39 months). PP was identified in 18% of treated segments (9 of 49) and LR in 29% (14 of 49). Earlier volume enlargement (5 months for PP vs 15 months for LR, P=.005), greater GTV to reference nonirradiated vertebral body T2 intensity ratio (+30% for PP vs −10% for LR, P=.005), and growth confined to 80% of the prescription isodose line (80% IDL) (8 of 9 PP cases vs 1 of 14 LR cases, P=.002) were associated with PP on univariate analysis. Multivariate analysis confirmed an earlier time to volume enlargement and growth within the 80% IDL as significant predictors of PP. LR involved the epidural space in all but 1 lesion, whereas PP was confined to the vertebral body in 7 of 9 cases. Conclusions: PP was observed in 18% of treated spinal segments. Tumor growth

  11. Early Tissue Effects of Stereotactic Body Radiation Therapy for Spinal Metastases

    NARCIS (Netherlands)

    Steverink, Jasper G.; Willems, Stefan M.; Philippens, Marielle E.P.; Kasperts, Nicolien; Eppinga, Wietse S.C.; Versteeg, Anne L.; van der Velden, Joanne M.; Faruqi, Salman; Sahgal, Arjun; Verlaan, Jorrit Jan

    2018-01-01

    Purpose: Stereotactic body radiation therapy (SBRT) is a highly effective and potentially ablative treatment for complex spinal metastases. Recent data have suggested radiobiologic effects of SBRT that expand beyond the traditional concept of DNA damage. Antitumor immunity, vascular damage leading

  12. Institutional experience in the treatment of colorectal liver metastases with stereotactic body radiation therapy

    NARCIS (Netherlands)

    Méndez Romero, Alejandra; Keskin-Cambay, Fatma; van Os, Rob M.; Nuyttens, Joost J.; Heijmen, Ben J. M.; Ijzermans, Jan N. M.; Verhoef, Cornelis

    2017-01-01

    To investigate whether the impact of dose escalation in our patient population represented an improvement in local control without increasing treatment related toxicity. A cohort of consecutive patients with colorectal liver metastases treated with stereotactic body radiation therapy (SBRT) between

  13. Stereotactic Body Radiation Therapy in Recurrent Hepatocellular Carcinoma

    International Nuclear Information System (INIS)

    Huang, Wen-Yen; Jen, Yee-Min; Lee, Meei-Shyuan; Chang, Li-Ping; Chen, Chang-Ming; Ko, Kai-Hsiung; Lin, Kuen-Tze; Lin, Jang-Chun; Chao, Hsing-Lung; Lin, Chun-Shu; Su, Yu-Fu; Fan, Chao-Yueh; Chang, Yao-Wen

    2012-01-01

    Purpose: To examine the safety and efficacy of Cyberknife stereotactic body radiation therapy (SBRT) and its effect on survival in patients of recurrent hepatocellular carcinoma (HCC). Methods and Materials: This was a matched-pair study. From January 2008 to December 2009, 36 patients with 42 lesions of unresectable recurrent HCC were treated with SBRT. The median prescribed dose was 37 Gy (range, 25 to 48 Gy) in 4–5 fractions over 4–5 consecutive working days. Another 138 patients in the historical control group given other or no treatments were selected for matched analyses. Results: The median follow-up time was 14 months for all patients and 20 months for those alive. The 1- and 2-year in-field failure-free rates were 87.6% and 75.1%, respectively. Out-field intrahepatic recurrence was the main cause of failure. The 2-year overall survival (OS) rate was 64.0%, and median time to progression was 8.0 months. In the multivariable analysis of all 174 patients, SBRT (yes vs. no), tumor size (≤4 cm vs. >4 cm), recurrent stage (stage IIIB/IV vs. I) and Child-Pugh classification (A vs. B/C) were independent prognostic factors for OS. Matched-pair analysis revealed that patients undergoing SBRT had better OS (2-year OS of 72.6% vs. 42.1%, respectively, p = 0.013). Acute toxicities were mild and tolerable. Conclusion: SBRT is a safe and efficacious modality and appears to be well-tolerated at the dose fractionation we have used, and its use correlates with improved survival in this cohort of patients with recurrent unresectable HCC. Out-field recurrence is the major cause of failure. Further studies of combinations of SBRT and systemic therapies may be reasonable.

  14. Tomotherapeutic stereotactic body radiation therapy: Techniques and comparison between modalities

    International Nuclear Information System (INIS)

    Fuss, Martin; Chengyu Shi; Papanikolaou, Niko

    2006-01-01

    Presentation and comparison of tomotherapeutic intensity-modulated techniques for planning and delivery of stereotactic body radiation therapy. Serial tomotherapeutic SBRT has been planned and delivered at our institution since 8/2001. Since 12/2005, 12 patients have been treated using a helical tomotherapy unit. For these 12 patients both helical and serial tomotherapy plans were computed and clinically approved. Techniques and considerations of tomotherapy SBRT planning, associated image-guidance, and delivery are presented. The respective treatment plans were compared based on dosimetric parameters as well as time to develop a treatment plan and delivery times. Also the associated quality of megavoltage CT (MVCT) image-guidance inherent to the helical tomotherapy unit was assessed. Tumor volumes averaged 9.3, 9.8, and 58.7 cm 3 for liver, lung, and spinal targets. Helical and serial tomotherapy plans showed comparable plan quality with respect to maximum and average doses to the gross tumor and planning target volumes. Time to develop helical tomotherapy plans averaged 3.5 h while serial tomotherapy planning consistently required less than one hour. Treatment delivery was also slower using helical tomotherapy, with differences of less than 10 min between modalities. MVCT image-guidance proved satisfactory for bony and lung targets, but failed to depict liver lesions, owing to poor soft-tissue contrast. SBRT planning and delivery is clinically feasible using either tomotherapeutic modality. While treatment planning time was consistently shorter and more readily accomplished in a standardized approach using the serial tomotherapy modality, actual plan quality and treatment delivery times are grossly comparable between the modalities. MVCT volumetric image-guidance, was observed to be valuable for thoracic and spinal target volumes, whereas it proved challenging for liver targets

  15. Dysuria Following Stereotactic Body Radiation Therapy for Prostate Cancer

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    Einsley-Marie eJanowski

    2015-07-01

    Full Text Available Background: Dysuria following prostate radiation therapy is a common toxicity that adversely affects patients’ quality of life and may be difficult to manage. Methods: 204 patients treated with stereotactic body radiation therapy (SBRT from 2007 to 2010 for localized prostate carcinoma with a minimum follow up of three years were included in this retrospective review of prospectively collected data. All patients were treated to 35-36.25Gy in 5 fractions delivered with robotic SBRT with real time fiducial tracking. Dysuria and other lower urinary tract symptoms were assessed via Question 4b (Pain or burning on urination of the Expanded Prostate Index Composite (EPIC-26 and the American Urological Association (AUA Symptom Score at baseline and at routine follow up. Results: 204 patients (82 low-, 105 intermediate-, and 17 high risk according to the D’Amico classification at a median age of 69 years (range 48-91 received SBRT for their localized prostate cancer with a median follow up of 47 months. Bother associated with dysuria significantly increased from a baseline of 12% to a maximum of 43% at one month (p<0.0001. There were two distinct peaks of moderate to severe dysuria bother at 1 month and at 6-12 months, with 9% of patients experiencing a late transient dysuria flare. While a low level of dysuria was seen through the first two years of follow-up, it returned to below baseline by two years (p=0.91. The median baseline AUA score of 7.5 significantly increased to 11 at 1 month (p<0.0001 and returned to 7 at 3 months (p= 0.54. Patients with dysuria had a statistically higher AUA score at baseline and at all follow-ups up to 30 months. Dysuria significantly correlated with dose and AUA score on multivariate analysis. Frequency and strain significantly correlated with dysuria on stepwise multivariate analysis.Conclusions: The rate and severity of dysuria following SBRT is comparable to patients treated with other radiation modalities.

  16. Potency preservation following stereotactic body radiation therapy for prostate cancer

    International Nuclear Information System (INIS)

    Obayomi-Davies, Olusola; Pahira, John; McGeagh, Kevin G; Collins, Brian T; Kowalczyk, Keith; Bandi, Gaurav; Kumar, Deepak; Suy, Simeng; Dritschilo, Anatoly; Lynch, John H; Collins, Sean P; Chen, Leonard N; Bhagat, Aditi; Wright, Henry C; Uhm, Sunghae; Kim, Joy S; Yung, Thomas M; Lei, Siyuan; Batipps, Gerald P

    2013-01-01

    Erectile dysfunction after prostate radiation therapy remains an ongoing challenge and critical quality of life issue. Given the higher dose of radiation per fraction using stereotactic body radiation therapy (SBRT) there is concern that post-SBRT impotency would be higher than conventional radiation therapy approaches. This study sought to evaluate potency preservation and sexual function following SBRT for prostate cancer. Between February 2008 and March 2011, 216 men with clinically localized prostate cancer were treated definitively with SBRT monotherapy at Georgetown University Hospital. Potency was defined as the ability to have an erection firm enough for intercourse with or without sexual aids while sexual activity was defined as the ability to have an erection firm enough for masturbation and foreplay. Patients who received androgen deprivation therapy (ADT) were excluded from this study. Ninety-seven hormone-naïve men were identified as being potent at the initiation of therapy and were included in this review. All patients were treated to 35–36.25 Gy in 5 fractions delivered with the CyberKnife Radiosurgical System (Accuray). Prostate specific antigen (PSA) and total testosterone levels were obtained pre-treatment, every 3 months for the first year and every 6 months for the subsequent year. Sexual function was assessed with the Sexual Health Inventory for Men (SHIM), the Expanded Prostate Index Composite (EPIC)-26 and Utilization of Sexual Medication/Device questionnaires at baseline and all follow-up visits. Ninety-seven men (43 low-, 50 intermediate- and 4 high-risk) at a median age of 68 years (range, 48–82 years) received SBRT. The median pre-treatment PSA was 5.9 ng/ml and the minimum follow-up was 24 months. The median pre-treatment total serum testosterone level was 11.4 nmol/L (range, 4.4-27.9 nmol/L). The median baseline SHIM was 22 and 36% of patients utilized sexual aids prior to treatment. Although potency rates declined following

  17. Adaptive Stereotactic Body Radiation Therapy Planning for Lung Cancer

    International Nuclear Information System (INIS)

    Qin, Yujiao; Zhang, Fan; Yoo, David S.; Kelsey, Chris R.; Yin, Fang-Fang; Cai, Jing

    2013-01-01

    Purpose: To investigate the dosimetric effects of adaptive planning on lung stereotactic body radiation therapy (SBRT). Methods and Materials: Forty of 66 consecutive lung SBRT patients were selected for a retrospective adaptive planning study. CBCT images acquired at each fraction were used for treatment planning. Adaptive plans were created using the same planning parameters as the original CT-based plan, with the goal to achieve comparable comformality index (CI). For each patient, 2 cumulative plans, nonadaptive plan (P NON ) and adaptive plan (P ADP ), were generated and compared for the following organs-at-risks (OARs): cord, esophagus, chest wall, and the lungs. Dosimetric comparison was performed between P NON and P ADP for all 40 patients. Correlations were evaluated between changes in dosimetric metrics induced by adaptive planning and potential impacting factors, including tumor-to-OAR distances (d T-OAR ), initial internal target volume (ITV 1 ), ITV change (ΔITV), and effective ITV diameter change (Δd ITV ). Results: 34 (85%) patients showed ITV decrease and 6 (15%) patients showed ITV increase throughout the course of lung SBRT. Percentage ITV change ranged from −59.6% to 13.0%, with a mean (±SD) of −21.0% (±21.4%). On average of all patients, P ADP resulted in significantly (P=0 to .045) lower values for all dosimetric metrics. Δd ITV /d T-OAR was found to correlate with changes in dose to 5 cc (ΔD5cc) of esophagus (r=0.61) and dose to 30 cc (ΔD30cc) of chest wall (r=0.81). Stronger correlations between Δd ITV /d T-OAR and ΔD30cc of chest wall were discovered for peripheral (r=0.81) and central (r=0.84) tumors, respectively. Conclusions: Dosimetric effects of adaptive lung SBRT planning depend upon target volume changes and tumor-to-OAR distances. Adaptive lung SBRT can potentially reduce dose to adjacent OARs if patients present large tumor volume shrinkage during the treatment

  18. Adaptive Stereotactic Body Radiation Therapy Planning for Lung Cancer

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    Qin, Yujiao [Medical Physics Graduate Program, Duke University, Durham, North Carolina (United States); Zhang, Fan [Occupational and Environmental Safety Office, Duke University Medical Center, Durham, North Carolina (United States); Yoo, David S.; Kelsey, Chris R. [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Yin, Fang-Fang [Medical Physics Graduate Program, Duke University, Durham, North Carolina (United States); Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Cai, Jing, E-mail: jing.cai@duke.edu [Medical Physics Graduate Program, Duke University, Durham, North Carolina (United States); Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States)

    2013-09-01

    Purpose: To investigate the dosimetric effects of adaptive planning on lung stereotactic body radiation therapy (SBRT). Methods and Materials: Forty of 66 consecutive lung SBRT patients were selected for a retrospective adaptive planning study. CBCT images acquired at each fraction were used for treatment planning. Adaptive plans were created using the same planning parameters as the original CT-based plan, with the goal to achieve comparable comformality index (CI). For each patient, 2 cumulative plans, nonadaptive plan (P{sub NON}) and adaptive plan (P{sub ADP}), were generated and compared for the following organs-at-risks (OARs): cord, esophagus, chest wall, and the lungs. Dosimetric comparison was performed between P{sub NON} and P{sub ADP} for all 40 patients. Correlations were evaluated between changes in dosimetric metrics induced by adaptive planning and potential impacting factors, including tumor-to-OAR distances (d{sub T-OAR}), initial internal target volume (ITV{sub 1}), ITV change (ΔITV), and effective ITV diameter change (Δd{sub ITV}). Results: 34 (85%) patients showed ITV decrease and 6 (15%) patients showed ITV increase throughout the course of lung SBRT. Percentage ITV change ranged from −59.6% to 13.0%, with a mean (±SD) of −21.0% (±21.4%). On average of all patients, P{sub ADP} resulted in significantly (P=0 to .045) lower values for all dosimetric metrics. Δd{sub ITV}/d{sub T-OAR} was found to correlate with changes in dose to 5 cc (ΔD5cc) of esophagus (r=0.61) and dose to 30 cc (ΔD30cc) of chest wall (r=0.81). Stronger correlations between Δd{sub ITV}/d{sub T-OAR} and ΔD30cc of chest wall were discovered for peripheral (r=0.81) and central (r=0.84) tumors, respectively. Conclusions: Dosimetric effects of adaptive lung SBRT planning depend upon target volume changes and tumor-to-OAR distances. Adaptive lung SBRT can potentially reduce dose to adjacent OARs if patients present large tumor volume shrinkage during the treatment.

  19. First clinical implementation of audiovisual biofeedback in liver cancer stereotactic body radiation therapy

    International Nuclear Information System (INIS)

    Pollock, Sean; Tse, Regina; Martin, Darren

    2015-01-01

    This case report details a clinical trial's first recruited liver cancer patient who underwent a course of stereotactic body radiation therapy treatment utilising audiovisual biofeedback breathing guidance. Breathing motion results for both abdominal wall motion and tumour motion are included. Patient 1 demonstrated improved breathing motion regularity with audiovisual biofeedback. A training effect was also observed.

  20. Role of functional imaging in treatment plan optimization of stereotactic body radiation therapy for liver cancer.

    Science.gov (United States)

    De Bari, Berardino; Jumeau, Raphael; Deantonio, Letizia; Adib, Salim; Godin, Sarah; Zeverino, Michele; Moeckli, Raphael; Bourhis, Jean; Prior, John O; Ozsahin, Mahmut

    2016-10-13

    We report the first known instance of the clinical use of 99mTc-mebrofenin hepatobiliary scintigraphy (HBS) for the optimization of radiotherapy treatment planning and for the follow-up of acute toxicity in a patient undergoing stereotactic body radiation therapy for hepatocellular carcinoma. In our experience, HBS allowed the identification and the sparing of more functioning liver areas, thus potentially reducing the risk of radiation-induced liver toxicity.

  1. SU-F-P-05: Initial Experience with an Independent Certification Program for Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy

    International Nuclear Information System (INIS)

    Solberg, T; Robar, J; Gevaert, T; Todorovic, M; Howe, J

    2016-01-01

    Purpose: The ASTRO document “Safety is no accident: A FRAMEWORK FOR QUALITY RADIATION ONCOLOGY AND CARE” recommends external reviews of specialized modalities. The purpose of this presentation is to describe the implementation of such a program for Stereotactic Radiosurgery (SRS) and Stereotactic Body radiation Therapy (SBRT). Methods: The margin of error for SRS and SBRT delivery is significantly smaller than that of conventional radiotherapy and therefore requires special attention and diligence. The Novalis Certified program was created to fill an unmet need for specialized SRS / SBRT credentialing. A standards document was drafted by a panel of experts from several disciplines, including medical physics, radiation oncology and neurosurgery. The document, based on national and international standards, covers requirements in program structure, personnel, training, clinical application, technology, quality management, and patient and equipment QA. The credentialing process was modeled after existing certification programs and includes an institution-generated self-study, extensive document review and an onsite audit. Reviewers generate a descriptive report, which is reviewed by a multidisciplinary expert panel. Outcomes of the review may include mandatory requirements and optional recommendations. Results: 15 institutions have received Novalis Certification, including 3 in the US, 7 in Europe, 4 in Australia and 1 in Asia. 87 other centers are at various stages of the process. Nine reviews have resulted in mandatory requirements, however all of these were addressed within three months of the audit report. All reviews have produced specific recommendations ranging from programmatic to technical in nature. Institutions felt that the credentialing process addressed a critical need and was highly valuable to the institution. Conclusion: Novalis Certification is a unique peer review program assessing safety and quality in SRS and SBRT, while recognizing

  2. SU-F-P-05: Initial Experience with an Independent Certification Program for Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Solberg, T [University of Pennsylvania, Philadelphia, PA (United States); Robar, J [Capital District Health Authority, Halifax, NS (Canada); Gevaert, T [University Hospital Brussels, Brussels (Belgium); Todorovic, M [Universitats-Klinikum Hamburg-Eppendorf, Hamburg (Germany); Howe, J [Associates In Medical Physics, Louisville, KY (United States)

    2016-06-15

    Purpose: The ASTRO document “Safety is no accident: A FRAMEWORK FOR QUALITY RADIATION ONCOLOGY AND CARE” recommends external reviews of specialized modalities. The purpose of this presentation is to describe the implementation of such a program for Stereotactic Radiosurgery (SRS) and Stereotactic Body radiation Therapy (SBRT). Methods: The margin of error for SRS and SBRT delivery is significantly smaller than that of conventional radiotherapy and therefore requires special attention and diligence. The Novalis Certified program was created to fill an unmet need for specialized SRS / SBRT credentialing. A standards document was drafted by a panel of experts from several disciplines, including medical physics, radiation oncology and neurosurgery. The document, based on national and international standards, covers requirements in program structure, personnel, training, clinical application, technology, quality management, and patient and equipment QA. The credentialing process was modeled after existing certification programs and includes an institution-generated self-study, extensive document review and an onsite audit. Reviewers generate a descriptive report, which is reviewed by a multidisciplinary expert panel. Outcomes of the review may include mandatory requirements and optional recommendations. Results: 15 institutions have received Novalis Certification, including 3 in the US, 7 in Europe, 4 in Australia and 1 in Asia. 87 other centers are at various stages of the process. Nine reviews have resulted in mandatory requirements, however all of these were addressed within three months of the audit report. All reviews have produced specific recommendations ranging from programmatic to technical in nature. Institutions felt that the credentialing process addressed a critical need and was highly valuable to the institution. Conclusion: Novalis Certification is a unique peer review program assessing safety and quality in SRS and SBRT, while recognizing

  3. A current perspective on stereotactic body radiation therapy for pancreatic cancer

    Directory of Open Access Journals (Sweden)

    Hong JC

    2016-10-01

    Full Text Available Julian C Hong, Brian G Czito, Christopher G Willett, Manisha Palta Department of Radiation Oncology, Duke University, Durham, NC, USA Abstract: Pancreatic cancer is a formidable malignancy with poor outcomes. The majority of patients are unable to undergo resection, which remains the only potentially curative treatment option. The management of locally advanced (unresectable pancreatic cancer is controversial; however, treatment with either chemotherapy or chemoradiation is associated with high rates of local tumor progression and metastases development, resulting in low survival rates. An emerging local modality is stereotactic body radiation therapy (SBRT, which uses image-guided, conformal, high-dose radiation. SBRT has demonstrated promising local control rates and resultant quality of life with acceptable rates of toxicity. Over the past decade, increasing clinical experience and data have supported SBRT as a local treatment modality. Nevertheless, additional research is required to further evaluate the role of SBRT and improve upon the persistently poor outcomes associated with pancreatic cancer. This review discusses the existing clinical experience and technical implementation of SBRT for pancreatic cancer and highlights the directions for ongoing and future studies. Keywords: pancreatic cancer, stereotactic body radiation therapy, SBRT, radiation therapy

  4. Stereotactic Ablative Body Radiation Therapy for Octogenarians With Non-Small Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Takeda, Atsuya; Sanuki, Naoko; Eriguchi, Takahisa [Radiation Oncology Center, Ofuna Chuo Hospital, Kanagawa (Japan); Kaneko, Takeshi [Respiratory Disease Center, Yokohama City University Medical Center, Kanagawa (Japan); Department of Respirology, Ofuna Chuo Hospital, Kanagawa (Japan); Morita, Satoshi [Department of Biostatistics and Epidemiology, Graduate School of Medicine, Yokohama City University, Kanagawa (Japan); Handa, Hiroshi [Respiratory Disease Center, Yokohama City University Medical Center, Kanagawa (Japan); Division of Respiratory and Infectious Diseases, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa (Japan); Aoki, Yousuke; Oku, Yohei [Radiation Oncology Center, Ofuna Chuo Hospital, Kanagawa (Japan); Kunieda, Etsuo, E-mail: kunieda-mi@umin.ac.jp [Department of Radiation Oncology, Tokai University, Kanagawa (Japan)

    2013-06-01

    Purpose: To retrospectively investigate treatment outcomes of stereotactic ablative body radiation therapy (SABR) for octogenarians with non-small cell lung cancer (NSCLC). Methods and Materials: Between 2005 and 2012, 109 patients aged ≥80 years with T1-2N0M0 NSCLC were treated with SABR: 47 patients had histology-unproven lung cancer; 62 patients had pathologically proven NSCLC. The prescribed doses were either 50 Gy/5 fractions for peripheral tumors or 40 Gy/5 fractions for centrally located tumors. The treatment outcomes, toxicities, and the correlating factors for overall survival (OS) were evaluated. Results: The median follow-up duration after SABR was 24.2 (range, 3.0-64.6) months. Only limited toxicities were observed, except for 1 grade 5 radiation pneumonitis. The 3-year local, regional, and distant metastasis-free survival rates were 82.3%, 90.1%, and 76.8%, respectively. The OS and lung cancer-specific survival rates were 53.7% and 70.8%, respectively. Multivariate analysis revealed that medically inoperable, low body mass index, high T stage, and high C-reactive protein were the predictors for short OS. The OS for the operable octogenarians was significantly better than that for inoperable (P<.01). Conclusions: Stereotactic ablative body radiation therapy for octogenarians was feasible, with excellent OS. Multivariate analysis revealed that operability was one of the predictors for OS. For medically operable octogenarians with early-stage NSCLC, SABR should be prospectively compared with resection.

  5. Frame-Based Immobilization and Targeting for Stereotactic Body Radiation Therapy

    International Nuclear Information System (INIS)

    Murray, Bryan C.; Forster, Kenneth; Timmerman, Robert

    2007-01-01

    Frame-based stereotactic body radiation therapy (SBRT), such as that conducted with Elekta's Stereotactic Body Frame, can provide an extra measure of precision in the delivery of radiation to extracranial targets, and facilitates secure patient immobilization. In this paper, we review the steps involved in optimal use of an extra-cranial immobilization device for SBRT treatments. Our approach to using frame-based SBRT consists of 4 steps: patient immobilization, tumor and organ motion control, treatment/planning correlation, and daily targeting with pretreatment quality assurance. Patient immobilization was achieved with the Vac-Loc bag, which uses styrofoam beads to conform to the patient's shape comfortably within the body frame. Organ and motion control was assessed under fluoroscopy and controlled via a frame-mounted abdominal pressure plate. The compression screw was tightened until the diaphragmatic excursion range was < 1 cm. Treatment planning was performed using the Philips Pinnacle 6.2b system. In this treatment process, a 20 to 30 noncoplanar beam arrangement was initially selected and an inverse beam weight optimization algorithm was applied. Those beams with low beam weights were removed, leaving a manageable number of beams for treatment delivery. After planning, daily targeting using computed tomography (CT) to verify x-, y-, and z-coordinates of the treatment isocenter were used as a measure of quality assurance. We found our daily setup variation typically averaged < 5 mm in all directions, which is comparable to other published studies on Stereotactic Body Frame. Treatment time ranged from 30 to 45 minutes. Results demonstrate that patients have experienced high rates of local control with acceptable rates of severe side effects-by virtue of the tightly constrained treatment fields. The body frame facilitated comfortable patient positioning and quality assurance checks of the tumor, in relation to another set of independent set of coordinates

  6. Stereotactic Body Radiation Therapy for Locally Progressive and Recurrent Pancreatic Cancer after Prior Radiation

    Directory of Open Access Journals (Sweden)

    Philip Sutera

    2018-03-01

    Full Text Available IntroductionPancreatic adenocarcinoma is an aggressive malignancy that has consistently demonstrated poor outcomes despite aggressive treatments. Despite multimodal treatment, local disease progression and local recurrence are common. Management of recurrent or progressive pancreatic carcinomas proves a further challenge. In patients previously treated with radiation therapy, stereotactic body radiation therapy (SBRT is a promising modality capable of delivering high dose to the tumor while limiting dose to critical structures. We aimed to determine the feasibility and tolerability of SBRT for recurrent or local pancreatic cancer in patients previously treated with external beam radiation therapy (EBRT.Materials and methodsPatients treated with EBRT who developed recurrent or local pancreatic ductal adenocarcinoma treated with SBRT reirradiation at our institution, from 2004 to 2014 were reviewed. Our primary endpoints included overall survival (OS, local control, regional control, and late grade 3+ radiation toxicity. Endpoints were analyzed with the Kaplan–Meier method. The association of these survival endpoints with risk factors was studied with univariate Cox proportional hazards models.ResultsWe identified 38 patients with recurrent/progressive pancreatic cancer treated with SBRT following prior radiation therapy. Prior radiation was delivered to a median dose of 50.4 Gy in 28 fractions. SBRT was delivered to a median dose of 24.5 Gy in 1–3 fractions. Surgical resection was performed on 55.3% of all patients. Within a median follow-up of 24.4 months (inter-quartile range, 14.9–32.7 months, the median OS from diagnosis for the entire cohort was 26.6 months (95% CI: 20.3–29.8 with 2-year OS of 53.0%. Median survival from SBRT was 9.7 months (95% CI, 5.5–13.8. The 2-year freedom from local progression and regional progression was 58 and 82%, respectively. For the entire cohort, 18.4 and 10.5% experienced late grade 2

  7. Stereotactic Radiosurgery (SRS) / Stereotactic body radiotherapy (SBRT): Benefit to Irish patients and Irish Healthcare Economy

    LENUS (Irish Health Repository)

    Cagney, DN

    2017-01-01

    Cancer incidence across Europe is projected to rise rapidly over the next decade. This rising cancer incidence is mirrored by increasing use of and indications for stereotactic radiation. This paper seeks to summarize the exponential increase in indications for stereotactic radiotherapy as well as the evolving economic advantages of stereotactic radiosurgery and stereotactic body radiotherapy

  8. Stereotactic body radiation therapy versus conventional radiation therapy in patients with early stage non-small cell lung cancer

    DEFF Research Database (Denmark)

    Jeppesen, Stefan Starup; Schytte, Tine; Jensen, Henrik R

    2013-01-01

    Abstract Introduction. Stereotactic body radiation therapy (SBRT) for early stage non-small cell lung cancer (NSCLC) is now an accepted and patient friendly treatment, but still controversy exists about its comparability to conventional radiation therapy (RT). The purpose of this single...... and SBRT predicted improved prognosis. However, staging procedure, confirmation procedure of recurrence and technical improvements of radiation treatment is likely to influence outcomes. However, SBRT seems to be as efficient as conventional RT and is a more convenient treatment for the patients....

  9. A current perspective on stereotactic body radiation therapy for pancreatic cancer.

    Science.gov (United States)

    Hong, Julian C; Czito, Brian G; Willett, Christopher G; Palta, Manisha

    2016-01-01

    Pancreatic cancer is a formidable malignancy with poor outcomes. The majority of patients are unable to undergo resection, which remains the only potentially curative treatment option. The management of locally advanced (unresectable) pancreatic cancer is controversial; however, treatment with either chemotherapy or chemoradiation is associated with high rates of local tumor progression and metastases development, resulting in low survival rates. An emerging local modality is stereotactic body radiation therapy (SBRT), which uses image-guided, conformal, high-dose radiation. SBRT has demonstrated promising local control rates and resultant quality of life with acceptable rates of toxicity. Over the past decade, increasing clinical experience and data have supported SBRT as a local treatment modality. Nevertheless, additional research is required to further evaluate the role of SBRT and improve upon the persistently poor outcomes associated with pancreatic cancer. This review discusses the existing clinical experience and technical implementation of SBRT for pancreatic cancer and highlights the directions for ongoing and future studies.

  10. Outcomes for Spine Stereotactic Body Radiation Therapy and an Analysis of Predictors of Local Recurrence

    International Nuclear Information System (INIS)

    Bishop, Andrew J.; Tao, Randa; Rebueno, Neal C.; Christensen, Eva N.; Allen, Pamela K.; Wang, Xin A.; Amini, Behrang; Tannir, Nizar M.; Tatsui, Claudio E.; Rhines, Laurence D.; Li, Jing; Chang, Eric L.; Brown, Paul D.; Ghia, Amol J.

    2015-01-01

    Purpose: To investigate local control, survival outcomes, and predictors of local relapse for patients treated with spine stereotactic body radiation therapy. Methods and Materials: We reviewed the records of 332 spinal metastases consecutively treated with stereotactic body radiation therapy between 2002 and 2012. The median follow-up for all living patients was 33 months (range, 0-111 months). Endpoints were overall survival and local control (LC); recurrences were classified as either in-field or marginal. Results: The 1-year actuarial LC and overall survival rates were 88% and 64%, respectively. Patients with local relapses had poorer dosimetric coverage of the gross tumor volume (GTV) compared with patients without recurrence (minimum dose [Dmin] biologically equivalent dose [BED] 23.9 vs 35.1 Gy, P<.001; D98 BED 41.8 vs 48.1 Gy, P=.001; D95 BED 47.2 vs 50.5 Gy, P=.004). Furthermore, patients with marginal recurrences had poorer prescription coverage of the GTV (86% vs 93%, P=.01) compared with those with in-field recurrences, potentially because of more upfront spinal canal disease (78% vs 24%, P=.001). Using a Cox regression univariate analysis, patients with a GTV BED Dmin ≥33.4 Gy (median dose) (equivalent to 14 Gy in 1 fraction) had a significantly higher 1-year LC rate (94% vs 80%, P=.001) compared with patients with a lower GTV BED Dmin; this factor was the only significant variable on multivariate Cox analysis associated with LC (P=.001, hazard ratio 0.29, 95% confidence interval 0.14-0.60) and also was the only variable significant in a separate competing risk multivariate model (P=.001, hazard ratio 0.30, 95% confidence interval 0.15-0.62). Conclusions: Stereotactic body radiation therapy offers durable control for spinal metastases, but there is a subset of patients that recur locally. Patients with local relapse had significantly poorer tumor coverage, which was likely attributable to treatment planning directives that prioritized the

  11. Outcomes for Spine Stereotactic Body Radiation Therapy and an Analysis of Predictors of Local Recurrence

    Energy Technology Data Exchange (ETDEWEB)

    Bishop, Andrew J.; Tao, Randa [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Rebueno, Neal C. [Department of Radiation Dosimetry, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Christensen, Eva N.; Allen, Pamela K. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Wang, Xin A. [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Amini, Behrang [Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Tannir, Nizar M. [Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Tatsui, Claudio E.; Rhines, Laurence D. [Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Li, Jing [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Chang, Eric L. [Department of Radiation Oncology, USC Norris Cancer Hospital, Keck School of Medicine of USC, Los Angeles, California (United States); Brown, Paul D. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Ghia, Amol J., E-mail: ajghia@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2015-08-01

    Purpose: To investigate local control, survival outcomes, and predictors of local relapse for patients treated with spine stereotactic body radiation therapy. Methods and Materials: We reviewed the records of 332 spinal metastases consecutively treated with stereotactic body radiation therapy between 2002 and 2012. The median follow-up for all living patients was 33 months (range, 0-111 months). Endpoints were overall survival and local control (LC); recurrences were classified as either in-field or marginal. Results: The 1-year actuarial LC and overall survival rates were 88% and 64%, respectively. Patients with local relapses had poorer dosimetric coverage of the gross tumor volume (GTV) compared with patients without recurrence (minimum dose [Dmin] biologically equivalent dose [BED] 23.9 vs 35.1 Gy, P<.001; D98 BED 41.8 vs 48.1 Gy, P=.001; D95 BED 47.2 vs 50.5 Gy, P=.004). Furthermore, patients with marginal recurrences had poorer prescription coverage of the GTV (86% vs 93%, P=.01) compared with those with in-field recurrences, potentially because of more upfront spinal canal disease (78% vs 24%, P=.001). Using a Cox regression univariate analysis, patients with a GTV BED Dmin ≥33.4 Gy (median dose) (equivalent to 14 Gy in 1 fraction) had a significantly higher 1-year LC rate (94% vs 80%, P=.001) compared with patients with a lower GTV BED Dmin; this factor was the only significant variable on multivariate Cox analysis associated with LC (P=.001, hazard ratio 0.29, 95% confidence interval 0.14-0.60) and also was the only variable significant in a separate competing risk multivariate model (P=.001, hazard ratio 0.30, 95% confidence interval 0.15-0.62). Conclusions: Stereotactic body radiation therapy offers durable control for spinal metastases, but there is a subset of patients that recur locally. Patients with local relapse had significantly poorer tumor coverage, which was likely attributable to treatment planning directives that prioritized the

  12. Pathological vertebral fracture after stereotactic body radiation therapy for lung metastases. Case report and literature review.

    Directory of Open Access Journals (Sweden)

    Rodríguez-Ruiz María

    2012-03-01

    Full Text Available Abstract Background Stereotactic body radiation therapy (SBRT is a radiation technique used in patients with oligometastatic lung disease. Lung and chest wall toxicities have been described in the patients but pathological vertebral fracture is an adverse effect no reported in patients treated with SBRT for lung metastases. Case presentation A 68-year-old woman with the diagnosis of a recurrence of a single lung metastatic nodule of urothelial carcinoma after third line of chemotherapy. The patient received a hypo-fractionated course of SBRT.A 3D-conformal multifield technique was used with six coplanar and one non-coplanar statics beams. A total dose of 48 Gy in three fractions over six days was prescribed to the 95% of the CTV. Ten months after the SBRT procedure, a CT scan showed complete response of the metastatic disease without signs of radiation pneumonitis. However, rib and vertebral bone toxicities were observed with the fracture-collapse of the 7th and 8th vertebral bodies and a fracture of the 7th and 8th left ribs. We report a unique case of pathological vertebral fracture appearing ten months after SBRT for an asymptomatic growing lung metastases of urothelial carcinoma. Conclusion Though SBRT allows for minimization of normal tissue exposure to high radiation doses SBRT tolerance for vertebral bone tissue has been poorly evaluated in patients with lung tumors. Oncologists should be alert to the potential risk of fatal bone toxicity caused by this novel treatment. We recommend BMD testing in all woman over 65 years old with clinical risk factors that could contribute to low BMD. If low BMD is demonstrated, we should carefully restrict the maximum radiation dose in the vertebral body in order to avoid intermediate or low radiation dose to the whole vertebral body.

  13. Quality of Life After Stereotactic Body Radiation Therapy for Primary and Metastatic Liver Tumors

    International Nuclear Information System (INIS)

    Mendez Romero, Alejandra; Wunderink, Wouter; Os, Rob M. van; Nowak, Peter J.C.M.; Heijmen, Ben J.M.; Nuyttens, Joost J.; Brandwijk, Rene P.; Verhoef, Cornelis; IJzermans, Jan N.M.; Levendag, Peter C.

    2008-01-01

    Purpose: Stereotactic body radiation therapy (SBRT) provides a high local control rate for primary and metastatic liver tumors. The aim of this study is to assess the impact of this treatment on the patient's quality of life. This is the first report of quality of life associated with liver SBRT. Methods and Materials: From October 2002 to March 2007, a total of 28 patients not suitable for other local treatments and with Karnofsky performance status of at least 80% were entered in a Phase I-II study of SBRT for liver tumors. Quality of life was a secondary end point. Two generic quality of life instruments were investigated, EuroQol-5D (EQ-5D) and EuroQoL-Visual Analogue Scale (EQ-5D VAS), in addition to a disease-specific questionnaire, the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ C-30). Points of measurement were directly before and 1, 3, and 6 months after treatment. Mean scores and SDs were calculated. Statistical analysis was performed using paired-samples t-test and Student t-test. Results: The calculated EQ-5D index, EQ-5D VAS and QLQ C-30 global health status showed that mean quality of life of the patient group was not significantly influenced by treatment with SBRT; if anything, a tendency toward improvement was found. Conclusions: Stereotactic body radiation therapy combines a high local control rate, by delivering a high dose per fraction, with no significant change in quality of life. Multicenter studies including larger numbers of patients are recommended and under development

  14. Stereotactic Body Radiation Therapy as an Alternative to Transarterial Chemoembolization for Hepatocellular Carcinoma.

    Science.gov (United States)

    Sapir, Eli; Tao, Yebin; Schipper, Matthew J; Bazzi, Latifa; Novelli, Paula M; Devlin, Pauline; Owen, Dawn; Cuneo, Kyle C; Lawrence, Theodore S; Parikh, Neehar D; Feng, Mary

    2018-01-01

    To conduct a large single-institution comparison of transarterial chemoembolization (TACE) and stereotactic body radiation therapy (SBRT) outcomes in similar groups of patients with hepatocellular carcinoma (HCC). From 2006 to 2014, 209 patients with 1 to 2 tumors underwent TACE (n=84) to 114 tumors or image guided SBRT (n=125) to 173 tumors. Propensity score analysis with inverse probability of treatment weighting was used to compare outcomes between treatments while adjusting for imbalances in treatment assignment. Local control (LC), toxicity, and overall survival (OS) were retrospectively analyzed. The TACE and SBRT groups were similar with respect to the number of tumors treated per patient, underlying liver disease, and baseline liver function. Patients treated with SBRT were older (65 vs 61 years, P=.01), had smaller tumors (2.3 vs 2.9 cm, P<.001), and less frequently underwent liver transplantation (8% vs 18%, P=.01). The 1- and 2-year LC favored SBRT: 97% and 91%, respectively, for SBRT and 47% and 23% for TACE (hazard ratio 66.5, P<.001). For patients treated with TACE, higher alpha-fetoprotein (hazard ratio 1.11 per doubling, P=.008) and segmental portal vein thrombosis (hazard ratio 9.9, P<.001) were associated with worse LC. Predictors associated with LC after SBRT were not identified. Grade 3+ toxicity occurred after 13% and 8% of TACE and SBRT treatments, respectively (P=.05). There was no difference in OS between patients treated with TACE or SBRT. Stereotactic body radiation therapy is a safe alternative to TACE for 1 to 2 tumors and provides better LC, with no observed difference in OS. Prospective comparative trials of TACE and SBRT are warranted. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. A comparison of robotic arm versus gantry linear accelerator stereotactic body radiation therapy for prostate cancer.

    Science.gov (United States)

    Avkshtol, Vladimir; Dong, Yanqun; Hayes, Shelly B; Hallman, Mark A; Price, Robert A; Sobczak, Mark L; Horwitz, Eric M; Zaorsky, Nicholas G

    2016-01-01

    Prostate cancer is the most prevalent cancer diagnosed in men in the United States besides skin cancer. Stereotactic body radiation therapy (SBRT; 6-15 Gy per fraction, up to 45 minutes per fraction, delivered in five fractions or less, over the course of approximately 2 weeks) is emerging as a popular treatment option for prostate cancer. The American Society for Radiation Oncology now recognizes SBRT for select low- and intermediate-risk prostate cancer patients. SBRT grew from the notion that high doses of radiation typical of brachytherapy could be delivered noninvasively using modern external-beam radiation therapy planning and delivery methods. SBRT is most commonly delivered using either a traditional gantry-mounted linear accelerator or a robotic arm-mounted linear accelerator. In this systematic review article, we compare and contrast the current clinical evidence supporting a gantry vs robotic arm SBRT for prostate cancer. The data for SBRT show encouraging and comparable results in terms of freedom from biochemical failure (>90% for low and intermediate risk at 5-7 years) and acute and late toxicity (6 MV). Finally, SBRT (particularly on a gantry) may also be more cost-effective than conventionally fractionated external-beam radiation therapy. Randomized controlled trials of SBRT using both technologies are underway.

  16. Hematuria following stereotactic body radiation therapy (SBRT) for clinically localized prostate cancer

    International Nuclear Information System (INIS)

    Gurka, Marie K; Chen, Leonard N; Bhagat, Aditi; Moures, Rudy; Kim, Joy S; Yung, Thomas; Lei, Siyuan; Collins, Brian T; Krishnan, Pranay; Suy, Simeng; Dritschilo, Anatoly; Lynch, John H; Collins, Sean P

    2015-01-01

    Hematuria following prostate radiotherapy is a known toxicity that may adversely affect a patient’s quality of life. Given the higher dose of radiation per fraction using stereotactic body radiation therapy (SBRT) there is concern that post-SBRT hematuria would be more common than with alternative radiation therapy approaches. Herein, we describe the incidence and severity of hematuria following stereotactic body radiation therapy (SBRT) for prostate cancer at our institution. Two hundred and eight consecutive patients with prostate cancer treated with SBRT monotherapy with at least three years of follow-up were included in this retrospective analysis. Treatment was delivered using the CyberKnife® (Accuray) to doses of 35–36.25 Gy in 5 fractions. Toxicities were scored using the CTCAE v.4. Hematuria was counted at the highest grade it occurred in the acute and late setting for each patient. Cystoscopy findings were retrospectively reviewed. Univariate and multivariate analyses were performed. Hematuria-associated bother was assessed via the Expanded Prostate Index Composite (EPIC)-26. The median age was 69 years with a median prostate volume of 39 cc. With a median follow-up of 48 months, 38 patients (18.3%) experienced at least one episode of hematuria. Median time to hematuria was 13.5 months. In the late period, there were three grade 3 events and five grade 2 events. There were no grade 4 or 5 events. The 3-year actuarial incidence of late hematuria ≥ grade 2 was 2.4%. On univariate analysis, prostate volume (p = 0.022) and history of prior procedure(s) for benign prostatic hypertrophy (BPH) (p = 0.002) were significantly associated with hematuria. On multivariate analysis, history of prior procedure(s) for BPH (p < 0.0001) and α 1A antagonist use (p = 0.008) were significantly associated with the development of hematuria. SBRT for prostate cancer was well tolerated with hematuria rates comparable to other radiation modalities. Patients factors

  17. Stereotactic body radiation therapy (S.B.R.T.) for early-stage lung cancer

    International Nuclear Information System (INIS)

    Hiraok, M.; Matsuo, Y.; Nagata, Y.

    2007-01-01

    Stereotactic body radiation therapy (SBRT) is a new treatment modality for early stage non-small-cell lung cancer, and has been developed in the United States, the European Union, and Japan. We started a feasibility study of this therapy in July 1998, using a stereotactic body frame. The eligibility criteria for primary lung cancer were: 1) solitary tumor less than 4 cm (T1-3NOM); 2) inoperable, or the patient refused operation; 3) no necessity for oxygen support; 4) performance status equal to or less than 2; 5) the peripheral tumor which dose constraints of mediastinal organs are maintained. A total dose of 48 Gy was delivered in four fractions in 2 weeks in most patients. Lung toxicity was minimal. No grade II toxicities for spinal cord, bronchus, pulmonary artery, or esophagus were observed. The 3 years overall survival for 32 patients with stage IA, and 13 patients with stage IB were 83% and 72%, respectively. Only one local recurrence was observed in a follow-up of 6 1 months. We retrospectively analyzed 241 patients from 13 Japanese institutions. The local recurrence rate was 20% when the biological equivalent dose (BED) was less than 100 Gy, and 6.5% when the BED was over 100 Gy. Overall survival at 3 years was 42% when the BED was less than 100 Gy, and 46% when it was over 100 Gy. In tumors, which received a BED of more than 100 Gy, overall survival at 3 years was 91% for operable patients, and 50% for inoperable patients. Long-term results, in terms of local control, regional recurrence, survival, and complications, are not yet evaluated. However, this treatment modality is highly expected to be a standard treatment for inoperable patients, and it may be an alternative to lobectomy for operative patients. A prospective trial, which is now ongoing, will, answer these questions. (author)

  18. 4π Noncoplanar Stereotactic Body Radiation Therapy for Centrally Located or Larger Lung Tumors

    International Nuclear Information System (INIS)

    Dong, Peng; Lee, Percy; Ruan, Dan; Long, Troy; Romeijn, Edwin; Low, Daniel A.; Kupelian, Patrick; Abraham, John; Yang, Yingli; Sheng, Ke

    2013-01-01

    Purpose: To investigate the dosimetric improvements in stereotactic body radiation therapy for patients with larger or central lung tumors using a highly noncoplanar 4π planning system. Methods and Materials: This study involved 12 patients with centrally located or larger lung tumors previously treated with 7- to 9-field static beam intensity modulated radiation therapy to 50 Gy. They were replanned using volumetric modulated arc therapy and 4π plans, in which a column generation method was used to optimize the beam orientation and the fluence map. Maximum doses to the heart, esophagus, trachea/bronchus, and spinal cord, as well as the 50% isodose volume, the lung volumes receiving 20, 10, and 5 Gy were minimized and compared against the clinical plans. A dose escalation study was performed to determine whether a higher prescription dose to the tumor would be achievable using 4π without violating dose limits set by the clinical plans. The deliverability of 4π plans was preliminarily tested. Results: Using 4π plans, the maximum heart, esophagus, trachea, bronchus and spinal cord doses were reduced by 32%, 72%, 37%, 44%, and 53% (P≤.001), respectively, and R 50 was reduced by more than 50%. Lung V 20 , V 10 , and V 5 were reduced by 64%, 53%, and 32% (P≤.001), respectively. The improved sparing of organs at risk was achieved while also improving planning target volume (PTV) coverage. The minimal PTV doses were increased by the 4π plans by 12% (P=.002). Consequently, escalated PTV doses of 68 to 70 Gy were achieved in all patients. Conclusions: We have shown that there is a large potential for plan quality improvement and dose escalation for patients with larger or centrally located lung tumors using noncoplanar beams with sufficient quality and quantity. Compared against the clinical volumetric modulated arc therapy and static intensity modulated radiation therapy plans, the 4π plans yielded significantly and consistently improved tumor coverage and

  19. 4π Noncoplanar Stereotactic Body Radiation Therapy for Centrally Located or Larger Lung Tumors

    Energy Technology Data Exchange (ETDEWEB)

    Dong, Peng; Lee, Percy; Ruan, Dan [Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California (United States); Long, Troy; Romeijn, Edwin [Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan (United States); Low, Daniel A.; Kupelian, Patrick; Abraham, John; Yang, Yingli [Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California (United States); Sheng, Ke, E-mail: ksheng@mednet.ucla.edu [Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California (United States)

    2013-07-01

    Purpose: To investigate the dosimetric improvements in stereotactic body radiation therapy for patients with larger or central lung tumors using a highly noncoplanar 4π planning system. Methods and Materials: This study involved 12 patients with centrally located or larger lung tumors previously treated with 7- to 9-field static beam intensity modulated radiation therapy to 50 Gy. They were replanned using volumetric modulated arc therapy and 4π plans, in which a column generation method was used to optimize the beam orientation and the fluence map. Maximum doses to the heart, esophagus, trachea/bronchus, and spinal cord, as well as the 50% isodose volume, the lung volumes receiving 20, 10, and 5 Gy were minimized and compared against the clinical plans. A dose escalation study was performed to determine whether a higher prescription dose to the tumor would be achievable using 4π without violating dose limits set by the clinical plans. The deliverability of 4π plans was preliminarily tested. Results: Using 4π plans, the maximum heart, esophagus, trachea, bronchus and spinal cord doses were reduced by 32%, 72%, 37%, 44%, and 53% (P≤.001), respectively, and R{sub 50} was reduced by more than 50%. Lung V{sub 20}, V{sub 10}, and V{sub 5} were reduced by 64%, 53%, and 32% (P≤.001), respectively. The improved sparing of organs at risk was achieved while also improving planning target volume (PTV) coverage. The minimal PTV doses were increased by the 4π plans by 12% (P=.002). Consequently, escalated PTV doses of 68 to 70 Gy were achieved in all patients. Conclusions: We have shown that there is a large potential for plan quality improvement and dose escalation for patients with larger or centrally located lung tumors using noncoplanar beams with sufficient quality and quantity. Compared against the clinical volumetric modulated arc therapy and static intensity modulated radiation therapy plans, the 4π plans yielded significantly and consistently improved tumor

  20. Stereotactic body radiation therapy for reirradiation of localized adenocarcinoma of the pancreas

    Directory of Open Access Journals (Sweden)

    Lominska Chris E

    2012-05-01

    Full Text Available Abstract Background Local control rates are poor in the treatment of pancreatic cancer. We investigated the role of hypofractionated stereotactic body radiation therapy (SBRT for salvage or boost treatment after conventional doses of external beam radiation therapy. Methods All patients treated with SBRT for pancreatic adenocarcinoma at Georgetown University from June 2002 through July 2007 were examined. Eligible patients had prior external beam radiation therapy to the pancreas. Treatment parameters and clinical and radiographic follow-up were evaluated. Results Twenty-eight patients were identified who received SBRT after a median prior external beam radiotherapy dose of 50.4 Gy. The median patient age was 63 years old and the median follow-up was 5.9 months. Twelve of fourteen (85.7% evaluable patients were free from local progression, with three partial responses and nine patients with stable disease. Toxicity consisted of one case of acute Grade II nausea/vomiting, and two cases of Grade III late GI toxicity. The median overall survival was 5.9 months, with 18% survival and 70% freedom from local progression at one year. Conclusions Hypofractionated SBRT reirradiation of localized pancreatic cancer is a well-tolerated treatment. Most patients are free from local progression, albeit with limited follow-up, but overall survival remains poor.

  1. Compton scatter imaging: A promising modality for image guidance in lung stereotactic body radiation therapy.

    Science.gov (United States)

    Redler, Gage; Jones, Kevin C; Templeton, Alistair; Bernard, Damian; Turian, Julius; Chu, James C H

    2018-03-01

    Lung stereotactic body radiation therapy (SBRT) requires delivering large radiation doses with millimeter accuracy, making image guidance essential. An approach to forming images of patient anatomy from Compton-scattered photons during lung SBRT is presented. To investigate the potential of scatter imaging, a pinhole collimator and flat-panel detector are used for spatial localization and detection of photons scattered during external beam therapy using lung SBRT treatment conditions (6 MV FFF beam). MCNP Monte Carlo software is used to develop a model to simulate scatter images. This model is validated by comparing experimental and simulated phantom images. Patient scatter images are then simulated from 4DCT data. Experimental lung tumor phantom images have sufficient contrast-to-noise to visualize the tumor with as few as 10 MU (0.5 s temporal resolution). The relative signal intensity from objects of different composition as well as lung tumor contrast for simulated phantom images agree quantitatively with experimental images, thus validating the Monte Carlo model. Scatter images are shown to display high contrast between different materials (lung, water, bone). Simulated patient images show superior (~double) tumor contrast compared to MV transmission images. Compton scatter imaging is a promising modality for directly imaging patient anatomy during treatment without additional radiation, and it has the potential to complement existing technologies and aid tumor tracking and lung SBRT image guidance. © 2018 American Association of Physicists in Medicine.

  2. Indirect Tumor Cell Death After High-Dose Hypofractionated Irradiation: Implications for Stereotactic Body Radiation Therapy and Stereotactic Radiation Surgery

    Energy Technology Data Exchange (ETDEWEB)

    Song, Chang W., E-mail: songx001@umn.edu [Department of Therapeutic Radiology-Radiation Oncology, University of Minnesota Medical School, Minneapolis, Minnesota (United States); Korea Institute of Radiological and Medical Sciences, Seoul (Korea, Republic of); Lee, Yoon-Jin [Korea Institute of Radiological and Medical Sciences, Seoul (Korea, Republic of); Griffin, Robert J. [Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas (United States); Park, Inhwan [Department of Therapeutic Radiology-Radiation Oncology, University of Minnesota Medical School, Minneapolis, Minnesota (United States); Koonce, Nathan A. [Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas (United States); Hui, Susanta [Department of Therapeutic Radiology-Radiation Oncology, University of Minnesota Medical School, Minneapolis, Minnesota (United States); Kim, Mi-Sook [Korea Institute of Radiological and Medical Sciences, Seoul (Korea, Republic of); Dusenbery, Kathryn E. [Department of Therapeutic Radiology-Radiation Oncology, University of Minnesota Medical School, Minneapolis, Minnesota (United States); Sperduto, Paul W. [Minneapolis Radiation Oncology and Gamma Knife Center, University of Minnesota, Minneapolis, Minnesota (United States); Cho, L. Chinsoo [Department of Therapeutic Radiology-Radiation Oncology, University of Minnesota Medical School, Minneapolis, Minnesota (United States)

    2015-09-01

    Purpose: The purpose of this study was to reveal the biological mechanisms underlying stereotactic body radiation therapy (SBRT) and stereotactic radiation surgery (SRS). Methods and Materials: FSaII fibrosarcomas grown subcutaneously in the hind limbs of C3H mice were irradiated with 10 to 30 Gy of X rays in a single fraction, and the clonogenic cell survival was determined with in vivo–in vitro excision assay immediately or 2 to 5 days after irradiation. The effects of radiation on the intratumor microenvironment were studied using immunohistochemical methods. Results: After cells were irradiated with 15 or 20 Gy, cell survival in FSaII tumors declined for 2 to 3 days and began to recover thereafter in some but not all tumors. After irradiation with 30 Gy, cell survival declined continuously for 5 days. Cell survival in some tumors 5 days after 20 to 30 Gy irradiation was 2 to 3 logs less than that immediately after irradiation. Irradiation with 20 Gy markedly reduced blood perfusion, upregulated HIF-1α, and increased carbonic anhydrase-9 expression, indicating that irradiation increased tumor hypoxia. In addition, expression of VEGF also increased in the tumor tissue after 20 Gy irradiation, probably due to the increase in HIF-1α activity. Conclusions: Irradiation of FSaII tumors with 15 to 30 Gy in a single dose caused dose-dependent secondary cell death, most likely by causing vascular damage accompanied by deterioration of intratumor microenvironment. Such indirect tumor cell death may play a crucial role in the control of human tumors with SBRT and SRS.

  3. Phase 1 Clinical Trial of Stereotactic Body Radiation Therapy Concomitant With Neoadjuvant Chemotherapy for Breast Cancer

    International Nuclear Information System (INIS)

    Bondiau, Pierre-Yves; Courdi, Adel; Bahadoran, Phillipe; Chamorey, Emmanuel; Queille-Roussel, Catherine; Lallement, Michel; Birtwisle-Peyrottes, Isabelle; Chapellier, Claire; Pacquelet-Cheli, Sandrine; Ferrero, Jean-Marc

    2013-01-01

    Purpose: Stereotactic body radiation therapy (SBRT) allows stereotactic irradiation of thoracic tumors. It may have a real impact on patients who may not otherwise qualify for breast-conserving surgery. We conducted a phase 1 trial that tested 5 dose levels of SBRT concomitant with neoadjuvant chemotherapy (NACT) before to surgery. The purpose of the current dose escalation study was to determine the maximum tolerable dose of SBRT in the treatment of breast cancer. Methods and Materials: To define toxicity, we performed dermatologic examinations that included clinical examinations by 2 separate physicians and technical evaluations using colorimetry, dermoscopy, and skin ultrasonography. Dermatologic examinations were performed before NACT, 36 and 56 days after the beginning of NACT, and before surgery. Surgery was performed 4 to 8 weeks after the last chemotherapy session. Efficacy, the primary endpoint, was determined by the pathologic complete response (pCR) rate. Results: Maximum tolerable dose was not reached. Only 1 case of dose-limiting toxicity was reported (grade 3 dermatologic toxicity), and SBRT was overall well tolerated. The pCR rate was 36%, with none being observed at the first 2 dose levels, and the highest rate being obtained at dose level 3 (25.5 Gy delivered in 3 fractions). Furthermore, the breast-conserving surgery rate was up to 92% compared with an 8% total mastectomy rate. No surgical complications were reported. Conclusions: This study demonstrates that SBRT can be safely combined with NACT. Regarding the efficacy endpoints, this trial showed promising results in terms of pCR rate (36%) and breast-conserving rate (92%). The findings provide a strong rationale for extending the study into a phase 2 trial. In view of the absence of correlation between dose and pCR, and given that the data from dose level 3 met the statistical requirements, a dose of 25.5 Gy in 3 fractions should be used for the phase 2 trial

  4. Phase 1 Clinical Trial of Stereotactic Body Radiation Therapy Concomitant With Neoadjuvant Chemotherapy for Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Bondiau, Pierre-Yves, E-mail: pierre-yves.bondiau@nice.unicancer.fr [Department of Radiotherapy, Centre Antoine Lacassagne, Nice (France); Courdi, Adel [Department of Radiotherapy, Centre Antoine Lacassagne, Nice (France); Bahadoran, Phillipe [Department of Dermatology, University Hospital of Nice, Nice (France); Chamorey, Emmanuel [Department of Radiotherapy, Centre Antoine Lacassagne, Nice (France); Queille-Roussel, Catherine [Centre de Pharmacologie Clinique Appliquée à la Dermatologie, Nice (France); Lallement, Michel; Birtwisle-Peyrottes, Isabelle; Chapellier, Claire; Pacquelet-Cheli, Sandrine; Ferrero, Jean-Marc [Department of Radiotherapy, Centre Antoine Lacassagne, Nice (France)

    2013-04-01

    Purpose: Stereotactic body radiation therapy (SBRT) allows stereotactic irradiation of thoracic tumors. It may have a real impact on patients who may not otherwise qualify for breast-conserving surgery. We conducted a phase 1 trial that tested 5 dose levels of SBRT concomitant with neoadjuvant chemotherapy (NACT) before to surgery. The purpose of the current dose escalation study was to determine the maximum tolerable dose of SBRT in the treatment of breast cancer. Methods and Materials: To define toxicity, we performed dermatologic examinations that included clinical examinations by 2 separate physicians and technical evaluations using colorimetry, dermoscopy, and skin ultrasonography. Dermatologic examinations were performed before NACT, 36 and 56 days after the beginning of NACT, and before surgery. Surgery was performed 4 to 8 weeks after the last chemotherapy session. Efficacy, the primary endpoint, was determined by the pathologic complete response (pCR) rate. Results: Maximum tolerable dose was not reached. Only 1 case of dose-limiting toxicity was reported (grade 3 dermatologic toxicity), and SBRT was overall well tolerated. The pCR rate was 36%, with none being observed at the first 2 dose levels, and the highest rate being obtained at dose level 3 (25.5 Gy delivered in 3 fractions). Furthermore, the breast-conserving surgery rate was up to 92% compared with an 8% total mastectomy rate. No surgical complications were reported. Conclusions: This study demonstrates that SBRT can be safely combined with NACT. Regarding the efficacy endpoints, this trial showed promising results in terms of pCR rate (36%) and breast-conserving rate (92%). The findings provide a strong rationale for extending the study into a phase 2 trial. In view of the absence of correlation between dose and pCR, and given that the data from dose level 3 met the statistical requirements, a dose of 25.5 Gy in 3 fractions should be used for the phase 2 trial.

  5. MO-B-201-00: Motion Management in Current Stereotactic Body Radiation Therapy (SBRT) Practice

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2016-06-15

    The motion management in stereotactic body radiation therapy (SBRT) is a key to success for a SBRT program, and still an on-going challenging task. A major factor is that moving structures behave differently than standing structures when examined by imaging modalities, and thus require special considerations and employments. Understanding the motion effects to these different imaging processes is a prerequisite for a decent motion management program. The commonly used motion control techniques to physically restrict tumor motion, if adopted correctly, effectively increase the conformity and accuracy of hypofractionated treatment. The effective application of such requires one to understand the mechanics of the application and the related physiology especially related to respiration. The image-guided radiation beam control, or tumor tracking, further realized the endeavor for precision-targeting. During tumor tracking, the respiratory motion is often constantly monitored by non-ionizing beam sources using the body surface as its surrogate. This then has to synchronize with the actual internal tumor motion. The latter is often accomplished by stereo X-ray imaging or similar techniques. With these advanced technologies, one may drastically reduce the treated volume and increase the clinicians’ confidence for a high fractional ablative radiation dose. However, the challenges in implementing the motion management may not be trivial and is dependent on each clinic case. This session of presentations is intended to provide an overview of the current techniques used in managing the tumor motion in SBRT, specifically for routine lung SBRT, proton based treatments, and newly-developed MR guided RT. Learning Objectives: Through this presentation, the audience will understand basic roles of commonly used imaging modalities for lung cancer studies; familiarize the major advantages and limitations of each discussed motion control methods; familiarize the major advantages and

  6. Dose impact of a carbon fiber couch for stereotactic body radiation therapy of lung tumors

    International Nuclear Information System (INIS)

    Tominaga, Hirofumi; Kanetake, Nagisa; Kawasaki, Keiichi; Iwashita, Yuki; Sakata, Junichi; Okuda, Tomoko; Araki, Fujio; Shimohigashi, Yoshinobu; Tomiyama, Yuki

    2013-01-01

    The aim of this study was to measure the dose attenuation caused by a carbon fiber radiation therapy table (Imaging Couch Top; ICT, BrainLab) and to evaluate the dosimetric impact of ICT during stereotactic body radiation therapy (SBRT) in lung tumors. The dose attenuation of ICT was measured using an ionization chamber and modeled by means of a treatment planning system (TPS). SBRT was planned with and without ICT in a lung tumor phantom and ten cases of clinical lung tumors. The results were analyzed from isocenter doses and a dose-volume histogram (DVH): D 95 , D mean , V 20 , V 5 , homogeneity index (HI), and conformity index (CI). The dose attenuation of the ICT modeled with TPS agreed to within ±1% of the actually measured values. The isocenter doses, D 95 and D mean with and without ICT showed differences of 4.1-5% for posterior single field and three fields in the phantom study, and differences of 0.6-2.4% for five fields and rotation in the phantom study and six fields in ten clinical cases. The dose impact of ICT was not significant for five or more fields in SBRT. It is thus possible to reduce the dose effect of ICT by modifying the beam angle and beam weight in the treatment plan. (author)

  7. Cyberknife Stereotactic Body Radiation Therapy for Nonresectable Tumors of the Liver: Preliminary Results

    Directory of Open Access Journals (Sweden)

    K. Goyal

    2010-01-01

    Full Text Available Purpose. Stereotactic body radiation therapy (SBRT has emerged as a treatment option for local tumor control of primary and secondary malignancies of the liver. We report on our updated experience with SBRT in patients with non-resectable tumors of the liver. Methods. Our first 17 consecutive patients (mean age 58.1 years receiving SBRT for HCC (=6, IHC (=3, and LM (=8 are presented. Mean radiation dose was 34Gy delivered over 1–3 fractions. Results. Treated patients had a mean decrease in maximum pretreatment tumor diameter from 6.9±4.6 cm to 5.0±2.1 cm at three months after treatment (<.05. The mean total tumor volume reduction was 44% at six months (<.05. 82% of all patients (14/17 achieved local control with a median follow-up of 8 months. 100% of patients with HCC (=6 achieved local control. Patients with surgically placed fiducial markers had no complications related to marker placement. Conclusion. Our preliminary results showed that SBRT is a safe and effective local treatment modality in selected patients with liver malignancies with minimal adverse events. Further studies are needed to define its role in the management of these malignancies.

  8. Delayed esophageal perforation from stereotactic body radiation therapy for locally recurrent central nonsmall cell lung cancer

    Directory of Open Access Journals (Sweden)

    Sandeep Sainathan

    2014-01-01

    Full Text Available Stereotactic body radiation therapy (SBRT is a novel form of external beam radiation therapy. It is used to treat early and locally recurrent nonsmall cell lung cancer (NSLC in medically inoperable patients. It uses high dose, hypofractionated radiotherapy, with targeting of the tumor by precise spatial localization, thus minimizing injury to surrounding tissues. It can be safely used to ablate NSLC in both central and peripheral locations. We present two cases of delayed esophageal perforation after SBRT for locally recurrent central NSLC. The perforations occurred several months after the therapy. They were treated with covered esophageal stents, with mortality, due to the perforation in one of the patients. SBRT should be judiciously used to ablate centrally located NSLC and patients who develop episodes of esophagitis during or after SBRT, need to be closely followed with endoscopy to look for esophageal ulcerations. These ulcers should be closely followed for healing as these may degenerate into full thickness perforations several months after SBRT.

  9. Obesity Increases the Risk of Chest Wall Pain From Thoracic Stereotactic Body Radiation Therapy

    International Nuclear Information System (INIS)

    Welsh, James; Thomas, Jimmy; Shah, Deep; Allen, Pamela K.; Wei, Xiong; Mitchell, Kevin; Gao, Song; Balter, Peter; Komaki, Ritsuko; Chang, Joe Y.

    2011-01-01

    Purpose: Stereotactic body radiation therapy (SBRT) is increasingly being used to treat thoracic tumors. We attempted here to identify dose-volume parameters that predict chest wall toxicity (pain and skin reactions) in patients receiving thoracic SBRT. Patients and Methods: We screened a database of patients treated with SBRT between August 2004 and August 2008 to find patients with pulmonary tumors within 2.5 cm of the chest wall. All patients received a total dose of 50 Gy in four daily 12.5-Gy fractions. Toxicity was scored according to the NCI-CTCAE V3.0. Results: Of 360 patients in the database, 265 (268 tumors) had tumors within 30 , or volume of the chest wall receiving 30 Gy. Body mass index (BMI) was also strongly associated with the development of chest pain: patients with BMI ≥29 had almost twice the risk of chronic pain (p = 0.03). Among patients with BMI >29, diabetes mellitus was a significant contributing factor to the development of chest pain. Conclusion: Safe use of SBRT with 50 Gy in four fractions for lesions close to the chest wall requires consideration of the chest wall volume receiving 30 Gy and the patient's BMI and diabetic state.

  10. Cost-Effectiveness of Surgery, Stereotactic Body Radiation Therapy, and Systemic Therapy for Pulmonary Oligometastases

    Energy Technology Data Exchange (ETDEWEB)

    Lester-Coll, Nataniel H., E-mail: nataniel.lester-coll@yale.edu [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States); Rutter, Charles E.; Bledsoe, Trevor J. [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States); Goldberg, Sarah B. [Department of Medicine (Medical Oncology), Yale University School of Medicine, New Haven, Connecticut (United States); Decker, Roy H.; Yu, James B. [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut (United States)

    2016-06-01

    Introduction: Pulmonary oligometastases have conventionally been managed with surgery and/or systemic therapy. However, given concerns about the high cost of systemic therapy and improvements in local treatment of metastatic cancer, the optimal cost-effective management of these patients is unclear. Therefore, we sought to assess the cost-effectiveness of initial management strategies for pulmonary oligometastases. Methods and Materials: A cost-effectiveness analysis using a Markov modeling approach was used to compare average cumulative costs, quality adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) among 3 initial disease management strategies: video-assisted thoracic surgery (VATS) wedge resection, stereotactic body radiation therapy (SBRT), and systemic therapy among 5 different cohorts of patient disease: (1) melanoma; (2) non-small cell lung cancer adenocarcinoma without an EGFR mutation (NSCLC AC); (3) NSCLC with an EGFR mutation (NSCLC EGFRm AC); (4) NSCLC squamous cell carcinoma (NSCLC SCC); and (5) colon cancer. One-way sensitivity analyses and probabilistic sensitivity analyses were performed to analyze uncertainty with regard to model parameters. Results: In the base case, SBRT was cost effective for melanoma, with costs/net QALYs of $467,787/0.85. In patients with NSCLC, the most cost-effective strategies were SBRT for AC ($156,725/0.80), paclitaxel/carboplatin for SCC ($123,799/0.48), and erlotinib for EGFRm AC ($147,091/1.90). Stereotactic body radiation therapy was marginally cost-effective for EGFRm AC compared to erlotinib with an incremental cost-effectiveness ratio of $126,303/QALY. For colon cancer, VATS wedge resection ($147,730/2.14) was the most cost-effective strategy. Variables with the greatest influence in the model were erlotinib-associated progression-free survival (EGFRm AC), toxicity (EGFRm AC), cost of SBRT (NSCLC SCC), and patient utilities (all histologies). Conclusions: Video-assisted thoracic

  11. Low Incidence of Fatigue after Hypofractionated Stereotactic Body Radiation Therapy (SBRT for Localized Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Chiranjeev eDash

    2012-10-01

    Full Text Available Background: Fatigue is a common side-effect of conventional prostate cancer radiation therapy. The increased delivery precision necessitated by the high dose per fraction of stereotactic body radiation therapy (SBRT offers the potential of reduce target volumes and hence the exposure of normal tissues to high radiation doses. Herein, we examine the level of fatigue associated with SBRT treatment.Methods: Forty patients with localized prostate cancer treated with hypofractionated SBRT, and a minimum of 12 months follow-up were included in this analysis. Self-reported fatigue and other quality of life measures were assessed at baseline and at 1, 3, 6, 9, and 12 months post-SBRT.Results: Mean levels of fatigue were elevated at 1 month post-SBRT compared to baseline values (p=0.02. Fatigue at the 3-month follow-up and later were higher but not statistically significantly different compared to baseline. African-American patients reported higher fatigue post-SBRT than Caucasian patients. Fatigue was correlated with hormonal symptoms as measured by the Expanded Prostate Cancer Index Composite (EPIC quality of life questionnaire, but not with urinary, bowel, or sexual symptoms. Age, co-morbidities, smoking, prostate specific antigen (PSA levels, testosterone levels, and tumor stage were not associated with fatigue. Conclusion: This is the first study to investigate fatigue as a side-effect of SBRT. In contrast to standard radiation therapy, results suggest SBRT-related fatigue is short-term rather than a long-term side effect of SBRT. These results also suggest post-SBRT fatigue to be a more frequent complication in African-Americans than Caucasians.

  12. Stereotactic body radiation therapy (SBRT) in the treatment of liver metastases: State of the art

    International Nuclear Information System (INIS)

    De Bari, B.; Guillet, M.; Mornex, F.

    2011-01-01

    Liver metastases are frequently found in oncologic patients. Chemotherapy is the standard treatment in pluri-metastatic patients, with the possibility to obtain a clear improvement of their prognosis. Local treatment (surgery, radiofrequency, cryo-therapy, radiotherapy, etc.) could be proposed for oligo-metastatic patients, particularly for those with a good prognosis. Historically, radiation therapy has had a limited role in the treatment of liver metastases because of its toxicity when whole liver irradiation was delivered. Improvements in the knowledge of liver radiobiology and radio-pathology as well as technical innovations in delivering radiation therapy are the basis of the modern partial liver irradiation concept. In this historical and therapeutic landscape, extracranial stereotactic radiation therapy is particularly interesting for the treatment of liver metastases. This review summarises published data on stereotactic radiotherapy for the treatment of liver metastases. (authors)

  13. Mortality following single-fraction stereotactic body radiation therapy for central pulmonary oligometastasis.

    Science.gov (United States)

    Ma, Sung Jun; Mix, Michael; Rivers, Charlotte; Hennon, Mark; Gomez, Jorge; Singh, Anurag K

    2017-01-01

    The case of a 56-year-old male who developed bronchopulmonary hemorrhage after a course of stereotactic body radiation therapy (SBRT) for centrally located squamous cell lung carcinoma is presented. The patient was previously treated with concurrent chemoradiation for stage IVA squamous cell carcinoma of the base of tongue. He showed no evidence of disease for 4 years until he developed a solitary metastasis of squamous cell carcinoma in the right hilum. He underwent a single fraction of 26 Gy with heterogeneity correction. He showed no evidence of disease for 13 months until he developed a sudden grade 4 bronchopulmonary hemorrhage. He underwent an urgent right pneumonectomy and later died of a post-operative complication. Pathologic analysis of the specimen revealed no evidence of tumor. Single-fraction SBRT of 26 Gy was sufficient to achieve complete response of his large central lung tumor. However, when treating patients with central lung tumors, some risk of mortality may be unavoidable with either SBRT or pneumonectomy.

  14. Treatment Options in Oligometastatic Disease: Stereotactic Body Radiation Therapy - Focus on Colorectal Cancer.

    Science.gov (United States)

    Wild, Aaron T; Yamada, Yoshiya

    2017-03-01

    Improvements in systemic therapy for metastatic colorectal cancer (CRC) have markedly extended survival, rendering local control of metastases to critical organs of increasing importance, especially in the oligometastatic setting where the disease may not yet have acquired the ability to widely disseminate. While surgical resection remains the gold standard for oligometastases in many organs, stereotactic body radiation therapy (SBRT) presents a non-invasive alternative for achieving local control. A literature review was performed to identify and summarize the findings of key prospective and retrospective studies that have shaped the field of SBRT for oligometastases to the lung, liver, and spine with a focus on oligometastases from CRC in particular. Modern dose-escalated SBRT regimens can achieve 1-year local control rates of 77-100%, 90-100%, and 81-95% for oligometastases involving the lung, liver, and spine, respectively. Rates of grade 3 or greater toxicity with contemporary SBRT techniques are consistently low at <10% in the lung, <5% in the liver, and <2%/8% for neurologic/non-neurologic toxicity in the spine, respectively. SBRT appears safe and effective for treating oligometastases involving the lung, liver, and spine. Randomized trials comparing SBRT to surgical resection and other local therapeutic modalities for the treatment of CRC oligometastases bear consideration.

  15. Evaluation of heterogeneity corrections in stereotactic body radiation therapy for the lung

    International Nuclear Information System (INIS)

    Matsuo, Yukinori; Narita, Yuichiro; Nakata, Manabu

    2008-01-01

    The purpose was to evaluate impact of heterogeneity corrections on dose distributions for stereotactic body radiation therapy (SBRT) for the lung. This study was conducted with the treatment plans of 28 cases in which we performed SBRT for solitary lung tumors with 48 Gy in 12-Gy fractions at the isocenter. The treatment plans were recalculated under three conditions of heterogeneity correction as follows: pencil beam convolution with Batho power law correction (PBC-BPL), pencil beam convolution with no correction (PBC-NC), and anisotropic analytical algorithm with heterogeneity correction (AAA). Dose-volumetric data were compared among the three conditions. Heterogeneity corrections had a significant impact on all dose-volumetric parameters. Means of isocenter dose were 48.0 Gy, 44.6 Gy, and 48.4 Gy in PBC-BPL, PBC-NC, and AAA, respectively. PTV D95 were 45.2 Gy, 41.1 Gy, and 42.1 Gy, and V20 of the lung were 4.1%, 3.7%, and 3.9%, respectively. Significant differences in dose distribution were observed among heterogeneity corrections. Attention needs to be paid to the differences. (author)

  16. Scoring system predictive of survival for patients undergoing stereotactic body radiation therapy for liver tumors

    Directory of Open Access Journals (Sweden)

    Kress Marie-Adele S

    2012-09-01

    Full Text Available Abstract Background Stereotactic body radiation therapy (SBRT is an emerging treatment option for liver tumors. This study evaluated outcomes after SBRT to identify prognostic variables and to develop a novel scoring system predictive of survival. Methods The medical records of 52 patients with a total of 85 liver lesions treated with SBRT from 2003 to 2010 were retrospectively reviewed. Twenty-four patients had 1 lesion; 27 had 2 or more. Thirteen lesions were primary tumors; 72 were metastases. Fiducials were placed in all patients prior to SBRT. The median prescribed dose was 30 Gy (range, 16 – 50 Gy in a median of 3 fractions (range, 1–5. Results With median follow-up of 11.3 months, median overall survival (OS was 12.5 months, and 1 year OS was 50.8%. In 42 patients with radiographic follow up, 1 year local control was 74.8%. On univariate analysis, number of lesions (p = 0.0243 and active extralesional disease (p  Conclusions SBRT offers a safe and feasible treatment option for liver tumors. A prognostic scoring system based on the number of liver lesions, activity of extralesional disease, and KPS predicts survival following SBRT and can be used as a guide for prospective validation and ultimately for treatment decision-making.

  17. Hypofractionated stereotactic body radiation therapy as monotherapy for intermediate-risk prostate cancer

    Directory of Open Access Journals (Sweden)

    Ju Andrew W

    2013-01-01

    Full Text Available Abstract Background Hypofractionated stereotactic body radiation therapy (SBRT has been advanced as monotherapy for low-risk prostate cancer. We examined the dose distributions and early clinical outcomes using this modality for the treatment of intermediate-risk prostate cancer. Methods Forty-one sequential hormone-naïve intermediate-risk prostate cancer patients received 35–36.25 Gy of CyberKnife-delivered SBRT in 5 fractions. Radiation dose distributions were analyzed for coverage of potential microscopic ECE by measuring the distance from the prostatic capsule to the 33 Gy isodose line. PSA levels, toxicities, and quality of life (QOL measures were assessed at baseline and follow-up. Results All patients completed treatment with a mean coverage by the 33 Gy isodose line extending >5 mm beyond the prostatic capsule in all directions except posteriorly. Clinical responses were documented by a mean PSA decrease from 7.67 ng/mL pretreatment to 0.64 ng/mL at the median follow-up of 21 months. Forty patients remain free from biochemical progression. No Grade 3 or 4 toxicities were observed. Mean EPIC urinary irritation/obstruction and bowel QOL scores exhibited a transient decline post-treatment with a subsequent return to baseline. No significant change in sexual QOL was observed. Conclusions In this intermediate-risk patient population, an adequate radiation dose was delivered to areas of expected microscopic ECE in the majority of patients. Although prospective studies are needed to confirm long-term tumor control and toxicity, the short-term PSA response, biochemical relapse-free survival rate, and QOL in this interim analysis are comparable to results reported for prostate brachytherapy or external beam radiotherapy. Trial registration The Georgetown Institutional Review Board has approved this retrospective study (IRB 2009–510.

  18. Validating FMEA output against incident learning data: A study in stereotactic body radiation therapy.

    Science.gov (United States)

    Yang, F; Cao, N; Young, L; Howard, J; Logan, W; Arbuckle, T; Sponseller, P; Korssjoen, T; Meyer, J; Ford, E

    2015-06-01

    Though failure mode and effects analysis (FMEA) is becoming more widely adopted for risk assessment in radiation therapy, to our knowledge, its output has never been validated against data on errors that actually occur. The objective of this study was to perform FMEA of a stereotactic body radiation therapy (SBRT) treatment planning process and validate the results against data recorded within an incident learning system. FMEA on the SBRT treatment planning process was carried out by a multidisciplinary group including radiation oncologists, medical physicists, dosimetrists, and IT technologists. Potential failure modes were identified through a systematic review of the process map. Failure modes were rated for severity, occurrence, and detectability on a scale of one to ten and risk priority number (RPN) was computed. Failure modes were then compared with historical reports identified as relevant to SBRT planning within a departmental incident learning system that has been active for two and a half years. Differences between FMEA anticipated failure modes and existing incidents were identified. FMEA identified 63 failure modes. RPN values for the top 25% of failure modes ranged from 60 to 336. Analysis of the incident learning database identified 33 reported near-miss events related to SBRT planning. Combining both methods yielded a total of 76 possible process failures, of which 13 (17%) were missed by FMEA while 43 (57%) identified by FMEA only. When scored for RPN, the 13 events missed by FMEA ranked within the lower half of all failure modes and exhibited significantly lower severity relative to those identified by FMEA (p = 0.02). FMEA, though valuable, is subject to certain limitations. In this study, FMEA failed to identify 17% of actual failure modes, though these were of lower risk. Similarly, an incident learning system alone fails to identify a large number of potentially high-severity process errors. Using FMEA in combination with incident learning may

  19. Hypofractionated stereotactic body radiation therapy as monotherapy for intermediate-risk prostate cancer

    International Nuclear Information System (INIS)

    Ju, Andrew W; Lei, Siyuan; Suy, Simeng; Lynch, John H; Dritschilo, Anatoly; Collins, Sean P; Wang, Hongkun; Oermann, Eric K; Sherer, Benjamin A; Uhm, Sunghae; Chen, Viola J; Pendharkar, Arjun V; Hanscom, Heather N; Kim, Joy S

    2013-01-01

    Hypofractionated stereotactic body radiation therapy (SBRT) has been advanced as monotherapy for low-risk prostate cancer. We examined the dose distributions and early clinical outcomes using this modality for the treatment of intermediate-risk prostate cancer. Forty-one sequential hormone-naïve intermediate-risk prostate cancer patients received 35–36.25 Gy of CyberKnife-delivered SBRT in 5 fractions. Radiation dose distributions were analyzed for coverage of potential microscopic ECE by measuring the distance from the prostatic capsule to the 33 Gy isodose line. PSA levels, toxicities, and quality of life (QOL) measures were assessed at baseline and follow-up. All patients completed treatment with a mean coverage by the 33 Gy isodose line extending >5 mm beyond the prostatic capsule in all directions except posteriorly. Clinical responses were documented by a mean PSA decrease from 7.67 ng/mL pretreatment to 0.64 ng/mL at the median follow-up of 21 months. Forty patients remain free from biochemical progression. No Grade 3 or 4 toxicities were observed. Mean EPIC urinary irritation/obstruction and bowel QOL scores exhibited a transient decline post-treatment with a subsequent return to baseline. No significant change in sexual QOL was observed. In this intermediate-risk patient population, an adequate radiation dose was delivered to areas of expected microscopic ECE in the majority of patients. Although prospective studies are needed to confirm long-term tumor control and toxicity, the short-term PSA response, biochemical relapse-free survival rate, and QOL in this interim analysis are comparable to results reported for prostate brachytherapy or external beam radiotherapy. The Georgetown Institutional Review Board has approved this retrospective study (IRB 2009–510)

  20. Dosimetric analysis of imaging changes following pulmonary stereotactic body radiation therapy.

    Science.gov (United States)

    Prendergast, Brendan M; Bonner, James A; Popple, Richard A; Spencer, Sharon A; Fiveash, John B; Keene, Kimberly S; Cerfolio, Robert J; Minnich, Douglas J; Dobelbower, Michael C

    2011-02-01

    The aim of this study was to determine whether late patterns of pulmonary fibrosis are related to specific radiation doses administered during thoracic stereotactic body radiation therapy (SBRT). The records of all patients treated with SBRT for either pulmonary metastases or inoperable primary lung tumours at the University of Alabama at Birmingham from November 2005 to July 2008 were reviewed. Patients selected for analysis had diagnostic chest computed tomography (CT) scans acquired at least 180 days after completion of therapy. CT scans acquired at follow-up were co-registered with the original treatment planning CT scans for 12 eligible patients (17 lesions), and late-occurring pulmonary imaging abnormalities (IAs) were contoured. Dosimetric parameters analysed include D(80) , D(90) , V(18) and V(prescription dose) of the IA and V(14) and V(18) of the lung. Late pulmonary IAs were identified in 11 treated areas from nine patients. Late IAs could not be identified in six treated areas from three patients secondary to emphysema, tumour progression and severe atelectasis, respectively. The mean doses to 80% (D(80) ) and 90% (D(90) ) of the IAs were 18.4 and 14.5 Gy, respectively (ranges: 5.6-27.8 and 3.3-22.4 Gy). On average, 79.4% (range: 45.6-97.5%) of the IA received at least 18 Gy, while an average of 19.3% (range: 0.2-42.2%) received the prescription dose. On average, only 4.2% (range: 1.1-7.8%) of the lungs received 18 Gy. Imaging abnormalities consistent with pulmonary fibrosis are common after SBRT and are well approximated by the 18 Gy isodose distribution. The clinical ramification of these findings should be evaluated in future studies. © 2011 The Authors. Journal of Medical Imaging and Radiation Oncology © 2011 The Royal Australian and New Zealand College of Radiologists.

  1. Definitive Stereotactic Body Radiotherapy (SBRT) for Extracranial Oligometastases: An International Survey of >1000 Radiation Oncologists.

    Science.gov (United States)

    Lewis, Stephen L; Porceddu, Sandro; Nakamura, Naoki; Palma, David A; Lo, Simon S; Hoskin, Peter; Moghanaki, Drew; Chmura, Steven J; Salama, Joseph K

    2017-08-01

    Stereotactic body radiotherapy (SBRT) is often used to treat patients with oligometastases (OM). Yet, patterns of SBRT practice for OM are unknown. Therefore, we surveyed radiation oncologists internationally, to understand how and when SBRT is used for OM. A 25-question survey was distributed to radiation oncologists. Respondents using SBRT for OM were asked how long they have been treating OM, number of patients treated, organs treated, primary reason for use, doses used, and future intentions. Respondents not using SBRT for OM were asked reasons why SBRT was not used and intentions for future adoption. Data were analyzed anonymously. We received 1007 surveys from 43 countries. Eighty-three percent began using SBRT after 2005 and greater than one third after 2010. Eighty-four percent cited perceived treatment response/durability as the primary reason for using SBRT in OM patients. Commonly treated organs were lung (90%), liver (75%), and spine (70%). SBRT dose/fractionation schemes varied widely. Most would offer a second course to new OM. Nearly all (99%) planned to continue and 66% planned to increase SBRT for OM. Of those not using SBRT, 59% plan to start soon. The most common reason for not using SBRT was lack of clinical efficacy (48%) or lack of necessary image guidance equipment (34%). Radiation oncologists are increasingly using SBRT for OM. The main reason for not using SBRT for OM is a perceived lack of evidence demonstrating clinical advantages. These data strengthen the need for robust prospective clinical trials (ongoing and in development) to demonstrate clinical efficacy given the widespread adoption of SBRT for OM.

  2. Evaluation of initial setup errors of two immobilization devices for lung stereotactic body radiation therapy (SBRT).

    Science.gov (United States)

    Ueda, Yoshihiro; Teshima, Teruki; Cárdenes, Higinia; Das, Indra J

    2017-07-01

    The aim of this study was to investigate the accuracy and efficacy of two commonly used commercial immobilization systems for stereotactic body radiation therapy (SBRT) in lung cancer. This retrospective study assessed the efficacy and setup accuracy of two immobilization systems: the Elekta Body Frame (EBF) and the Civco Body Pro-Lok (CBP) in 80 patients evenly divided for each system. A cone beam CT (CBCT) was used before each treatment fraction for setup correction in both devices. Analyzed shifts were applied for setup correction and CBCT was repeated. If a large shift (>5 mm) occurred in any direction, an additional CBCT was employed for verification after localization. The efficacy of patient setup was analyzed for 105 sessions (48 with the EBF, 57 with the CBP). Result indicates that the CBCT was repeated at the 1 st treatment session in 22.5% and 47.5% of the EBF and CBP cases, respectively. The systematic errors {left-right (LR), anterior-posterior (AP), cranio-caudal (CC), and 3D vector shift: (LR 2 + AP 2 + CC 2 ) 1/2 (mm)}, were {0.5 ± 3.7, 2.3 ± 2.5, 0.7 ± 3.5, 7.1 ± 3.1} mm and {0.4 ± 3.6, 0.7 ± 4.0, 0.0 ± 5.5, 9.2 ± 4.2} mm, and the random setup errors were {5.1, 3.0, 3.5, 3.9} mm and {4.6, 4.8, 5.4, 5.3} mm for the EBF and the CBP, respectively. The 3D vector shift was significantly larger for the CBP (P patient comfort could dictate the use of CBP system with slightly reduced accuracy. © 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

  3. Acceptable Toxicity After Stereotactic Body Radiation Therapy for Liver Tumors Adjacent to the Central Biliary System

    Energy Technology Data Exchange (ETDEWEB)

    Eriguchi, Takahisa; Takeda, Atsuya; Sanuki, Naoko; Oku, Yohei; Aoki, Yousuke [Radiation Oncology Center, Ofuna Chuo Hospital, Kanagawa (Japan); Shigematsu, Naoyuki [Department of Radiology, Keio University School of Medicine, Tokyo (Japan); Kunieda, Etsuo, E-mail: kunieda-mi@umin.ac.jp [Department of Radiation Oncology, Tokai University, Kanagawa (Japan)

    2013-03-15

    Purpose: To evaluate biliary toxicity after stereotactic body radiation therapy (SBRT) for liver tumors. Methods and Materials: Among 297 consecutive patients with liver tumors treated with SBRT of 35 to 50 Gy in 5 fractions, patients who were irradiated with >20 Gy to the central biliary system (CBS), including the gallbladder, and had follow-up times >6 months were retrospectively analyzed. Toxicity profiles, such as clinical symptoms and laboratory and radiologic data especially for obstructive jaundice and biliary infection, were investigated in relation to the dose volume and length relationship for each biliary organ. Results: Fifty patients with 55 tumors were irradiated with >20 Gy to the CBS. The median follow-up period was 18.2 months (range, 6.0-80.5 months). In the dose length analysis, 39, 34, 14, and 2 patients were irradiated with >20 Gy, >30 Gy, >40 Gy, and >50 Gy, respectively, to >1 cm of the biliary tract. Seven patients were irradiated with >20 Gy to >20% of the gallbladder. Only 2 patients experienced asymptomatic bile duct stenosis. One patient, metachronously treated twice with SBRT for tumors adjacent to each other, had a transient increase in hepatic and biliary enzymes 12 months after the second treatment. The high-dose area >80 Gy corresponded to the biliary stenosis region. The other patient experienced biliary stenosis 5 months after SBRT and had no laboratory changes. The biliary tract irradiated with >20 Gy was 7 mm and did not correspond to the bile duct stenosis region. No obstructive jaundice or biliary infection was found in any patient. Conclusions: SBRT for liver tumors adjacent to the CBS was feasible with minimal biliary toxicity. Only 1 patient had exceptional radiation-induced bile duct stenosis. For liver tumors adjacent to the CBS without other effective treatment options, SBRT at a dose of 40 Gy in 5 fractions is a safe treatment with regard to biliary toxicity.

  4. Spine stereotactic body radiation therapy plans: Achieving dose coverage, conformity, and dose falloff

    International Nuclear Information System (INIS)

    Hong, Linda X.; Shankar, Viswanathan; Shen, Jin; Kuo, Hsiang-Chi; Mynampati, Dinesh; Yaparpalvi, Ravindra; Goddard, Lee; Basavatia, Amar; Fox, Jana; Garg, Madhur; Kalnicki, Shalom; Tomé, Wolfgang A.

    2015-01-01

    We report our experience of establishing planning objectives to achieve dose coverage, conformity, and dose falloff for spine stereotactic body radiation therapy (SBRT) plans. Patients with spine lesions were treated using SBRT in our institution since September 2009. Since September 2011, we established the following planning objectives for our SBRT spine plans in addition to the cord dose constraints: (1) dose coverage—prescription dose (PD) to cover at least 95% planning target volume (PTV) and 90% PD to cover at least 99% PTV; (2) conformity index (CI)—ratio of prescription isodose volume (PIV) to the PTV < 1.2; (3) dose falloff—ratio of 50% PIV to the PTV (R 50% ); (4) and maximum dose in percentage of PD at 2 cm from PTV in any direction (D 2cm ) to follow Radiation Therapy Oncology Group (RTOG) 0915. We have retrospectively reviewed 66 separate spine lesions treated between September 2009 and December 2012 (31 treated before September 2011 [group 1] and 35 treated after [group 2]). The χ 2 test was used to examine the difference in parameters between groups. The PTV V 100% PD ≥ 95% objective was met in 29.0% of group 1 vs 91.4% of group 2 (p < 0.01) plans. The PTV V 90% PD ≥ 99% objective was met in 38.7% of group 1 vs 88.6% of group 2 (p < 0.01) plans. Overall, 4 plans in group 1 had CI > 1.2 vs none in group 2 (p = 0.04). For D 2cm , 48.3% plans yielded a minor violation of the objectives and 16.1% a major violation for group 1, whereas 17.1% exhibited a minor violation and 2.9% a major violation for group 2 (p < 0.01). Spine SBRT plans can be improved on dose coverage, conformity, and dose falloff employing a combination of RTOG spine and lung SBRT protocol planning objectives

  5. SU-F-P-23: Setup Uncertainties for the Lung Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Q; Vigneri, P; Madu, C; Potters, L [Northwell Health, New Hyde Park, NY (United States); Cao, Y; Jamshidi, A [Northwell Health, Lake Success, NY (United States); Klein, E [Long Island Jewish Medical Center, Lake Success, NY (United States)

    2016-06-15

    Purpose: The Exactrack X-ray system with six degree-of-freedom (6DoF) adjustment ability can be used for setup of lung stereotactic body radiation therapy. The setup uncertainties from ExacTrack 6D system were analyzed. Methods: The Exactrack X-ray 6D image guided radiotherapy system is used in our clinic. The system is an integration of 2 subsystems: (1): an infrared based optical position system and (2) a radiography kV x-ray imaging system. The infrared system monitors reflective body markers on the patient’s skin to assistant in the initial setup. The radiographic kV devices were used for patient positions verification and adjustment. The position verification was made by fusing the radiographs with the digitally reconstructed radiograph (DRR) images generated by simulation CT images using 6DoF fusion algorithms. Those results were recorded in our system. Gaussian functions were used to fit the data. Results: For 37 lung SBRT patients, the image registration results for the initial setup by using surface markers and for the verifications, were measured. The results were analyzed for 143 treatments. The mean values for the lateral, longitudinal, vertical directions were 0.1, 0.3 and 0.3mm, respectively. The standard deviations for the lateral, longitudinal and vertical directions were 0.62, 0.78 and 0.75mm respectively. The mean values for the rotations around lateral, longitudinal and vertical directions were 0.1, 0.2 and 0.4 degrees respectively, with standard deviations of 0.36, 0.34, and 0.42 degrees. Conclusion: The setup uncertainties for the lung SBRT cases by using Exactrack 6D system were analyzed. The standard deviations of the setup errors were within 1mm for all three directions, and the standard deviations for rotations were within 0.5 degree.

  6. SU-F-P-23: Setup Uncertainties for the Lung Stereotactic Body Radiation Therapy

    International Nuclear Information System (INIS)

    Zhang, Q; Vigneri, P; Madu, C; Potters, L; Cao, Y; Jamshidi, A; Klein, E

    2016-01-01

    Purpose: The Exactrack X-ray system with six degree-of-freedom (6DoF) adjustment ability can be used for setup of lung stereotactic body radiation therapy. The setup uncertainties from ExacTrack 6D system were analyzed. Methods: The Exactrack X-ray 6D image guided radiotherapy system is used in our clinic. The system is an integration of 2 subsystems: (1): an infrared based optical position system and (2) a radiography kV x-ray imaging system. The infrared system monitors reflective body markers on the patient’s skin to assistant in the initial setup. The radiographic kV devices were used for patient positions verification and adjustment. The position verification was made by fusing the radiographs with the digitally reconstructed radiograph (DRR) images generated by simulation CT images using 6DoF fusion algorithms. Those results were recorded in our system. Gaussian functions were used to fit the data. Results: For 37 lung SBRT patients, the image registration results for the initial setup by using surface markers and for the verifications, were measured. The results were analyzed for 143 treatments. The mean values for the lateral, longitudinal, vertical directions were 0.1, 0.3 and 0.3mm, respectively. The standard deviations for the lateral, longitudinal and vertical directions were 0.62, 0.78 and 0.75mm respectively. The mean values for the rotations around lateral, longitudinal and vertical directions were 0.1, 0.2 and 0.4 degrees respectively, with standard deviations of 0.36, 0.34, and 0.42 degrees. Conclusion: The setup uncertainties for the lung SBRT cases by using Exactrack 6D system were analyzed. The standard deviations of the setup errors were within 1mm for all three directions, and the standard deviations for rotations were within 0.5 degree.

  7. Lymphocyte-Sparing Effect of Stereotactic Body Radiation Therapy in Patients With Unresectable Pancreatic Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Wild, Aaron T. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Herman, Joseph M.; Dholakia, Avani S.; Moningi, Shalini [Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Lu, Yao [Department of Oncology Biostatistics, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Rosati, Lauren M.; Hacker-Prietz, Amy; Assadi, Ryan K.; Saeed, Ali M. [Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Pawlik, Timothy M. [Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Jaffee, Elizabeth M.; Laheru, Daniel A. [Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Tran, Phuoc T. [Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Weiss, Matthew J.; Wolfgang, Christopher L. [Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Ford, Eric [Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington (United States); Grossman, Stuart A. [Department of Medical Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Ye, Xiaobu [Department of Oncology Biostatistics, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Ellsworth, Susannah G., E-mail: sbatkoy2@jhmi.edu [Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States)

    2016-03-01

    Purpose: Radiation-induced lymphopenia (RIL) is associated with inferior survival in patients with glioblastoma, lung cancer, and pancreatic cancer. We asked whether stereotactic body radiation therapy (SBRT) decreases severity of RIL compared to conventional chemoradiation therapy (CRT) in locally advanced pancreatic cancer (LAPC). Methods and Materials: Serial total lymphocyte counts (TLCs) from patients enrolled in a prospective trial of SBRT for LAPC were compared to TLCs from an existing database of LAPC patients undergoing definitive CRT. SBRT patients received 33 Gy (6.6 Gy × 5 fractions). CRT patients received a median dose of 50.4 Gy (1.8 Gy × 28 fractions) with concurrent 5-fluorouracil (77%) or gemcitabine (23%) therapy. Univariate and multivariate analyses (MVA) were used to identify associations between clinical factors and post-treatment TLC and between TLC and survival. Results: Thirty-two patients received SBRT and 101 received CRT. Median planning target volume (PTV) was smaller in SBRT (88.7 cm{sup 3}) than in CRT (344.6 cm{sup 3}; P<.001); median tumor diameter was larger for SBRT (4.6 cm) than for CRT (3.6 cm; P=.01). SBRT and CRT groups had similar median baseline TLCs. One month after starting radiation, 71.7% of CRT patients had severe lymphopenia (ie, TLC <500 cells/mm{sup 3} vs 13.8% of SBRT patients; P<.001). At 2 months, 46.0% of CRT patients remained severely lymphopenic compared with 13.6% of SBRT patients (P=.007). MVA demonstrated that treatment technique and baseline TLCs were significantly associated with post-treatment TLC at 1 but not 2 months after treatment. Higher post-treatment TLC was associated with improved survival regardless of treatment technique (hazard ratio [HR] for death: 2.059; 95% confidence interval: 1.310-3.237; P=.002). Conclusions: SBRT is associated with significantly less severe RIL than CRT at 1 month in LAPC, suggesting that radiation technique affects RIL and supporting previous modeling

  8. Design and development of spine phantom to verify dosimetric accuracy of stereotactic body radiation therapy using 3D prnter

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Seu Ran; Lee, Min Young; Kim, Min Joo; Park, So Hyun; Song Ji Hye; Suh, Tae Suk [Dept. of Biomedical Engineering, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of); Sohn, Jason W. [Dept. of Radiation Oncology, College of Medicine, Case Western Reserve University, Cleveland (United States)

    2015-10-15

    The purpose of this study is to verify dosimetric accuracy of delivered dose in spine SBRT as highly precise radiotherapy depending on cancer position using dedicated spine phantom based on 3D printer. Radiation therapy oncology group (RTOG) 0631 suggest different planning method in spine stereotactic body radiation therapy (SBRT) according to location of cancer owing to its distinct shape. The developed phantom especially using DLP method can be utilized as spine SBRT dosimetry research. Our study was able to confirm that the phantom was indeed similar with HU value of human spine as well as its shape.

  9. Long-term safety and efficacy of fractionated stereotactic body radiation therapy for spinal metastases

    Energy Technology Data Exchange (ETDEWEB)

    Mantel, Frederick; Glatz, Stefan; Toussaint, Andre; Flentje, Michael; Guckenberger, Matthias [University Hospital Wuerzburg, Department of Radiation Oncology, Wuerzburg (Germany)

    2014-12-15

    Patients with long life expectancy despite metastatic status might benefit from long-term local control of spinal metastases. Dose-intensified radiotherapy (RT) is believed to control tumor growth better and thus offers longer pain relief. This single-institution study reports on fractionated stereotactic body radiation therapy (SBRT) for spinal metastases in patients with good life expectancy based on performance status, extent of metastases, histology, and time to metastasis. Between 2004 and 2010, 36 treatment sites in 32 patients (median age 55 years; male 61 %; median Karnofsky performance score 85) were treated with fractionated SBRT. The median treatment dose was 60 Gy (range, 48.5-65 Gy) given in a median of 20 fractions (range, 17-33); the median maximum dose to the planning risk volume for the spinal cord (PRV-SC) was 46.6 Gy. All patients suffering from pain prior to RT reported pain relief after treatment; after a median follow-up of 20.3 months, 61 % of treatment sites were pain-free, another 25 % associated with mild pain. In 86 % of treatments, patients were free from neurological symptoms at the time of the last clinical follow-up. Acute grade 1 toxicities (CTCAE 3.0) were observed in 11 patients. Myelopathy did not occur in any patient. Radiologically controlled freedom from local progression was 92 and 84 % after 12 and 24 months, respectively. Median overall survival (OS) was 19.6 months. Patient selection resulted in long OS despite metastatic disease, and dose-intensified fractionated SBRT for spinal metastases was safe and achieved long-term local tumor control and palliation of pain. (orig.) [German] Patienten mit guter Lebenserwartung trotz metastasierter Erkrankung koennten von einer lang andauernden lokalen Kontrolle von Wirbelsaeulenmetastasen profitieren. Eine dosisintensivierte Radiotherapie (RT) kann vermutlich eine bessere Tumorkontrolle und daher eine laengere Schmerzpalliation erreichen. Ausgewertet wurden die monozentrischen

  10. Specific toxicity after stereotactic body radiation therapy to the central chest. A comprehensive review

    Energy Technology Data Exchange (ETDEWEB)

    Oskan, Feras; Becker, Gerd; Bleif, Martin [Alb-Fils Kliniken GmbH, Department of Radiation Oncology, Goeppingen (Germany); CyberKnife Suedwest Centre, Radiochirurgicum, Goeppingen (Germany)

    2017-03-15

    The toxicity of stereotactic body radiation therapy in the central chest remains an unsettled issue. The collected data concerning the observed complications are poorly understood and are limited in their quantity and quality, thus hampering a precise delineation of treatment-specific toxicity. The majority of complications scored as toxicity grade 5, namely respiratory failure and fatal hemoptysis, are most likely related to multiple competing risks and occurred at different dose fractionation schemas, e. g., 10-12 fractions of 4-5 Gy, 5 fractions of 10 Gy, 3 fractions of 20-22 Gy, and 1 fraction of 15-30 Gy. Further investigations with longer follow-up and more details of patients' pretreatment and tumor characteristics are required. Furthermore, satisfactory documentation of complications and details of dosimetric parameters, as well as limitation of the wide range of possible fractionation schemes is also warranted for a better understanding of the risk factors relevant for macroscopic damage to the serially organized anatomic structure within the central chest. (orig.) [German] Das Risiko fuer schwere Nebenwirkungen der stereotaktischen Strahlentherapie bei zentralen Lungentumoren ist bisher schlecht definiert. Nicht nur die begrenzte Zahl der dokumentierten Ereignisse, sondern auch die Vielzahl der verwendeten Fraktionierungsschemata erschwert das Herausarbeiten valider prognostischer Faktoren. Auf Basis dieser Datenlage laesst sich das Risiko fuer Grad-5-Toxizitaeten, insbesondere Atemversagen und toedliche Blutungen, kaum einem bestimmten Dosis- oder Fraktionierungsschema, wie z. B. 10-12 Fraktionen mit 4-5 Gy, 5 Fraktionen mit 10 Gy, 3 Fraktionen mit 20-22 Gy und 1 Fraktion mit 15-30 Gy zuordnen, da multiple patientenspezifische, konkurrierende Risiken dabei einen wesentlichen Einfluss zu haben scheinen. Es wird zukuenftig erforderlich sein, praetherapeutische Patienten- und Tumorcharakteristika genauer zu erfassen, dosimetrische Parameter besser zu

  11. The efficacy of stereotactic body radiation therapy on huge hepatocellular carcinoma unsuitable for other local modalities

    International Nuclear Information System (INIS)

    Que, Jenny Y; Lin, Li-Ching; Lin, Kuei-Li; Lin, Chia-Hui; Lin, Yu-Wei; Yang, Ching-Chieh

    2014-01-01

    To evaluate the safety and efficacy of Cyberknife stereotactic body radiation therapy (SBRT) and its effect on survival in patients with unresectable huge hepatocellular carcinoma (HCC) unsuitable of other standard treatment option. Between 2009 and 2011, 22 patients with unresectable huge HCC (≧10 cm) were treated with SBRT. dose ranged from 26 Gy to 40 Gy in five fractions. Overall survival (OS) and disease-progression free survival (DPFS) were determined by Kaplan-Meier analysis. Tumor response and toxicities were also assessed. After a median follow-up of 11.5 month (range 2–46 months). The objective response rate was achieved in 86.3% (complete response (CR): 22.7% and partial response (PR): 63.6%). The 1-yr. local control rate was 55.56%. The 1-year OS was 50% and median survival was 11 months (range 2–46 months). In univariate analysis, Child-Pugh stage (p = 0.0056) and SBRT dose (p = 0.0017) were significant factors for survival. However, in multivariate analysis, SBRT dose (p = 0.0072) was the most significant factor, while Child-Pugh stage of borderline significance. (p = 0.0514). Acute toxicities were mild and well tolerated. This study showed that SBRT can be delivered safely to huge HCC and achieved a substantial tumor regression and survival. The results suggest this technique should be considered a salvage treatment. However, local and regional recurrence remain the major cause of failure. Further studies of combination of SBRT and other treatment modalities may be reasonable

  12. Stereotactic body radiation therapy as an ablative treatment for inoperable hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Huertas, Andres; Baumann, Anne-Sophie; Saunier-Kubs, Fleur; Salleron, Julia; Oldrini, Guillaume; Croisé-Laurent, Valérie; Barraud, Hélène; Ayav, Ahmed; Bronowicki, Jean-Pierre; Peiffert, Didier

    2015-01-01

    Purpose: To describe efficacy and safety of stereotactic body radiation therapy (SBRT) for the treatment of inoperable hepatocellular carcinoma. Methods: The records of 77 consecutive patients treated with SBRT for 97 liver-confined HCC were reviewed. A total dose of 45 Gy in 3 fractions was prescribed to the 80% isodose line. Local control (LC), overall survival (OS), progression-free survival (PFS) and toxicity were studied. Results: The median follow-up was 12 months. The median tumor diameter was 2.4 cm. The LC rate was 99% at 1 and 2 years. The 1 and 2-year OS were 81.8% and 56.6% respectively. The median time to progression was 9 months (0–38). The rate of hepatic toxicity was 7.7% [1.6–13.7], 14.9% [5.7–23.2] and 23.1% [9.9–34.3] at 6 months, 1 year and 2 years respectively. In multivariate analysis, female gender (HR 7.87 [3.14–19.69]), a BCLC B-C stage (HR 3.71 [1.41–9.76]), a sum of all lesion diameters ⩾2 cm (HR 7.48 [2.09–26.83]) and a previous treatment (HR 0.10 [0.01–0.79]) were independent prognostic factors of overall survival. Conclusion: SBRT allows high local control for inoperable hepatocellular carcinomas. It should be considered when an ablative treatment is indicated in Child A patients

  13. Dose Escalated Liver Stereotactic Body Radiation Therapy at the Mean Respiratory Position

    International Nuclear Information System (INIS)

    Velec, Michael; Moseley, Joanne L.; Dawson, Laura A.; Brock, Kristy K.

    2014-01-01

    Purpose: The dosimetric impact of dose probability based planning target volume (PTV) margins for liver cancer patients receiving stereotactic body radiation therapy (SBRT) was compared with standard PTV based on the internal target volume (ITV). Plan robustness was evaluated by accumulating the treatment dose to ensure delivery of the intended plan. Methods and Materials: Twenty patients planned on exhale CT for 27 to 50 Gy in 6 fractions using an ITV-based PTV and treated free-breathing were retrospectively evaluated. Isotoxic, dose escalated plans were created on midposition computed tomography (CT), representing the mean breathing position, using a dose probability PTV. The delivered doses were accumulated using biomechanical deformable registration of the daily cone beam CT based on liver targeting at the exhale or mean breathing position, for the exhale and midposition CT plans, respectively. Results: The dose probability PTVs were on average 38% smaller than the ITV-based PTV, enabling an average ± standard deviation increase in the planned dose to 95% of the PTV of 4.0 ± 2.8 Gy (9 ± 5%) on the midposition CT (P<.01). For both plans, the delivered minimum gross tumor volume (GTV) doses were greater than the planned nominal prescribed dose in all 20 patients and greater than the planned dose to 95% of the PTV in 18 (90%) patients. Nine patients (45%) had 1 or more GTVs with a delivered minimum dose more than 5 Gy higher with the midposition CT plan using dose probability PTV, compared with the delivered dose with the exhale CT plan using ITV-based PTV. Conclusions: For isotoxic liver SBRT planned and delivered at the mean respiratory, reduced dose probability PTV enables a mean escalation of 4 Gy (9%) in 6 fractions over ITV-based PTV. This may potentially improve local control without increasing the risk of tumor underdosing

  14. Stereotactic body radiation therapy for liver oligo-recurrence and oligo-progression from various tumors

    Energy Technology Data Exchange (ETDEWEB)

    Cha, Yu Jin; Kim, Mi Sook; Jang, Won Il; Seo, Young Seok; Cho, Chul Koo; Yoo, Hyung Jun; Paik, Eun Kyung [Dept. of Radiation Oncology, Korea Institute of Radiological and Medical Sciences, Seoul (Korea, Republic of)

    2017-06-15

    To evaluate the outcomes of stereotactic body radiation therapy (SBRT) for patients with liver oligo-recurrence and oligo-progression from various primary tumors. Between 2002 and 2013, 72 patients with liver oligo-recurrence (oligo-metastasis with a controlled primary tumor) and oligo-progression (contradictory progression of a few sites of disease despite an overall tumor burden response to therapy) underwent SBRT. Of these, 9 and 8 patients with uncontrollable distant metastases and patients immediate loss to follow-up, respectively, were excluded. The total planning target volume was used to select the SBRT dose (median, 48 Gy; range, 30 to 60 Gy, 3–4 fractions). Toxicity was evaluated using the Common Toxicity Criteria for Adverse Events v4.0. We evaluated 55 patients (77 lesions) treated with SBRT for liver metastases. All patients had controlled primary lesions, and 28 patients had stable lesions at another site (oligo-progression). The most common primary site was the colon (36 patients), followed by the stomach (6 patients) and other sites (13 patients). The 2-year local control and progression-free survival rates were 68% and 22%, respectively. The 2- and 5-year overall survival rates were 56% and 20%, respectively. The most common adverse events were grade 1–2 fatigue, nausea, and vomiting; no grade ≥3 toxicities were observed. Univariate analysis revealed that oligo-progression associated with poor survival. SBRT for liver oligo-recurrence and oligo-progression appears safe, with similar local control rates. For liver oligo-progression, criteria are needed to select patients in whom improved overall survival can be expected through SBRT.

  15. Dosimetric effects of rotational offsets in stereotactic body radiation therapy (SBRT) for lung cancer

    International Nuclear Information System (INIS)

    Yang, Yun; Catalano, Suzanne; Kelsey, Chris R.; Yoo, David S.; Yin, Fang-Fang; Cai, Jing

    2014-01-01

    To quantitatively evaluate dosimetric effects of rotational offsets in stereotactic body radiation therapy (SBRT) for lung cancer. Overall, 11 lung SBRT patients (8 female and 3 male; mean age: 75.0 years) with medially located tumors were included. Treatment plans with simulated rotational offsets of 1°, 3°, and 5° in roll, yaw, and pitch were generated and compared with the original plans. Both clockwise and counterclockwise rotations were investigated. The following dosimetric metrics were quantitatively evaluated: planning target volume coverage (PTV V 100% ), max PTV dose (PTV D max ), percentage prescription dose to 0.35 cc of cord (cord D 0.35 cc ), percentage prescription dose to 0.35 cc and 5 cc of esophagus (esophagus D 0.35 cc and D 5 cc ), and volume of the lungs receiving at least 20 Gy (lung V 20 ). Statistical significance was tested using Wilcoxon signed rank test at the significance level of 0.05. Overall, small differences were found in all dosimetric matrices at all rotational offsets: 95.6% of differences were 100% , PTV D max , cord D 0.35 cc , esophagus D 0.35 cc , esophagus D 5 cc , and lung V 20 was − 8.36%, − 6.06%, 11.96%, 8.66%, 6.02%, and − 0.69%, respectively. No significant correlation was found between any dosimetric change and tumor-to-cord/esophagus distances (R 2 range: 0 to 0.44). Larger dosimetric changes and intersubject variations were observed at larger rotational offsets. Small dosimetric differences were found owing to rotational offsets up to 5° in lung SBRT for medially located tumors. Larger intersubject variations were observed at larger rotational offsets

  16. Dosimetric evaluation of simultaneous integrated boost during stereotactic body radiation therapy for pancreatic cancer

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Wensha, E-mail: wensha.yang@cshs.org [Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, CA (United States); Reznik, Robert; Fraass, Benedick A. [Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, CA (United States); Nissen, Nicholas [Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA (United States); Hendifar, Andrew [Department of Gastrointestinal Oncology, Cedars Sinai Medical Center, Los Angeles, CA (United States); Wachsman, Ashley [Department of Cross-Sectional Imaging Interventional Oncology, Cedars Sinai Medical Center, Los Angeles, CA (United States); Sandler, Howard; Tuli, Richard [Department of Radiation Oncology, Cedars Sinai Medical Center, Los Angeles, CA (United States)

    2015-04-01

    Stereotactic body radiation therapy (SBRT) provides a promising way to treat locally advanced pancreatic cancer and borderline resectable pancreatic cancer. A simultaneous integrated boost (SIB) to the region of vessel abutment or encasement during SBRT has the potential to downstage otherwise likely positive surgical margins. Despite the potential benefit of using SIB-SBRT, the ability to boost is limited by the local geometry of the organs at risk (OARs), such as stomach, duodenum, and bowel (SDB), relative to tumor. In this study, we have retrospectively replanned 20 patients with 25 Gy prescribed to the planning target volume (PTV) and 33~80 Gy to the boost target volume (BTV) using an SIB technique for all patients. The number of plans and patients able to satisfy a set of clinically established constraints is analyzed. The ability to boost vessels (within the gross target volume [GTV]) is shown to correlate with the overlap volume (OLV), defined to be the overlap between the GTV + a 1(OLV1)- or 2(OLV2)-cm margin with the union of SDB. Integral dose, boost dose contrast (BDC), biologically effective BDC, tumor control probability for BTV, and normal tissue complication probabilities are used to analyze the dosimetric results. More than 65% of the cases can deliver a boost to 40 Gy while satisfying all OAR constraints. An OLV2 of 100 cm{sup 3} is identified as the cutoff volume: for cases with OLV2 larger than 100 cm{sup 3}, it is very unlikely the case could achieve 25 Gy to the PTV while successfully meeting all the OAR constraints.

  17. Novel Technique for Hepatic Fiducial Marker Placement for Stereotactic Body Radiation Therapy

    International Nuclear Information System (INIS)

    Jarraya, Hajer; Chalayer, Chloé; Tresch, Emmanuelle; Bonodeau, Francois; Lacornerie, Thomas; Mirabel, Xavier; Boulanger, Thomas; Taieb, Sophie; Kramar, Andrew; Lartigau, Eric; Ceugnart, Luc

    2014-01-01

    Purpose: To report experience with fiducial marker insertion and describe an advantageous, novel technique for fiducial placement in the liver for stereotactic body radiation therapy with respiratory tracking. Methods and Materials: We implanted 1444 fiducials (single: 834; linked: 610) in 328 patients with 424 hepatic lesions. Two methods of implantation were compared: the standard method (631 single fiducials) performed on 153 patients from May 2007 to May 2010, and the cube method (813 fiducials: 610 linked/203 single) applied to 175 patients from April 2010 to March 2013. The standard method involved implanting a single marker at a time. The novel technique entailed implanting 2 pairs of linked markers when possible in a way to occupy the perpendicular edges of a cube containing the tumor inside. Results: Mean duration of the cube method was shorter than the standard method (46 vs 61 minutes; P<.0001). Median numbers of skin and subcapsular entries were significantly smaller with the cube method (2 vs 4, P<.0001, and 2 vs 4, P<.0001, respectively). The rate of overall complications (total, major, and minor) was significantly lower in the cube method group compared with the standard method group (5.7% vs 13.7%; P=.013). Major complications occurred while using single markers only. The success rate was 98.9% for the cube method and 99.3% for the standard method. Conclusions: We propose a new technique of hepatic fiducial implantation that makes use of linked fiducials and involves fewer skin entries and shorter time of implantation. The technique is less complication-prone and is migration-resistant

  18. Prostate-specific antigen bounce following stereotactic body radiation therapy for prostate cancer

    Directory of Open Access Journals (Sweden)

    Charles C. Vu

    2014-01-01

    Full Text Available Introduction: Prostate-specific antigen (PSA bounce after brachytherapy has been well-documented. This phenomenon has also been identified in patients undergoing stereotactic body radiation therapy (SBRT. While the parameters that predict PSA bounce have been extensively studied in prostate brachytherapy patients, this study is the first to analyze the clinical and pathologic predictors of PSA bounce in prostate SBRT patients. Materials and Methods: Our institution has maintained a prospective database of patients undergoing SBRT for prostate cancer since 2006. Our study population includes patients between May 2006 and November 2011 who have at least 18 months of follow-up. All patients were treated using the CyberKnife treatment system. The prescription dose was 3500-3625cGy in 5 fractions.Results: 120 patients were included in our study. Median PSA follow-up was 24 months (range 18-78 months. 34 (28% patients had a PSA bounce. The median time to PSA bounce was 9 months, and the median bounce size was 0.50ng/mL. On univariate analysis, only younger age (p = .011 was shown to be associated with an increased incidence of PSA bounce. Other patient factors, including race, prostate size, prior treatment by hormones, and family history of prostate cancer, did not predict PSA bounces. None of the tumor characteristics studied, including Gleason score, pre-treatment PSA, T-stage, or risk classification by NCCN guidelines, was associated with increased incidence of PSA bounces. Younger age was the only statistically significant predictor of PSA bounce on multivariate analysis (OR = 0.937, p = 0.009.Conclusion: PSA bounce, which has been reported after prostate brachytherapy, is also seen in a significant percentage of patients after CyberKnife SBRT. Close observation rather than biopsy can be considered for these patients. Younger age was the only factor that predicted PSA bounce.

  19. [Doses to organs at risk in conformational and stereotactic body radiation therapy: Liver].

    Science.gov (United States)

    Debbi, K; Janoray, G; Scher, N; Deutsch, É; Mornex, F

    2017-10-01

    The liver is an essential organ that ensures many vital functions such as metabolism of bilirubin, glucose, lipids, synthesis of coagulation factors, destruction of many toxins, etc. The hepatic parenchyma can be irradiated during the management of digestive tumors, right basithoracic, esophagus, abdomen in toto or TBI. In addition, radiotherapy of the hepatic area, which is mainly stereotactic, now occupies a central place in the management of primary or secondary hepatic tumors. Irradiation of the whole liver, or part of it, may be complicated by radiation-induced hepatitis. It is therefore necessary to respect strict dosimetric constraints both in stereotactic and in conformational irradiation in order to limit the undesired irradiation of the hepatic parenchyma which may vary according to the treatment techniques, the basic hepatic function or the lesion size. The liver is an organ with a parallel architecture, so the average tolerable dose in the whole liver should be considered rather than the maximum tolerable dose at one point. The purpose of this article is to propose a development of dose recommendations during conformation or stereotactic radiotherapy of the liver. Copyright © 2017 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  20. Stereotactic Body Radiation Therapy for Patients with Heavily Pretreated Liver Metastases and Liver Tumors

    Energy Technology Data Exchange (ETDEWEB)

    Lanciano, Rachelle; Lamond, John; Yang, Jun; Feng, Jing; Arrigo, Steve; Good, Michael; Brady, Luther, E-mail: rlancmd@gmail.com [Philadelphia CyberKnife, Drexel University, Havertown, PA (United States)

    2012-03-09

    We present our initial experience with CyberKnife stereotactic body radiation therapy (SBRT) in a heavily pretreated group of patients with liver metastases and primary liver tumors. From October 2007 to June 2009, 48 patients were treated at the Philadelphia CyberKnife Center for liver metastases or primary liver tumors. We report on 30 patients with 41 discrete lesions (1–4 tumors per patient) who received an ablative radiation dose (BED ≥ 79.2 Gy10 = 66 Gy EQD2). The treatment goal was to achieve a high SBRT dose to the liver tumor while sparing at least 700 cc of liver from radiation doses above 15 Gy. Twenty-three patients were treated with SBRT for metastatic cancer to the liver; the remainder (n = 7) were primary liver tumors. Eighty-seven percent of patients had prior systemic chemotherapy with a median 24 months from diagnosis to SBRT; 37% had prior liver directed therapy. Local control was assessed for 28 patients (39 tumors) with 4 months or more follow-up. At a median follow-up of 22 months (range, 10–40 months), 14/39 (36%) tumors had documented local failure. A decrease in local failure was found with higher doses of SBRT (p = 0.0237); 55% of tumors receiving a BED ≤ 100 Gy10 (10/18) had local failure compared with 19% receiving a BED > 100 Gy10 (4/21). The 2-year actuarial rate of local control for tumors treated with BED > 100 Gy10 was 75% compared to 38% for those patients treated with BED ≤ 100 Gy10 (p = 0.04). At last follow-up, 22/30 patients (73%) had distant progression of disease. Overall, seven patients remain alive with a median survival of 20 months from treatment and 57 months from diagnosis. To date, no patient experienced persistent or severe adverse effects. Despite the heavy pretreatment of these patients, SBRT was well tolerated with excellent local control rates when adequate doses (BED > 100 Gy10) were used. Median survival was limited secondary to development of further metastatic disease in the majority of patients.

  1. SU-E-T-642: Safety Procedures for Error Elimination in Cyberknife Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT)

    International Nuclear Information System (INIS)

    Hussain, A; Alkafi, A; Al-Najjar, W; Moftah, B

    2014-01-01

    Purpose: Cyberknife system is used for providing stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) hypofractionation scheme. The whole treatment delivery is based on live imaging of the patient. The minor error made at any stage may bring severe radiation injury to the patient or damage to the system itself. Several safety measures were taken to make the system safer. Methods: The radiation treatment provided thru a 6MV linac attached to Kuka robot (Cyberknife G4, Accuray Inc. Sunnyvale, CA, USA). Several possible errors were identified related to patient alignment, treatment planning, dose delivery and physics quality assurance. During dose delivery, manual and visual checks were introduced to confirm pre and intra-treatment imaging to reduce possible errors. One additional step was introduced to confirm that software tracking-tools had worked correctly with highest possible confidence level. Robotic head move in different orientations over and around the patient body, the rigidity of linac-head cover and other accessories was checked periodically. The vender was alerted when a tiny or bigger piece of equipment needed additional interlocked support. Results: As of our experience treating 525 patients on Cyberknife during the last four years, we saw on and off technical issues. During image acquisition, it was made essential to follow the site-specific imaging protocols. Adequate anatomy was contoured to document the respective doses. Followed by auto-segmentation, manual tweaking was performed on every structure. The calculation box was enclosing the whole image during the final calculation. Every plan was evaluated on slice-by slice basis. To review the whole process, a check list was maintained during the physics 2nd-check. Conclusion: The implementation of manual and visual additional checks introduced along with automated checks for confirmation was found promising in terms of reduction in systematic errors and making the system

  2. The impact of respiratory motion and treatment technique on stereotactic body radiation therapy for liver cancer

    International Nuclear Information System (INIS)

    Wu, Q. Jackie; Thongphiew, Danthai; Wang Zhiheng; Chankong, Vira; Yin Fangfang

    2008-01-01

    Stereotactic body radiation therapy (SBRT), which delivers a much higher fractional dose than conventional treatment in only a few fractions, is an effective treatment for liver metastases. For patients who are treated under free-breathing conditions, however, respiration-induced tumor motion in the liver is a concern. Limited clinical information is available related to the impact of tumor motion and treatment technique on the dosimetric consequences. This study evaluated the dosimetric deviations between planned and delivered SBRT dose in the presence of tumor motion for three delivery techniques: three-dimensional conformal static beams (3DCRT), dynamic conformal arc (DARC), and intensity-modulated radiation therapy (IMRT). Five cases treated with SBRT for liver metastases were included in the study, with tumor motions ranging from 0.5 to 1.75 cm. For each case, three different treatment plans were developed using 3DCRT, DARC, and IMRT. The gantry/multileaf collimator (MLC) motion in the DARC plans and the MLC motion in the IMRT plans were synchronized to the patient's respiratory motion. Retrospectively sorted four-dimensional computed tomography image sets were used to determine patient-organ motion and to calculate the dose delivered during each respiratory phase. Deformable registration, using thin-plate-spline models, was performed to encode the tumor motion and deformation and to register the dose-per-phase to the reference phase images. The different dose distributions resulting from the different delivery techniques and motion ranges were compared to assess the effect of organ motion on dose delivery. Voxel dose variations occurred mostly in the high gradient regions, typically between the target volume and normal tissues, with a maximum variation up to 20%. The greatest CTV variation of all the plans was seen in the IMRT technique with the largest motion range (D99: -8.9%, D95: -8.3%, and D90: -6.3%). The greatest variation for all 3DCRT plans was less

  3. Functional image-guided stereotactic body radiation therapy planning for patients with hepatocellular carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Tsegmed, Uranchimeg [Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima (Japan); Kimura, Tomoki, E-mail: tkkimura@hiroshima-u.ac.jp [Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima (Japan); Nakashima, Takeo [Division of Radiation Therapy, Hiroshima University Hospital, Hiroshima (Japan); Nakamura, Yuko; Higaki, Toru [Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima (Japan); Imano, Nobuki; Doi, Yoshiko; Kenjo, Masahiro; Ozawa, Shuichi; Murakami, Yuji [Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima (Japan); Awai, Kazuo [Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima (Japan); Nagata, Yasushi [Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima (Japan)

    2017-07-01

    The aim of the current planning study is to evaluate the ability of gadoxetate disodium-enhanced magnetic resonance imaging (EOB-MRI)–guided stereotactic body radiation therapy (SBRT) planning by using intensity-modulated radiation therapy (IMRT) techniques in sparing the functional liver tissues during SBRT for hepatocellular carcinoma. In this study, 20 patients with hepatocellular carcinoma were enrolled. Functional liver tissues were defined according to quantitative liver-spleen contrast ratios ≥ 1.5 on a hepatobiliary phase scan. Functional images were fused with the planning computed tomography (CT) images; the following 2 SBRT plans were designed using a “step-and-shoot” static IMRT technique for each patient: (1) an anatomical SBRT plan optimization based on the total liver; and (2) a functional SBRT plan based on the functional liver. The total prescribed dose was 48 gray (Gy) in 4 fractions. Dosimetric parameters, including dose to 95% of the planning target volume (PTV D{sub 95%}), percentages of total and functional liver volumes, which received doses from 5 to 30 Gy (V5 to V30 and fV5 to fV30), and mean doses to total and functional liver (MLD and fMLD, respectively) of the 2 plans were compared. Compared with anatomical plans, functional image-guided SBRT plans reduced MLD (mean: plan A, 5.5 Gy; and plan F, 5.1 Gy; p < 0.0001) and fMLD (mean: plan A, 5.4 Gy; and plan F, 4.9 Gy; p < 0.0001), as well as V5 to V30 and fV5 to fV30. No differences were noted in PTV coverage and nonhepatic organs at risk (OARs) doses. In conclusion, EOB-MRI–guided SBRT planning using the IMRT technique may preserve functional liver tissues in patients with hepatocellular carcinoma (HCC).

  4. Spine stereotactic body radiation therapy plans: Achieving dose coverage, conformity, and dose falloff

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Linda X., E-mail: lhong0812@gmail.com [Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY (United States); Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, NY (United States); Shankar, Viswanathan [Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (United States); Shen, Jin [Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY (United States); Kuo, Hsiang-Chi [Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY (United States); Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, NY (United States); Mynampati, Dinesh [Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY (United States); Yaparpalvi, Ravindra [Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY (United States); Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, NY (United States); Goddard, Lee [Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY (United States); Basavatia, Amar; Fox, Jana; Garg, Madhur; Kalnicki, Shalom; Tomé, Wolfgang A. [Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY (United States); Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, NY (United States)

    2015-10-01

    We report our experience of establishing planning objectives to achieve dose coverage, conformity, and dose falloff for spine stereotactic body radiation therapy (SBRT) plans. Patients with spine lesions were treated using SBRT in our institution since September 2009. Since September 2011, we established the following planning objectives for our SBRT spine plans in addition to the cord dose constraints: (1) dose coverage—prescription dose (PD) to cover at least 95% planning target volume (PTV) and 90% PD to cover at least 99% PTV; (2) conformity index (CI)—ratio of prescription isodose volume (PIV) to the PTV < 1.2; (3) dose falloff—ratio of 50% PIV to the PTV (R{sub 50%}); (4) and maximum dose in percentage of PD at 2 cm from PTV in any direction (D{sub 2cm}) to follow Radiation Therapy Oncology Group (RTOG) 0915. We have retrospectively reviewed 66 separate spine lesions treated between September 2009 and December 2012 (31 treated before September 2011 [group 1] and 35 treated after [group 2]). The χ{sup 2} test was used to examine the difference in parameters between groups. The PTV V{sub 100%} {sub PD} ≥ 95% objective was met in 29.0% of group 1 vs 91.4% of group 2 (p < 0.01) plans. The PTV V{sub 90%} {sub PD} ≥ 99% objective was met in 38.7% of group 1 vs 88.6% of group 2 (p < 0.01) plans. Overall, 4 plans in group 1 had CI > 1.2 vs none in group 2 (p = 0.04). For D{sub 2cm}, 48.3% plans yielded a minor violation of the objectives and 16.1% a major violation for group 1, whereas 17.1% exhibited a minor violation and 2.9% a major violation for group 2 (p < 0.01). Spine SBRT plans can be improved on dose coverage, conformity, and dose falloff employing a combination of RTOG spine and lung SBRT protocol planning objectives.

  5. A mouse radiation-induced liver disease model for stereotactic body radiation therapy validated in patients with hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Wu, Zhi-Feng; Zhang, Jian-Ying; Shen, Xiao-Yun; Gao, Ya-Bo; Hu, Yong; Zeng, Zhao-Chong; Zhou, Le-Yuan

    2016-01-01

    Purpose: Lower radiation tolerance of the whole liver hinders dose escalations of stereotactic body radiation therapy (SBRT) in hepatocellular carcinoma (HCC) treatment. This study was conducted to define the exact doses that result in radiation-induced liver disease (RILD) as well as to determine dose constraints for the critical organs at risk (OARs) in mice; these parameters are still undefined in HCC SBRT. Methods: This study consisted of two phases. In the primary phase, mice treated with helical tomotherapy-based SBRT were stratified according to escalating radiation doses to the livers. The pathological differences, signs [such as mouse performance status (MPS)], and serum aspartate aminotransferase (AST)/alanine aminotransferase (ALT)/albumin levels were observed. Radiation-induced disease severities of the OARs were scored using systematic evaluation standards. In the validation phase in humans, 13 patients with HCC who had undergone radiotherapy before hepatectomy were enrolled to validate RILD pathological changes in a mouse study. Results: The evaluation criteria of the mouse liver radiotherapy-related signs were as follows: MPS ≥ 2.0 ± 0.52, AST/ALT ≥ 589.2 ± 118.5/137.4 ± 15.3 U/L, serum albumin ≤ 16.8 ± 2.29 g/L. The preliminary dose constraints of the OARs were also obtained, such as those for the liver (average dose ≤ 26.36 ± 1.71 Gy) and gastrointestinal tract (maximum dose ≤ 22.63 Gy). Mouse RILD models were able to be developed when the livers were irradiated with average doses of ≥31.76 ± 1.94 Gy (single fraction). RILD pathological changes in mice have also been validated in HCC patients. Conclusions: Mouse RILD models could be developed with SBRT based on the dose constraints for the OARs and evaluation criteria of mouse liver radiotherapy-related signs, and the authors’ results favor the study of further approaches to treat HCC with SBRT.

  6. Potentially curative stereotactic body radiation therapy (SBRT) for single or oligometastasis to the lung.

    Science.gov (United States)

    Oh, Dongryul; Ahn, Yong Chan; Seo, Jeong Min; Shin, Eun Hyuk; Park, Hee Chul; Lim, Do Hoon; Pyo, Hongryull

    2012-05-01

    To analyze the treatment outcomes of a potentially curative therapy, stereotactic body radiation therapy (SBRT), for patients with single or oligometastasis to the lungs. Sixty-seven metastatic lung lesions in 57 patients were treated with SBRT between September 2001 and November 2010. All patients had single or oligo-metastasis to the lungs following a meticulous clinical work-up, including PET-CT scans. The lungs were the most common primary organ (33 lesions, 49.3%), followed by the head and neck (11 lesions, 16.4%), the liver (nine lesions, 13.5%), the colorectum (seven lesions, 10.4%), and other organs (seven lesions, 10.4%). Three different fractionation schedules were used: 50 Gy/5 fractions to four lesions (6.0%); 60 Gy/5 fractions to 44 lesions (65.7%); and 60 Gy/4 fractions to 19 lesions (28.3%). Local tumor progression occurred in three lesions (4.5%). The three-year actuarial local control rate was 94.5%. Tumors larger than or equal to 2.5 cm showed poorer local control (98.3% vs. 77.8%, p <0.01). Metastatic tumors from the liver and colorectum showed lower local control rates than those from other organs (77.8%, 85.7%, and 100%, p =0.04). The two-year overall survival rate was 57.2%. Patients with tumors smaller than 2.5 cm had more favorable survival rates (64.0% vs. 38.9% at two-year, p =0.032). Patients with extrathoracic disease had poorer survival rates (66.1% vs. 0% at two-year, p =0.003). Patients with disease-free intervals longer than two years showed a trend toward good prognosis (71.1% vs. 51.1% at two-year, p =0.106). Grade 2 lung toxicity occurred in four patients (6.0%). One patient experienced Grade 5 lung toxicity following SBRT. SBRT for single or oligo-metastasis to the lung seems quite effective and safe. Tumor size, disease-free interval, and presence of extrathoracic disease are prognosticators for survival.

  7. Patterns of Intraosseous Recurrence After Stereotactic Body Radiation Therapy for Coxal Bone Metastasis.

    Science.gov (United States)

    Ito, Kei; Shimizuguchi, Takuya; Nihei, Keiji; Furuya, Tomohisa; Ogawa, Hiroaki; Tanaka, Hiroshi; Sasai, Keisuke; Karasawa, Katsuyuki

    2018-01-01

    To analyze the detailed pattern of intraosseous failure after stereotactic body radiation therapy (SBRT) for coxal bone metastasis. Patients treated with SBRT to coxal bone metastasis were identified by retrospective chart review. The SBRT doses were 30 Gy or 35 Gy in 5 fractions. A margin of 5 to 10 mm was added to the gross tumor volume to create the clinical target volume. We evaluated the presence or absence of intraosseous recurrence using magnetic resonance imaging. Intraosseous recurrences were assessed as "in-field" or "marginal/out-of-field." In addition, we measured the distance between the center of the recurrent tumor and the nearest edge of the initial bone metastasis in cases of marginal/out-of-field recurrence. Seventeen patients treated for 17 coxal bone metastases were included. Median age was 64 years (range, 48-79 years). Coxal lesions involved the ilium in 14 cases, pubis in 3, and ischium in 4 (3 lesions crossed over multiple regions). Patients most commonly had renal cell carcinoma (29.4%), followed by lung, hepatic cell, and colorectal cancers (23.5%, 11.8%, and 11.8%, respectively). Median follow-up after SBRT was 13 months (range, 2-44 months). Among all 17 cases, 7 cases developed 8 intraosseous recurrences, including in-field recurrence in 1 case and marginal/out-of-field recurrences in 7 cases. Median time to intraosseous recurrence was 10 months (range, 2-35 months). Among 7 cases with marginal/out-of-field recurrence, mean distance to the center of the recurrent tumor from the nearest edge of the initial bone metastasis was 34 mm (range, 15-55 mm). Most recurrences were observed out-of-field in the same coxal bone. These results suggest that defining the optimal clinical target volume in SBRT for coxal bone metastasis to obtain sufficient local tumor control is difficult. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Potentially curative stereotactic body radiation therapy (SBRT) for single or oligometastasis to the lung

    International Nuclear Information System (INIS)

    Oh, Dongryul; Ahn, Yong Chan; Park, Hee Chul; Lim, Do Hoon; Pyo, Hongryull; Seo, Jeong Min; Shin, Eun Hyuk

    2012-01-01

    Background. To analyze the treatment outcomes of a potentially curative therapy, stereotactic body radiation therapy (SBRT), for patients with single or oligometastasis to the lungs. Material and methods. Sixty-seven metastatic lung lesions in 57 patients were treated with SBRT between September 2001 and November 2010. All patients had single or oligo-metastasis to the lungs following a meticulous clinical work-up, including PET-CT scans. The lungs were the most common primary organ (33 lesions, 49.3%), followed by the head and neck (11 lesions, 16.4%), the liver (nine lesions, 13.5%), the colorectum (seven lesions, 10.4%), and other organs (seven lesions, 10.4%). Three different fractionation schedules were used: 50 Gy/5 fractions to four lesions (6.0%); 60 Gy/5 fractions to 44 lesions (65.7%); and 60 Gy/4 fractions to 19 lesions (28.3%). Results. Local tumor progression occurred in three lesions (4.5%). The three-year actuarial local control rate was 94.5%. Tumors larger than or equal to 2.5 cm showed poorer local control (98.3% vs. 77.8%, p <0.01). Metastatic tumors from the liver and colorectum showed lower local control rates than those from other organs (77.8%, 85.7%, and 100%, p =0.04). The two-year overall survival rate was 57.2%. Patients with tumors smaller than 2.5 cm had more favorable survival rates (64.0% vs. 38.9% at two-year, p =0.032). Patients with extrathoracic disease had poorer survival rates (66.1% vs. 0% at two-year, p =0.003). Patients with disease-free intervals longer than two years showed a trend toward good prognosis (71.1% vs. 51.1% at two-year, p =0.106). Grade 2 lung toxicity occurred in four patients (6.0%). One patient experienced Grade 5 lung toxicity following SBRT. Conclusion. SBRT for single or oligo-metastasis to the lung seems quite effective and safe. Tumor size, disease-free interval, and presence of extrathoracic disease are prognosticators for survival

  9. PROCTITIS ONE WEEK AFTER STEREOTACTIC BODY RADIATION THERAPY FOR PROSTATE CANCER: IMPLICATIONS FOR CLINICAL TRIAL DESIGN

    Directory of Open Access Journals (Sweden)

    Ima Paydar

    2016-07-01

    Full Text Available Background: Proctitis following prostate cancer radiation therapy is a primary determinant of quality of life (QOL. While previous studies have assessed acute rectal morbidity at 1 month after stereotactic body radiotherapy (SBRT, little data exist on the prevalence and severity of rectal morbidity within the first week following treatment. This study reports the acute bowel morbidity one week following prostate SBRT. Materials and methods: Between May 2013 and August 2014, 103 patients with clinically localized prostate cancer were treated with 35 to 36.25 Gy in five fractions using robotic SBRT delivered on a prospective clinical trial. Bowel toxicity was graded using the Common Terminology Criteria for Adverse Events version 4.0 (CTCAEv.4. Bowel QOL was assessed using EPIC-26 questionnaire bowel domain at baseline, one week, one month, and three months. Time-dependent changes in bowel symptoms were statistically compared using the Wilcoxon signed-rank test. Clinically significant change was assessed by the minimally important difference (MID in EPIC score. This was defined as a change of one-half standard deviation (SD from the baseline score. Results: One hundred and three patients with a minimum of three months of follow-up were analyzed. The cumulative incidence of acute grade 2 GI toxicity was 23%. There were no acute ≥ grade 3 bowel toxicities. EPIC bowel summary scores maximally declined at 1 week after SBRT (-13.9, p<0.0001 before returning to baseline at three months after SBRT (+0.03, p=0.94. Prior to treatment, 4.9% of men reported that their bowel bother was a moderate to big problem. This increased to 28.4% (p<0.0001 one week after SBRT and returned to baseline at three months after SBRT (0.0%, p=0.66. Only the bowel summary and bowel bother score declines at 1 week met the MID threshold for clinically significant change. Conclusion: The rate and severity of acute proctitis following prostate SBRT peaked at one week after

  10. Stereotactic body radiation therapy for isolated hilar and mediastinal non-small cell lung cancers.

    Science.gov (United States)

    Horne, Zachary D; Richman, Adam H; Dohopolski, Michael J; Clump, David A; Burton, Steven A; Heron, Dwight E

    2018-01-01

    The seminal phase II trial for pulmonary stereotactic body radiation therapy (SBRT) suggested that SBRT to central lesions resulted in unacceptable toxicity. Alternative dose-fractionation schemes have been proposed which may improve safety without compromise of efficacy. We report our institutional outcomes of SBRT for hilar/mediastinal non-small cell lung cancer (NSCLC). A retrospective review was conducted of patients with NSCLC in a hilar or mediastinal nodal station which was treated with SBRT. Patients presented with a lesion involving the hilum or mediastinum from primary or oligorecurrent NSCLC. Kaplan-Meier with log-rank testing and Cox analysis were utilized for outcomes analysis. From 2008-2015, 40 patients with median age of 70 were treated with SBRT for primary/oligorecurrent hilar/mediastinal NSCLC with median follow-up of 16.4 months. 85% presented with oligorecurrent disease at a median of 22.4 months following definitive therapy. The aortico-pulmonary window was the target in 40%, the hilum in 25%, lower paratracheal in 20%, subcarinal in 10%, and prevascular in 5%. The median dose was 48Gy in 4 fractions (range: 35-48Gy in 4-5 fractions). Median overall (OS) and progression-free (PFS) survivals were 22.7 and 13.1 months, respectively. Two-year local control was 87.7% and not significantly different between hilar and mediastinal targets. Median PFS was significantly improved in patients with hilar vs mediastinal nodal targets: 33.3 vs 8.4 months, respectively (p=0.031). OS was not statistically different between hilar and mediastinal targets (p=0.359). On multivariable analysis, hilar vs mediastinal target predicted for PFS (HR 3.045 95%CI [1.044-8.833], p=0.042), as did shorter time to presentation in patients with oligorecurrence (HR 0.983 [95%CI 0.967-1.000], p=0.049). Acute grade 3+ morbidity was seen in 3 patients (hemoptysis, pericardial/pleural effusion, heart failure) and late grade 3+ morbidity (hemoptysis) in 1 patient. Hilar

  11. Stereotactic body radiation therapy as an alternative treatment for small hepatocellular carcinoma.

    Directory of Open Access Journals (Sweden)

    Sang Min Yoon

    Full Text Available BACKGROUND: Even with early stage hepatocellular carcinoma (HCC, patients are often ineligible for surgical resection, transplantation, or local ablation due to advanced cirrhosis, donor shortage, or difficult location. Stereotactic body radiation therapy (SBRT has been established as a standard treatment option for patients with stage I lung cancer, who are not eligible for surgery, and may be a promising alternative treatment for patients with small HCC who are not eligible for curative treatment. MATERIALS AND METHODS: A registry database of 93 patients who were treated with SBRT for HCC between 2007 and 2009 was analyzed. A dose of 10-20 Gy per fraction was given over 3-4 consecutive days, resulting in a total dose of 30-60 Gy. The tumor response was determined using dynamic computed tomography or magnetic resonance imaging, which was performed 3 months after completion of SBRT. RESULTS: The median follow-up period was 25.6 months. Median size of tumors was 2 cm (range: 1-6 cm. Overall patients' survival rates at 1 and 3 years were 86.0% and 53.8%, respectively. Complete and partial tumor response were achieved in 15.5% and 45.7% of patients, respectively. Local recurrence-free survival rate was 92.1% at 3 years. Most local failures were found in patients with HCCs > 3 cm, and local control rate at 3 years was 76.3% in patients with HCC > 3 cm, 93.3% in patients with tumors between 2.1-3 cm, and 100% in patients with tumors ≤ 2 cm, respectively. Out-of-field intrahepatic recurrence-free survival rates at 1 and 3 years were 51.9% and 32.4%, respectively. Grade ≥ 3 hepatic toxicity was observed in 6 (6.5%. CONCLUSIONS: SBRT was effective in local control of small HCC. SBRT may be a promising alternative treatment for patients with small HCC which is unsuitable for other curative therapy.

  12. Stereotactic Body Radiation Therapy for Oligometastases to the Lung: A Phase 2 Study

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    Nuyttens, Joost J., E-mail: j.nuyttens@erasmusmc.nl [Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam (Netherlands); Voort van Zyp, Noëlle C.M.G. van der [Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam (Netherlands); Verhoef, Cornelis [Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam (Netherlands); Maat, A. [Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam (Netherlands); Klaveren, Robertus J. van [Department of Pulmonology, Erasmus MC Cancer Institute, Rotterdam (Netherlands); Holt, Bronno van der [Clinical Trial Center, Erasmus MC Cancer Institute, Rotterdam (Netherlands); Aerts, Joachim [Department of Pulmonology, Erasmus MC Cancer Institute, Rotterdam (Netherlands); Hoogeman, Mischa [Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam (Netherlands)

    2015-02-01

    Purpose: To assess, in a phase 2 study, the efficacy and toxicity of stereotactic body radiation therapy for oligometastases to the lung in inoperable patients. Methods and Materials: Patients with lung metastases were included in this study if (1) the primary tumor was controlled; (2) patients were ineligible for or refused surgery and chemotherapy; and (3) patients had 5 or fewer metastatic lesions in no more than 2 organs. Large peripheral tumors were treated with a dose of 60 Gy (3 fractions), small peripheral tumors with 30 Gy (1 fraction), central tumors received 60 Gy (5 fractions), and mediastinal tumors or tumors close to the esophagus received 56 Gy (7 fractions). Results: Thirty patients with 57 metastatic lung tumors from various primary cancers were analyzed. The median follow-up was 36 months (range, 4-60 months). At 2 years, local control for the 11 central tumors was 100%, for the 23 peripheral tumors treated to 60 Gy it was 91%, and for the 23 tumors treated in a single 30-Gy fraction it was 74% (P=.13). This resulted in an overall local control rate at 1 year of 79%, with a 2-sided 80% confidence interval of 67% to 87%. Because the hypothesized value of 70% lies within the confidence interval, we cannot reject the hypothesis that the true local control rate at 1 year is ≤70%, and therefore we did not achieve the goal of the study: an actuarial local control of the treated lung lesions at 1 year of 90%. The 4-year overall survival rate was 38%. Grade 3 acute toxicity occurred in 5 patients. Three patients complained of chronic grade 3 toxicity, including pain, fatigue, and pneumonitis, and 3 patients had rib fractures. Conclusions: The local control was promising, and the 4-year overall survival rate was 38%. The treatment was well tolerated, even for central lesions.

  13. Stereotactic Body Radiation Therapy for Oligometastases to the Lung: A Phase 2 Study

    International Nuclear Information System (INIS)

    Nuyttens, Joost J.; Voort van Zyp, Noëlle C.M.G. van der; Verhoef, Cornelis; Maat, A.; Klaveren, Robertus J. van; Holt, Bronno van der; Aerts, Joachim; Hoogeman, Mischa

    2015-01-01

    Purpose: To assess, in a phase 2 study, the efficacy and toxicity of stereotactic body radiation therapy for oligometastases to the lung in inoperable patients. Methods and Materials: Patients with lung metastases were included in this study if (1) the primary tumor was controlled; (2) patients were ineligible for or refused surgery and chemotherapy; and (3) patients had 5 or fewer metastatic lesions in no more than 2 organs. Large peripheral tumors were treated with a dose of 60 Gy (3 fractions), small peripheral tumors with 30 Gy (1 fraction), central tumors received 60 Gy (5 fractions), and mediastinal tumors or tumors close to the esophagus received 56 Gy (7 fractions). Results: Thirty patients with 57 metastatic lung tumors from various primary cancers were analyzed. The median follow-up was 36 months (range, 4-60 months). At 2 years, local control for the 11 central tumors was 100%, for the 23 peripheral tumors treated to 60 Gy it was 91%, and for the 23 tumors treated in a single 30-Gy fraction it was 74% (P=.13). This resulted in an overall local control rate at 1 year of 79%, with a 2-sided 80% confidence interval of 67% to 87%. Because the hypothesized value of 70% lies within the confidence interval, we cannot reject the hypothesis that the true local control rate at 1 year is ≤70%, and therefore we did not achieve the goal of the study: an actuarial local control of the treated lung lesions at 1 year of 90%. The 4-year overall survival rate was 38%. Grade 3 acute toxicity occurred in 5 patients. Three patients complained of chronic grade 3 toxicity, including pain, fatigue, and pneumonitis, and 3 patients had rib fractures. Conclusions: The local control was promising, and the 4-year overall survival rate was 38%. The treatment was well tolerated, even for central lesions

  14. An evaluation of planning techniques for stereotactic body radiation therapy in lung tumors

    International Nuclear Information System (INIS)

    Wu Jianzhou; Li Huiling; Shekhar, Raj; Suntharalingam, Mohan; D'Souza, Warren

    2008-01-01

    Purpose: To evaluate four planning techniques for stereotactic body radiation therapy (SBRT) in lung tumors. Methods and materials: Four SBRT plans were performed for 12 patients with stage I/II non-small-cell lung cancer under the following conditions: (1) conventional margins on free-breathing CT (plan 1), (2) generation of an internal target volume (ITV) using 4DCT with beam delivery under free-breathing conditions (plan 2), (3) gating at end-exhale (plan 3), and (4) gating at end-inhale (plan 4). Planning was performed following the RTOG 0236 protocol with a prescription dose of 54 Gy (3 fractions). For each plan 4D dose was calculated using deformable-image registration. Results: There was no significant difference in tumor dose delivered by the 4 plans. However, compared with plan 1, plans 2-4 reduced total lung BED by 1.9 ± 1.2, 3.1 ± 1.6 and 3.5 ± 2.1 Gy, reduced mean lung dose by 0.8 ± 0.5, 1.5 ± 0.8, and 1.6 ± 1.0 Gy, reduced V20 by 1.5 ± 1.0%, 2.7 ± 1.4%, and 2.8 ± 1.8%, respectively, with p < 0.01. Compared with plan 2, plans 3-4 reduced lung BED by 1.2 ± 1.0 and 1.6 ± 1.5 Gy, reduced mean lung dose by 0.6 ± 0.5 and 0.8 ± 0.7 Gy, reduced V20 by 1.2 ± 1.1% and 1.3 ± 1.5%, respectively, with p < 0.01. The differences in lung BED, mean dose and V20 of plan 4 compared with plan 3 were insignificant. Conclusions: Tumor dose coverage was statistically insignificant between all plans. However, compared with plan 1, plans 2-4 significantly reduced lung doses. Compared with plan 2, plan 3-4 also reduced lung toxicity. The difference in lung doses between plan 3 and plan 4 was not significant

  15. Predictors of Liver Toxicity Following Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Velec, Michael [Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Haddad, Carol R. [Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales (Australia); Craig, Tim [Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Wang, Lisa [Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Lindsay, Patricia; Brierley, James; Brade, Anthony; Ringash, Jolie; Wong, Rebecca; Kim, John [Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Dawson, Laura A., E-mail: Laura.Dawson@rmp.uhn.on.ca [Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada)

    2017-04-01

    Purpose: To identify risk factors associated with a decline in liver function after stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma. Methods and Materials: Data were analyzed from patients with hepatocellular carcinoma treated on clinical trials of 6-fraction SBRT. Liver toxicity was defined as an increase in Child-Pugh (CP) score ≥2 three months after SBRT. Clinical factors, SBRT details, and liver dose-volume histogram (DVH) parameters were tested for association with toxicity using logistic regression. CP class B patients were analyzed separately. Results: Among CP class A patients, 101 were evaluable, with a baseline score of A5 (72%) or A6 (28%). Fifty-three percent had portal vein thrombus. The median liver volume was 1286 cc (range, 766-3967 cc), and the median prescribed dose was 36 Gy (range, 27-54 Gy). Toxicity was seen in 26 patients (26%). Thrombus, baseline CP of A6, and lower platelet count were associated with toxicity on univariate analysis, as were several liver DVH-based parameters. Absolute and spared liver volumes were not significant. On multivariate analysis for CP class A patients, significant associations were found for baseline CP score of A6 (odds ratio [OR], 4.85), lower platelet count (OR, 0.90; median, 108 × 10{sup 9}/L vs 150 × 10{sup 9}/L), higher mean liver dose (OR, 1.33; median, 16.9 Gy vs 14.7 Gy), and higher dose to 800 cc of liver (OR, 1.11; median, 14.3 Gy vs 6.0 Gy). With 13 CP-B7 patients included or when dose to 800 cc of liver was replaced with other DVH parameters (eg, dose to 700 or 900 cc of liver) in the multivariate analysis, effective volume and portal vein thrombus were associated with an increased risk. Conclusions: Baseline CP scores and higher liver doses (eg, mean dose, effective volume, doses to 700-900 cc) were strongly associated with liver function decline 3 months after SBRT. A lower baseline platelet count and portal vein thrombus were also associated with an

  16. Dosimetric effects of rotational offsets in stereotactic body radiation therapy (SBRT) for lung cancer

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    Yang, Yun; Catalano, Suzanne; Kelsey, Chris R.; Yoo, David S.; Yin, Fang-Fang; Cai, Jing, E-mail: jing.cai@duke.edu

    2014-04-01

    To quantitatively evaluate dosimetric effects of rotational offsets in stereotactic body radiation therapy (SBRT) for lung cancer. Overall, 11 lung SBRT patients (8 female and 3 male; mean age: 75.0 years) with medially located tumors were included. Treatment plans with simulated rotational offsets of 1°, 3°, and 5° in roll, yaw, and pitch were generated and compared with the original plans. Both clockwise and counterclockwise rotations were investigated. The following dosimetric metrics were quantitatively evaluated: planning target volume coverage (PTV V{sub 100%}), max PTV dose (PTV D{sub max}), percentage prescription dose to 0.35 cc of cord (cord D{sub 0.35} {sub cc}), percentage prescription dose to 0.35 cc and 5 cc of esophagus (esophagus D{sub 0.35} {sub cc} and D{sub 5} {sub cc}), and volume of the lungs receiving at least 20 Gy (lung V{sub 20}). Statistical significance was tested using Wilcoxon signed rank test at the significance level of 0.05. Overall, small differences were found in all dosimetric matrices at all rotational offsets: 95.6% of differences were < 1% or < 1 Gy. Of all rotational offsets, largest change in PTV V{sub 100%}, PTV D{sub max}, cord D{sub 0.35} {sub cc}, esophagus D{sub 0.35} {sub cc}, esophagus D{sub 5} {sub cc}, and lung V{sub 20} was − 8.36%, − 6.06%, 11.96%, 8.66%, 6.02%, and − 0.69%, respectively. No significant correlation was found between any dosimetric change and tumor-to-cord/esophagus distances (R{sup 2} range: 0 to 0.44). Larger dosimetric changes and intersubject variations were observed at larger rotational offsets. Small dosimetric differences were found owing to rotational offsets up to 5° in lung SBRT for medially located tumors. Larger intersubject variations were observed at larger rotational offsets.

  17. Salvage Stereotactic Body Radiation Therapy (SBRT) for Local Failure After Primary Lung SBRT

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    Hearn, Jason W.D., E-mail: hearnj@ccf.org; Videtic, Gregory M.M.; Djemil, Toufik; Stephans, Kevin L.

    2014-10-01

    Purpose: Local failure after definitive stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer (NSCLC) is uncommon. We report the safety and efficacy of SBRT for salvage of local failure after previous SBRT with a biologically effective dose (BED) of ≥100 Gy{sub 10}. Methods and Materials: Using an institutional review board–approved lung SBRT registry, we identified all patients initially treated for early-stage NSCLC between August 2004 and January 2012 who received salvage SBRT for isolated local failure. Failure was defined radiographically and confirmed histologically unless contraindicated. All patients were treated on a Novalis/BrainLAB system using ExacTrac for image guidance, and received a BED of ≥100 Gy{sub 10} for each SBRT course. Tumor motion control involved a Bodyfix vacuum system for immobilization along with abdominal compression. Results: Of 436 patients treated from August 2004 through January 2012, we identified 22 patients with isolated local failure, 10 of whom received SBRT for salvage. The median length of follow-up was 13.8 months from salvage SBRT (range 5.3-43.5 months). Median tumor size was 3.4 cm (range 1.7-4.8 cm). Two of the 10 lesions were “central” by proximity to the mediastinum, but were outside the zone of the proximal bronchial tree. Since completing salvage, 3 patients are alive and without evidence of disease. A fourth patient died of medical comorbidities without recurrence 13.0 months after salvage SBRT. Two patients developed distant disease only. Four patients had local failure. Toxicity included grade 1-2 fatigue (3 patients) and grade 1-2 chest wall pain (5 patients). There was no grade 3-5 toxicity. Conclusions: Repeat SBRT with a BED of ≥100 Gy{sub 10} after local failure in patients with early-stage medically inoperable NSCLC was well tolerated in this series and may represent a viable salvage strategy in select patients with peripheral tumors ≤5 cm.

  18. Potentially curative stereotactic body radiation therapy (SBRT) for single or oligometastasis to the lung

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    Oh, Dongryul; Ahn, Yong Chan; Park, Hee Chul; Lim, Do Hoon; Pyo, Hongryull [Dept. of Radiation Oncology, Samsung Medical Center, Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of)], Email: ahnyc@skku.edu; Seo, Jeong Min [Dept. of Nuclear Engineering, Hanyang Univ., Seoul (Korea, Republic of); Dept. of Radiological Science, Daewon Univ. College, Jecheon (Korea, Republic of); Shin, Eun Hyuk [Dept. of Radiation Oncology, Samsung Medical Center, Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of); Dept. of Nuclear Engineering, Hanyang Univ., Seoul (Korea, Republic of)

    2012-05-15

    Background. To analyze the treatment outcomes of a potentially curative therapy, stereotactic body radiation therapy (SBRT), for patients with single or oligometastasis to the lungs. Material and methods. Sixty-seven metastatic lung lesions in 57 patients were treated with SBRT between September 2001 and November 2010. All patients had single or oligo-metastasis to the lungs following a meticulous clinical work-up, including PET-CT scans. The lungs were the most common primary organ (33 lesions, 49.3%), followed by the head and neck (11 lesions, 16.4%), the liver (nine lesions, 13.5%), the colorectum (seven lesions, 10.4%), and other organs (seven lesions, 10.4%). Three different fractionation schedules were used: 50 Gy/5 fractions to four lesions (6.0%); 60 Gy/5 fractions to 44 lesions (65.7%); and 60 Gy/4 fractions to 19 lesions (28.3%). Results. Local tumor progression occurred in three lesions (4.5%). The three-year actuarial local control rate was 94.5%. Tumors larger than or equal to 2.5 cm showed poorer local control (98.3% vs. 77.8%, p <0.01). Metastatic tumors from the liver and colorectum showed lower local control rates than those from other organs (77.8%, 85.7%, and 100%, p =0.04). The two-year overall survival rate was 57.2%. Patients with tumors smaller than 2.5 cm had more favorable survival rates (64.0% vs. 38.9% at two-year, p =0.032). Patients with extrathoracic disease had poorer survival rates (66.1% vs. 0% at two-year, p =0.003). Patients with disease-free intervals longer than two years showed a trend toward good prognosis (71.1% vs. 51.1% at two-year, p =0.106). Grade 2 lung toxicity occurred in four patients (6.0%). One patient experienced Grade 5 lung toxicity following SBRT. Conclusion. SBRT for single or oligo-metastasis to the lung seems quite effective and safe. Tumor size, disease-free interval, and presence of extrathoracic disease are prognosticators for survival.

  19. Statistical analysis of target motion in gated lung stereotactic body radiation therapy

    International Nuclear Information System (INIS)

    Zhao Bo; Yang Yong; Li Tianfang; Li Xiang; Heron, Dwight E; Huq, M Saiful

    2011-01-01

    An external surrogate-based respiratory gating technique is a useful method to reduce target margins for the treatment of a moving lung tumor. The success of this technique relies on a good correlation between the motion of the external markers and the internal tumor as well as the repeatability of the respiratory motion. In gated lung stereotactic body radiation therapy (SBRT), the treatment time for each fraction could exceed 30 min due to large fractional dose. Tumor motion may experience pattern changes such as baseline shift during such extended treatment time. The purpose of this study is to analyze tumor motion traces in actual treatment situations and to evaluate the effect of the target baseline shift in gated lung SBRT treatment. Real-time motion data for both the external markers and tumors from 51 lung SBRT treatments with Cyberknife Synchrony technology were analyzed in this study. The treatment time is typically greater than 30 min. The baseline shift was calculated with a rolling average window equivalent to ∼20 s and subtracted from that at the beginning. The magnitude of the baseline shift and its relationship with treatment time were investigated. Phase gating simulation was retrospectively performed on 12 carefully selected treatments with respiratory amplitude larger than 5 mm and regular phases. A customized gating window was defined for each individual treatment. It was found that the baseline shifts are specific to each patient and each fraction. Statistical analysis revealed that more than 69% treatments exhibited increased baseline shifts with the lapse of treatment time. The magnitude of the baseline shift could reach 5.3 mm during a 30 min treatment. Gating simulation showed that tumor excursion was caused mainly by the uncertainties in phase gating simulation and baseline shift, the latter being the primary factor. With a 5 mm gating window, 2 out of 12 treatments in the study group showed significant tumor excursion. Baseline shifts

  20. Biological-based optimization and volumetric modulated arc therapy delivery for stereotactic body radiation therapy

    International Nuclear Information System (INIS)

    Diot, Quentin; Kavanagh, Brian; Timmerman, Robert; Miften, Moyed

    2012-01-01

    Purpose: To describe biological-based optimization and Monte Carlo (MC) dose calculation-based treatment planning for volumetric modulated arc therapy (VMAT) delivery of stereotactic body radiation therapy (SBRT) in lung, liver, and prostate patients. Methods: Optimization strategies and VMAT planning parameters using a biological-based optimization MC planning system were analyzed for 24 SBRT patients. Patients received a median dose of 45 Gy [range, 34-54 Gy] for lung tumors in 1-5 fxs and a median dose of 52 Gy [range, 48-60 Gy] for liver tumors in 3-6 fxs. Prostate patients received a fractional dose of 10 Gy in 5 fxs. Biological-cost functions were used for plan optimization, and its dosimetric quality was evaluated using the conformity index (CI), the conformation number (CN), the ratio of the volume receiving 50% of the prescription dose over the planning target volume (Rx/PTV50). The quality and efficiency of the delivery were assessed according to measured quality assurance (QA) passing rates and delivery times. For each disease site, one patient was replanned using physical cost function and compared to the corresponding biological plan. Results: Median CI, CN, and Rx/PTV50 for all 24 patients were 1.13 (1.02-1.28), 0.79 (0.70-0.88), and 5.3 (3.1-10.8), respectively. The median delivery rate for all patients was 410 MU/min with a maximum possible rate of 480 MU/min (85%). Median QA passing rate was 96.7%, and it did not significantly vary with the tumor site. Conclusions: VMAT delivery of SBRT plans optimized using biological-motivated cost-functions result in highly conformal dose distributions. Plans offer shorter treatment-time benefits and provide efficient dose delivery without compromising the plan conformity for tumors in the prostate, lung, and liver, thereby improving patient comfort and clinical throughput. The short delivery times minimize the risk of patient setup and intrafraction motion errors often associated with long SBRT treatment

  1. Extended distance non-isocentric treatment in stereotactic body radiation therapy (SBRT for lung cancer

    Directory of Open Access Journals (Sweden)

    Long Huang

    2015-03-01

    Full Text Available Purpose: To obtain the maximum differential non-coplanar beams angle for a faster dose dropping outside Plan Target Volume (PTV for lung cancer treated by Stereotactic body radiation therapy (SBRT, an extended distance non-isocentric (EDNI treatment method was explored and developed.Methods: The EDNI requires delivering of the treatment beam at 120 cm or farther for sauce axial distance (SAD instead of standard 100 cm. This change provides a more compact dose distribution around PTV and the lower toxicity to organs at risk (OAR due to benefit of 120 cm SAD and more choice of beam and couch angle. A hand calculation formula for the translation between 100 SAD and EDNI was used to verify the treatment plan results. A phantom for end to end study based on this EDNI technique was used to compare with standard 100 SAD deliveries for SBRT. Three patients who underwent SBRT treatment were randomly chosen to demonstrate the benefits of EDNI technique. These treatment re-plans were applied to EDNI and evaluated for conformal index (CI of PTV, R50% of PTV, 2 cm distance (D2cm of PTV and Maximum dose (Dmaxof OARs to compare with original clinical plans.Results: All of the cases delivered by the EDNI technique satisfied dose requirements of RTOG 0263 and showed a faster dose dropping outside of PTV than standard SAD deliveries. The distance from PTV after 1.5 cm for the EDNI technique had a smaller maximum dose and much lower standard deviation for dose distribution. The EDNI applied plans for patients showed less R50% and D2cm of PTV (P≤ 0.05, also similar results for Dmax of esophagus, trachea and spinal cord.Conclusion: The EDNI method enhances the capabilities of linear accelerators as far as the increased gradient of dose drop-off outside of PTV is concerned. More angular separation between beams leads to more compact dose distributions, which allow decreasing volume of high dose exposure in SBRT treatments and better dose distribution on sensitive

  2. Stereotactic Body Radiation Therapy (SBRT) for clinically localized prostate cancer: the Georgetown University experience

    International Nuclear Information System (INIS)

    Chen, Leonard N; Lei, Siyuan; Batipps, Gerald P; Kowalczyk, Keith; Bandi, Gaurav

    2013-01-01

    Stereotactic body radiation therapy (SBRT) delivers fewer high-dose fractions of radiation which may be radiobiologically favorable to conventional low-dose fractions commonly used for prostate cancer radiotherapy. We report our early experience using SBRT for localized prostate cancer. Patients treated with SBRT from June 2008 to May 2010 at Georgetown University Hospital for localized prostate carcinoma, with or without the use of androgen deprivation therapy (ADT), were included in this retrospective review of data that was prospectively collected in an institutional database. Treatment was delivered using the CyberKnife® with doses of 35 Gy or 36.25 Gy in 5 fractions. Biochemical control was assessed using the Phoenix definition. Toxicities were recorded and scored using the CTCAE v.3. Quality of life was assessed before and after treatment using the Short Form-12 Health Survey (SF-12), the American Urological Association Symptom Score (AUA) and Sexual Health Inventory for Men (SHIM) questionnaires. Late urinary symptom flare was defined as an AUA score ≥ 15 with an increase of ≥ 5 points above baseline six months after the completion of SBRT. One hundred patients (37 low-, 55 intermediate- and 8 high-risk according to the D’Amico classification) at a median age of 69 years (range, 48–90 years) received SBRT, with 11 patients receiving ADT. The median pre-treatment prostate-specific antigen (PSA) was 6.2 ng/ml (range, 1.9-31.6 ng/ml) and the median follow-up was 2.3 years (range, 1.4-3.5 years). At 2 years, median PSA decreased to 0.49 ng/ml (range, 0.1-1.9 ng/ml). Benign PSA bounce occurred in 31% of patients. There was one biochemical failure in a high-risk patient, yielding a two-year actuarial biochemical relapse free survival of 99%. The 2-year actuarial incidence rates of GI and GU toxicity ≥ grade 2 were 1% and 31%, respectively. A median baseline AUA symptom score of 8 significantly increased to 11 at 1 month (p = 0.001), however returned to

  3. A study on uncertainty by passage of time of stereotactic body radiation therapy for spine metastasis cancer

    International Nuclear Information System (INIS)

    Cho, Yong Wan; Kim, Joo Ho; Ahn, Seung Kwon; Lee, Sang Kyoo; Cho, Jeong Hee

    2015-01-01

    The purpose of this study was to determine the proper treatment time of stereotactic body radiation therapy for spine metastasis cancer by using the image guidance system of CyberKnife(Accuracy Incorporated, USA) which is able to correct movements of patients during the treatment. Fifty seven spine metastasis cancer patients who have stereotactic body radiation therapy of CyberKnife participate, 8 of them with cervical spine cancer, 26 of them with thoracic spine cancer, and 23 of them with lumbar spine cancer. X-ray images acquired during the treatment were classified by treatment site. From the starting point of treatment, motion tendency of patients is analyzed in each section which is divided into every 5 minutes. In case of cervical spine, there is sudden increase of variation in 15 minutes after the treatment starts in rotational direction. In case of thoracic spine, there is no significantly variable section. However, variation increases gradually with the passage of time so that it is assumed that noticeable value comes up in approximately 40 minutes. In case of lumbar spine, sharp increase of variation is seen in 20 minutes in translational and rotational direction. Without having corrections during the treatment, proper treatment time is considered as less than 15 minutes for cervical spine, 40 minutes for thoracic spine, and 20 minutes for lumbar spine. If treatment time is longer than these duration, additional patient alignments are required or PTV margin should be enlarged

  4. A study on uncertainty by passage of time of stereotactic body radiation therapy for spine metastasis cancer

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Yong Wan; Kim, Joo Ho; Ahn, Seung Kwon; Lee, Sang Kyoo; Cho, Jeong Hee [Dept. of Radiation Oncology, Yonsei Cancer Center, Seoul (Korea, Republic of)

    2015-06-15

    The purpose of this study was to determine the proper treatment time of stereotactic body radiation therapy for spine metastasis cancer by using the image guidance system of CyberKnife(Accuracy Incorporated, USA) which is able to correct movements of patients during the treatment. Fifty seven spine metastasis cancer patients who have stereotactic body radiation therapy of CyberKnife participate, 8 of them with cervical spine cancer, 26 of them with thoracic spine cancer, and 23 of them with lumbar spine cancer. X-ray images acquired during the treatment were classified by treatment site. From the starting point of treatment, motion tendency of patients is analyzed in each section which is divided into every 5 minutes. In case of cervical spine, there is sudden increase of variation in 15 minutes after the treatment starts in rotational direction. In case of thoracic spine, there is no significantly variable section. However, variation increases gradually with the passage of time so that it is assumed that noticeable value comes up in approximately 40 minutes. In case of lumbar spine, sharp increase of variation is seen in 20 minutes in translational and rotational direction. Without having corrections during the treatment, proper treatment time is considered as less than 15 minutes for cervical spine, 40 minutes for thoracic spine, and 20 minutes for lumbar spine. If treatment time is longer than these duration, additional patient alignments are required or PTV margin should be enlarged.

  5. Image-Guided Robotic Stereotactic Body Radiation Therapy for Liver Metastases: Is There a Dose Response Relationship?

    International Nuclear Information System (INIS)

    Vautravers-Dewas, Claire; Dewas, Sylvain; Bonodeau, Francois; Adenis, Antoine; Lacornerie, Thomas; Penel, Nicolas; Lartigau, Eric; Mirabel, Xavier

    2011-01-01

    Purpose: To evaluate the outcome, tolerance, and toxicity of stereotactic body radiotherapy, using image-guided robotic radiation delivery, for the treatment of patients with unresectable liver metastases. Methods and Material: Patients were treated with real-time respiratory tracking between July 2007 and April 2009. Their records were retrospectively reviewed. Metastases from colorectal carcinoma and other primaries were not necessarily confined to liver. Toxicity was evaluated using National Cancer Institute Common Criteria for Adverse Events version 3.0. Results: Forty-two patients with 62 metastases were treated with two dose levels of 40 Gy in four Dose per Fraction (23) and 45 Gy in three Dose per Fraction (13). Median follow-up was 14.3 months (range, 3-23 months). Actuarial local control for 1 and 2 years was 90% and 86%, respectively. At last follow-up, 41 (66%) complete responses and eight (13%) partial responses were observed. Five lesions were stable. Nine lesions (13%) were locally progressed. Overall survival was 94% at 1 year and 48% at 2 years. The most common toxicity was Grade 1 or 2 nausea. One patient experienced Grade 3 epidermitis. The dose level did not significantly contribute to the outcome, toxicity, or survival. Conclusion: Image-guided robotic stereotactic body radiation therapy is feasible, safe, and effective, with encouraging local control. It provides a strong alternative for patients who cannot undergo surgery.

  6. Lung deformations and radiation-induced regional lung collapse in patients treated with stereotactic body radiation therapy

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    Diot, Quentin, E-mail: quentin.diot@ucdenver.edu; Kavanagh, Brian; Vinogradskiy, Yevgeniy; Gaspar, Laurie; Miften, Moyed [Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado 80045 (United States); Garg, Kavita [Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado 80045 (United States)

    2015-11-15

    Purpose: To differentiate radiation-induced fibrosis from regional lung collapse outside of the high dose region in patients treated with stereotactic body radiation therapy (SBRT) for lung tumors. Methods: Lung deformation maps were computed from pre-treatment and post-treatment computed tomography (CT) scans using a point-to-point translation method. Fifty anatomical landmarks inside the lung (vessel or airway branches) were matched on planning and follow-up scans for the computation process. Two methods using the deformation maps were developed to differentiate regional lung collapse from fibrosis: vector field and Jacobian methods. A total of 40 planning and follow-ups CT scans were analyzed for 20 lung SBRT patients. Results: Regional lung collapse was detected in 15 patients (75%) using the vector field method, in ten patients (50%) using the Jacobian method, and in 12 patients (60%) by radiologists. In terms of sensitivity and specificity the Jacobian method performed better. Only weak correlations were observed between the dose to the proximal airways and the occurrence of regional lung collapse. Conclusions: The authors presented and evaluated two novel methods using anatomical lung deformations to investigate lung collapse and fibrosis caused by SBRT treatment. Differentiation of these distinct physiological mechanisms beyond what is usually labeled “fibrosis” is necessary for accurate modeling of lung SBRT-induced injuries. With the help of better models, it becomes possible to expand the therapeutic benefits of SBRT to a larger population of lung patients with large or centrally located tumors that were previously considered ineligible.

  7. Integral Dose and Radiation-Induced Secondary Malignancies: Comparison between Stereotactic Body Radiation Therapy and Three-Dimensional Conformal Radiotherapy

    Directory of Open Access Journals (Sweden)

    Stefano G. Masciullo

    2012-11-01

    Full Text Available The aim of the present paper is to compare the integral dose received by non-tumor tissue (NTID in stereotactic body radiation therapy (SBRT with modified LINAC with that received by three-dimensional conformal radiotherapy (3D-CRT, estimating possible correlations between NTID and radiation-induced secondary malignancy risk. Eight patients with intrathoracic lesions were treated with SBRT, 23 Gy × 1 fraction. All patients were then replanned for 3D-CRT, maintaining the same target coverage and applying a dose scheme of 2 Gy × 32 fractions. The dose equivalence between the different treatment modalities was achieved assuming α/β = 10Gy for tumor tissue and imposing the same biological effective dose (BED on the target (BED = 76Gy10. Total NTIDs for both techniques was calculated considering α/β = 3Gy for healthy tissue. Excess absolute cancer risk (EAR was calculated for various organs using a mechanistic model that includes fractionation effects. A paired two-tailed Student t-test was performed to determine statistically significant differences between the data (p ≤ 0.05. Our study indicates that despite the fact that for all patients integral dose is higher for SBRT treatments than 3D-CRT (p = 0.002, secondary cancer risk associated to SBRT patients is significantly smaller than that calculated for 3D-CRT (p = 0.001. This suggests that integral dose is not a good estimator for quantifying cancer induction. Indeed, for the model and parameters used, hypofractionated radiotherapy has the potential for secondary cancer reduction. The development of reliable secondary cancer risk models seems to be a key issue in fractionated radiotherapy. Further assessments of integral doses received with 3D-CRT and other special techniques are also strongly encouraged.

  8. Postoperative Stereotactic Body Radiation Therapy (SBRT) for Spine Metastases: A Critical Review to Guide Practice

    Energy Technology Data Exchange (ETDEWEB)

    Redmond, Kristin J., E-mail: kjanson3@jhmi.edu [Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (United States); Lo, Simon S. [Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, Ohio (United States); Fisher, Charles [Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia (Canada); Sahgal, Arjun [Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario (Canada)

    2016-08-01

    Postoperative stereotactic body radiation therapy (SBRT) for metastatic spinal tumors is increasingly being performed in clinical practice. Whereas the fundamentals of SBRT practice for intact spinal metastases are established, there are as yet no comprehensive practice guidelines for the postoperative indications. In particular, there are unique considerations for patient selection and treatment planning specific to postoperative spine SBRT that are critical for safe and effective management. The purpose of this critical review is to discuss the rationale for treatment, describe those factors affecting surgical decision making, introduce modern surgical trends, and summarize treatment outcomes for both conventional postoperative external beam radiation therapy and postoperative spine SBRT. Lastly, an in-depth practical discussion with respect to treatment planning and delivery considerations is provided to help guide optimal practice.

  9. Spatial and dose–response analysis of fibrotic lung changes after stereotactic body radiation therapy

    International Nuclear Information System (INIS)

    Vinogradskiy, Yevegeniy; Diot, Quentin; Kavanagh, Brian; Schefter, Tracey; Gaspar, Laurie; Miften, Moyed

    2013-01-01

    Purpose: Stereotactic body radiation therapy (SBRT) is becoming the standard of care for early stage nonoperable lung cancers. Accurate dose–response modeling is challenging for SBRT because of the decreased number of clinical toxicity events. As a surrogate for a clinical toxicity endpoint, studies have proposed to use radiographic changes in follow up computed tomography (CT) scans to evaluate lung SBRT normal tissue effects. The purpose of the current study was to use local fibrotic lung regions to spatially and dosimetrically evaluate lung changes in patients that underwent SBRT.Methods: Forty seven SBRT patients treated at our institution from 2003 to 2009 were used for the current study. Our patient cohort had a total of 148 follow up CT scans ranging from 3 to 48 months post-therapy. Post-treatment scans were binned into intervals of 3, 6, 12, 18, 24, 30, and 36 months after the completion of treatment. Deformable image registration was used to align the follow up CT scans with the pretreatment CT and dose distribution. Areas of visible fibrotic changes were contoured. The centroid of each gross tumor volume (GTV) and contoured fibrosis volume was calculated and the fibrosis volume location and movement (magnitude and direction) relative to the GTV and 30 Gy isodose centroid were analyzed. To perform a dose–response analysis, each voxel in the fibrosis volume was sorted into 10 Gy dose bins and the average CT number value for each dose bin was calculated. Dose–response curves were generated by plotting the CT number as a function of dose bin and time posttherapy.Results: Both fibrosis and GTV centroids were concentrated in the upper third of the lung. The average radial movement of fibrosis centroids relative to the GTV centroids was 2.6 cm with movement greater than 5 cm occurring in 11% of patients. Evaluating dose–response curves revealed an overall trend of increasing CT number as a function of dose. The authors observed a CT number plateau at

  10. Reirradiation of head and neck cancer focusing on hypofractionated stereotactic body radiation therapy

    International Nuclear Information System (INIS)

    Yamazaki, Hideya; Kodani, Naohiro; Ogita, Mikio; Sato, Kengo; Himei, Kengo

    2011-01-01

    Reirradiation is a feasible option for patients who do not otherwise have treatment options available. Depending on the location and extent of the tumor, reirradiation may be accomplished with external beam radiotherapy, brachytherapy, radiosurgery, or intensity modulated radiation therapy (IMRT). Although there has been limited experience with hypofractionated stereotactic radiotherapy (hSRT), it may have the potential for curative or palliative treatment due to its advanced precision technology, particularly for limited small lesion. On the other hand, severe late adverse reactions are anticipated with reirradiation than with initial radiation therapy. The risk of severe late complications has been reported to be 20- 40% and is related to prior radiotherapy dose, primary site, retreatment radiotherapy dose, treatment volume, and technique. Early researchers have observed lethal bleeding in such patients up to a rate of 14%. Recently, similar rate of 10-15% was observed for fatal bleeding with use of modern hSRT like in case of carotid blowout syndrome. To determine the feasibility and efficacy of reirradiation using modern technology, we reviewed the pertinent literature. The potentially lethal side effects should be kept in mind when reirradiation by hSRT is considered for treatment, and efforts should be made to minimize the risk in any future investigations

  11. Reirradiation of head and neck cancer focusing on hypofractionated stereotactic body radiation therapy

    Directory of Open Access Journals (Sweden)

    Ogita Mikio

    2011-08-01

    Full Text Available Abstract Reirradiation is a feasible option for patients who do not otherwise have treatment options available. Depending on the location and extent of the tumor, reirradiation may be accomplished with external beam radiotherapy, brachytherapy, radiosurgery, or intensity modulated radiation therapy (IMRT. Although there has been limited experience with hypofractionated stereotactic radiotherapy (hSRT, it may have the potential for curative or palliative treatment due to its advanced precision technology, particularly for limited small lesion. On the other hand, severe late adverse reactions are anticipated with reirradiation than with initial radiation therapy. The risk of severe late complications has been reported to be 20- 40% and is related to prior radiotherapy dose, primary site, retreatment radiotherapy dose, treatment volume, and technique. Early researchers have observed lethal bleeding in such patients up to a rate of 14%. Recently, similar rate of 10-15% was observed for fatal bleeding with use of modern hSRT like in case of carotid blowout syndrome. To determine the feasibility and efficacy of reirradiation using modern technology, we reviewed the pertinent literature. The potentially lethal side effects should be kept in mind when reirradiation by hSRT is considered for treatment, and efforts should be made to minimize the risk in any future investigations.

  12. Radiation-Induced Rib Fractures After Hypofractionated Stereotactic Body Radiation Therapy: Risk Factors and Dose-Volume Relationship

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    Asai, Kaori [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Shioyama, Yoshiyuki, E-mail: shioyama@radiol.med.kyushu-u.ac.jp [Department of Heavy Particle Therapy and Radiation Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Nakamura, Katsumasa; Sasaki, Tomonari; Ohga, Saiji; Nonoshita, Takeshi [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Yoshitake, Tadamasa [Department of Heavy Particle Therapy and Radiation Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Ohnishi, Kayoko [Department of Radiology, National Center for Global Health and Medicine, Tokyo (Japan); Terashima, Kotaro; Matsumoto, Keiji [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Hirata, Hideki [Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Honda, Hiroshi [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan)

    2012-11-01

    Purpose: The purpose of this study was to clarify the incidence, the clinical risk factors, and the dose-volume relationship of radiation-induced rib fracture (RIRF) after hypofractionated stereotactic body radiation therapy (SBRT). Methods and Materials: One hundred sixteen patients treated with SBRT for primary or metastatic lung cancer at our institution, with at least 6 months of follow-up and no previous overlapping radiation exposure, were included in this study. To determine the clinical risk factors associated with RIRF, correlations between the incidence of RIRF and the variables, including age, sex, diagnosis, gross tumor volume diameter, rib-tumor distance, and use of steroid administration, were analyzed. Dose-volume histogram analysis was also conducted. Regarding the maximum dose, V10, V20, V30, and V40 of the rib, and the incidences of RIRF were compared between the two groups divided by the cutoff value determined by the receiver operating characteristic curves. Results: One hundred sixteen patients and 374 ribs met the inclusion criteria. Among the 116 patients, 28 patients (46 ribs) experienced RIRF. The estimated incidence of rib fracture was 37.7% at 3 years. Limited distance from the rib to the tumor (<2.0 cm) was the only significant risk factor for RIRF (p = 0.0001). Among the dosimetric parameters used for receiver operating characteristic analysis, the maximum dose showed the highest area under the curve. The 3-year estimated risk of RIRF and the determined cutoff value were 45.8% vs. 1.4% (maximum dose, {>=}42.4 Gy or less), 51.6% vs. 2.0% (V40, {>=}0.29 cm{sup 3} or less), 45.8% vs. 2.2% (V30, {>=}1.35 cm{sup 3} or less), 42.0% vs. 8.5% (V20, {>=}3.62 cm{sup 3} or less), or 25.9% vs. 10.5% (V10, {>=}5.03 cm{sup 3} or less). Conclusions: The incidence of RIRF after hypofractionated SBRT is relatively high. The maximum dose and high-dose volume are strongly correlated with RIRF.

  13. Adaptive Liver Stereotactic Body Radiation Therapy: Automated Daily Plan Reoptimization Prevents Dose Delivery Degradation Caused by Anatomy Deformations

    Energy Technology Data Exchange (ETDEWEB)

    Leinders, Suzanne M. [Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Delft University of Technology, Delft (Netherlands); Breedveld, Sebastiaan; Méndez Romero, Alejandra [Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Schaart, Dennis [Delft University of Technology, Delft (Netherlands); Seppenwoolde, Yvette, E-mail: y.seppenwoolde@erasmusmc.nl [Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Heijmen, Ben J.M. [Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands)

    2013-12-01

    Purpose: To investigate how dose distributions for liver stereotactic body radiation therapy (SBRT) can be improved by using automated, daily plan reoptimization to account for anatomy deformations, compared with setup corrections only. Methods and Materials: For 12 tumors, 3 strategies for dose delivery were simulated. In the first strategy, computed tomography scans made before each treatment fraction were used only for patient repositioning before dose delivery for correction of detected tumor setup errors. In adaptive second and third strategies, in addition to the isocenter shift, intensity modulated radiation therapy beam profiles were reoptimized or both intensity profiles and beam orientations were reoptimized, respectively. All optimizations were performed with a recently published algorithm for automated, multicriteria optimization of both beam profiles and beam angles. Results: In 6 of 12 cases, violations of organs at risk (ie, heart, stomach, kidney) constraints of 1 to 6 Gy in single fractions occurred in cases of tumor repositioning only. By using the adaptive strategies, these could be avoided (<1 Gy). For 1 case, this needed adaptation by slightly underdosing the planning target volume. For 2 cases with restricted tumor dose in the planning phase to avoid organ-at-risk constraint violations, fraction doses could be increased by 1 and 2 Gy because of more favorable anatomy. Daily reoptimization of both beam profiles and beam angles (third strategy) performed slightly better than reoptimization of profiles only, but the latter required only a few minutes of computation time, whereas full reoptimization took several hours. Conclusions: This simulation study demonstrated that replanning based on daily acquired computed tomography scans can improve liver stereotactic body radiation therapy dose delivery.

  14. Role of Stereotactic Body Radiation Therapy Before Orthotopic Liver Transplantation: Retrospective Evaluation of Pathologic Response and Outcomes

    International Nuclear Information System (INIS)

    Mannina, Edward Michael; Cardenes, Higinia Rosa; Lasley, Foster D.; Goodman, Benjamin; Zook, Jennifer; Althouse, Sandra; Cox, John Alvin; Saxena, Romil; Tector, Joseph; Maluccio, Mary

    2017-01-01

    Purpose: To analyze the results of stereotactic body radiation therapy (SBRT) in patients with early-stage, localized hepatocellular carcinoma who underwent definitive orthotopic liver transplantation (OLT). Methods and Materials: The subjects of this retrospective report are 38 patients diagnosed with hepatocellular carcinoma who underwent SBRT per institutional phase 1 to 2 eligibility criteria, before definitive OLT. Pre-OLT radiographs were compared with pathologic gold standard. Analysis of treatment failures and deaths was undertaken. Results: With median follow-up of 4.8 years from OLT, 9 of 38 patients (24%) recurred, whereas 10 of 38 patients (26%) died. Kaplan-Meier estimates of 3-year overall survival and disease-free survival are 77% and 74%, respectively. Sum longest dimension of tumors was significantly associated with disease-free survival (hazard ratio 1.93, P=.026). Pathologic response rate (complete plus partial response) was 68%. Radiographic scoring criteria performed poorly; modified Response Evaluation Criteria in Solid Tumors produced highest concordance (κ = 0.224). Explants revealed viable tumor in 74% of evaluable patients. Treatment failures had statistically larger sum longest dimension of tumors (4.0 cm vs 2.8 cm, P=.014) and non–statistically significant higher rates of lymphovascular space invasion (44% vs 17%), cT2 disease (44% vs 21%), ≥pT2 disease (67% vs 34%), multifocal tumors at time of SBRT (44% vs 21%), and less robust mean α-fetoprotein response (−25 IU/mL vs −162 IU/mL). Conclusions: Stereotactic body radiation therapy before to OLT is a well-tolerated treatment providing 68% pathologic response, though 74% of explants ultimately contained viable tumor. Radiographic response criteria poorly approximate pathology. Our data suggest further stratification of patients according to initial disease burden and treatment response.

  15. Cost-Effectiveness Analysis of Stereotactic Body Radiation Therapy Compared With Radiofrequency Ablation for Inoperable Colorectal Liver Metastases

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    Kim, Hayeon, E-mail: kimh2@upmc.edu [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Gill, Beant; Beriwal, Sushil; Huq, M. Saiful [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Roberts, Mark S. [Department of Health Policy and Management, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania (United States); Smith, Kenneth J. [Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (United States)

    2016-07-15

    Purpose: To conduct a cost-effectiveness analysis to determine whether stereotactic body radiation therapy (SBRT) is a cost-effective therapy compared with radiofrequency ablation (RFA) for patients with unresectable colorectal cancer (CRC) liver metastases. Methods and Materials: A cost-effectiveness analysis was conducted using a Markov model and 1-month cycle over a lifetime horizon. Transition probabilities, quality of life utilities, and costs associated with SBRT and RFA were captured in the model on the basis of a comprehensive literature review and Medicare reimbursements in 2014. Strategies were compared using the incremental cost-effectiveness ratio, with effectiveness measured in quality-adjusted life years (QALYs). To account for model uncertainty, 1-way and probabilistic sensitivity analyses were performed. Strategies were evaluated with a willingness-to-pay threshold of $100,000 per QALY gained. Results: In base case analysis, treatment costs for 3 fractions of SBRT and 1 RFA procedure were $13,000 and $4397, respectively. Median survival was assumed the same for both strategies (25 months). The SBRT costs $8202 more than RFA while gaining 0.05 QALYs, resulting in an incremental cost-effectiveness ratio of $164,660 per QALY gained. In 1-way sensitivity analyses, results were most sensitive to variation of median survival from both treatments. Stereotactic body radiation therapy was economically reasonable if better survival was presumed (>1 month gain) or if used for large tumors (>4 cm). Conclusions: If equal survival is assumed, SBRT is not cost-effective compared with RFA for inoperable colorectal liver metastases. However, if better local control leads to small survival gains with SBRT, this strategy becomes cost-effective. Ideally, these results should be confirmed with prospective comparative data.

  16. Cost-Effectiveness Analysis of Stereotactic Body Radiation Therapy Compared With Radiofrequency Ablation for Inoperable Colorectal Liver Metastases

    International Nuclear Information System (INIS)

    Kim, Hayeon; Gill, Beant; Beriwal, Sushil; Huq, M. Saiful; Roberts, Mark S.; Smith, Kenneth J.

    2016-01-01

    Purpose: To conduct a cost-effectiveness analysis to determine whether stereotactic body radiation therapy (SBRT) is a cost-effective therapy compared with radiofrequency ablation (RFA) for patients with unresectable colorectal cancer (CRC) liver metastases. Methods and Materials: A cost-effectiveness analysis was conducted using a Markov model and 1-month cycle over a lifetime horizon. Transition probabilities, quality of life utilities, and costs associated with SBRT and RFA were captured in the model on the basis of a comprehensive literature review and Medicare reimbursements in 2014. Strategies were compared using the incremental cost-effectiveness ratio, with effectiveness measured in quality-adjusted life years (QALYs). To account for model uncertainty, 1-way and probabilistic sensitivity analyses were performed. Strategies were evaluated with a willingness-to-pay threshold of $100,000 per QALY gained. Results: In base case analysis, treatment costs for 3 fractions of SBRT and 1 RFA procedure were $13,000 and $4397, respectively. Median survival was assumed the same for both strategies (25 months). The SBRT costs $8202 more than RFA while gaining 0.05 QALYs, resulting in an incremental cost-effectiveness ratio of $164,660 per QALY gained. In 1-way sensitivity analyses, results were most sensitive to variation of median survival from both treatments. Stereotactic body radiation therapy was economically reasonable if better survival was presumed (>1 month gain) or if used for large tumors (>4 cm). Conclusions: If equal survival is assumed, SBRT is not cost-effective compared with RFA for inoperable colorectal liver metastases. However, if better local control leads to small survival gains with SBRT, this strategy becomes cost-effective. Ideally, these results should be confirmed with prospective comparative data.

  17. Role of Stereotactic Body Radiation Therapy Before Orthotopic Liver Transplantation: Retrospective Evaluation of Pathologic Response and Outcomes

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    Mannina, Edward Michael, E-mail: emmannina@gmail.com [Department of Radiation Oncology, Slidell Memorial Hospital Regional Cancer Center, Slidell, Louisiana (United States); Cardenes, Higinia Rosa [Department of Radiation Oncology, Schneck Medical Center, Seymour, Indiana (United States); Lasley, Foster D. [Department of Radiation Oncology, Mercy Hospital, Oklahoma City, Oklahoma (United States); Goodman, Benjamin [Department of Radiation Oncology, St. Francis Healthcare, Cape Girardeau, Missouri (United States); Zook, Jennifer [Department of Radiation Oncology, Community Hospital Anderson, Anderson, Indiana (United States); Althouse, Sandra [Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana (United States); Cox, John Alvin [Department of Radiation Oncology, Columbus Regional, Columbus, Indiana (United States); Saxena, Romil [Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana (United States); Tector, Joseph [Department of Surgery, University of Alabama-Birmingham, Birmingham, Alabama (United States); Maluccio, Mary [Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana (United States)

    2017-04-01

    Purpose: To analyze the results of stereotactic body radiation therapy (SBRT) in patients with early-stage, localized hepatocellular carcinoma who underwent definitive orthotopic liver transplantation (OLT). Methods and Materials: The subjects of this retrospective report are 38 patients diagnosed with hepatocellular carcinoma who underwent SBRT per institutional phase 1 to 2 eligibility criteria, before definitive OLT. Pre-OLT radiographs were compared with pathologic gold standard. Analysis of treatment failures and deaths was undertaken. Results: With median follow-up of 4.8 years from OLT, 9 of 38 patients (24%) recurred, whereas 10 of 38 patients (26%) died. Kaplan-Meier estimates of 3-year overall survival and disease-free survival are 77% and 74%, respectively. Sum longest dimension of tumors was significantly associated with disease-free survival (hazard ratio 1.93, P=.026). Pathologic response rate (complete plus partial response) was 68%. Radiographic scoring criteria performed poorly; modified Response Evaluation Criteria in Solid Tumors produced highest concordance (κ = 0.224). Explants revealed viable tumor in 74% of evaluable patients. Treatment failures had statistically larger sum longest dimension of tumors (4.0 cm vs 2.8 cm, P=.014) and non–statistically significant higher rates of lymphovascular space invasion (44% vs 17%), cT2 disease (44% vs 21%), ≥pT2 disease (67% vs 34%), multifocal tumors at time of SBRT (44% vs 21%), and less robust mean α-fetoprotein response (−25 IU/mL vs −162 IU/mL). Conclusions: Stereotactic body radiation therapy before to OLT is a well-tolerated treatment providing 68% pathologic response, though 74% of explants ultimately contained viable tumor. Radiographic response criteria poorly approximate pathology. Our data suggest further stratification of patients according to initial disease burden and treatment response.

  18. Safety and Efficacy of Stereotactic Body Radiation Therapy in the Treatment of Pulmonary Metastases from High Grade Sarcoma

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    Niraj Mehta

    2013-01-01

    Full Text Available Introduction. Patients with high-grade sarcoma (HGS frequently develop metastatic disease thus limiting their long-term survival. Lung metastases (LM have historically been treated with surgical resection (metastasectomy. A potential alternative for controlling LM could be stereotactic body radiation therapy (SBRT. We evaluated the outcomes from our institutional experience utilizing SBRT. Methods. Sixteen consecutive patients with LM from HGS were treated with SBRT between 2009 and 2011. Routine radiographic and clinical follow-up was performed. Local failure was defined as CT progression on 2 consecutive scans or growth after initial shrinkage. Radiation pneumonitis and radiation esophagitis were scored using Common Toxicity Criteria (CTC version 3.0. Results. All 16 patients received chemotherapy, and a subset (38% also underwent prior pulmonary metastasectomy. Median patient age was 56 (12–85, and median follow-up time was 20 months (range 3–43. A total of 25 lesions were treated and evaluable for this analysis. Most common histologies were leiomyosarcoma (28%, synovial sarcoma (20%, and osteosarcoma (16%. Median SBRT prescription dose was 54 Gy (36–54 in 3-4 fractions. At 43 months, local control was 94%. No patient experienced G2-4 radiation pneumonitis, and no patient experienced radiation esophagitis. Conclusions. Our retrospective experience suggests that SBRT for LM from HGS provides excellent local control and minimal toxicity.

  19. Breathing-motion-compensated robotic guided stereotactic body radiation therapy. Patterns of failure analysis

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    Stera, Susanne; Imhoff, Detlef; Roedel, Claus [University Hospital Frankfurt, Department of Radiation Oncology, Frankfurt am Main (Germany); Balermpas, Panagiotis; Keller, Christian [University Hospital Frankfurt, Department of Radiation Oncology, Frankfurt am Main (Germany); Saphir Radiosurgery Center, Frankfurt (Germany); Chan, Mark K.H. [University Medical Center Schleswig-Holstein, Department of Radiation Oncology, Kiel (Germany); Huttenlocher, Stefan [Saphir Radiosurgery Center, Guestrow (Germany); Wurster, Stefan [Saphir Radiosurgery Center, Guestrow (Germany); University Medicine Greifswald, Department of Radiation Oncology, Greifswald (Germany); Rades, Dirk [University Medical Center Schleswig-Holstein, Department of Radiation Oncology, Luebeck (Germany); Dunst, Juergen [University Medical Center Schleswig-Holstein, Department of Radiation Oncology, Kiel (Germany); University Hospital Copenhagen, Department of Radiation Oncology, Copenhagen (Denmark); Hildebrandt, Guido [University Medicine Rostock, Department of Radiation Oncology, Rostock (Germany); Blanck, Oliver [Saphir Radiosurgery Center, Frankfurt (Germany); University Medical Center Schleswig-Holstein, Department of Radiation Oncology, Kiel (Germany); Saphir Radiosurgery Center, Guestrow (Germany)

    2018-02-15

    We retrospectively evaluated the patterns of failure for robotic guided real-time breathing-motion-compensated (BMC) stereotactic body radiation therapy (SBRT) in the treatment of tumors in moving organs. Between 2011 and 2016, a total of 198 patients with 280 lung, liver, and abdominal tumors were treated with BMC-SBRT. The median gross tumor volume (GTV) was 12.3 cc (0.1-372.0 cc). Medians of mean GTV BED{sub α/β=10} {sub Gy} (BED = biological effective dose) was 148.5 Gy{sub 10} (31.5-233.3 Gy{sub 10}) and prescribed planning target volume (PTV) BED{sub α/β=10} {sub Gy} was 89.7 Gy{sub 10} (28.8-151.2 Gy{sub 10}), respectively. We analyzed overall survival (OS) and local control (LC) based on various factors, including BEDs with α/ β ratios of 15 Gy (lung metastases), 21 Gy (primary lung tumors), and 27 Gy (liver metastases). Median follow-up was 10.4 months (2.0-59.0 months). The 2-year actuarial LC was 100 and 86.4% for primary early and advanced stage lung tumors, respectively, 100% for lung metastases, 82.2% for liver metastases, and 90% for extrapulmonary extrahepatic metastases. The 2-year OS rate was 47.9% for all patients. In uni- and multivariate analysis, comparatively lower PTV prescription dose (equivalence of 3 x 12-13 Gy) and higher average GTV dose (equivalence of 3 x 18 Gy) to current practice were significantly associated with LC. For OS, Karnofsky performance score (100%), gender (female), and SBRT without simultaneous chemotherapy were significant prognostic factors. Grade 3 side effects were rare (0.5%). Robotic guided BMC-SBRT can be considered a safe and effective treatment for solid tumors in moving organs. To reach sufficient local control rates, high average GTV doses are necessary. Further prospective studies are warranted to evaluate these points. (orig.) [German] Wir fuehrten eine retrospektive Untersuchung der Rezidivmuster bei der Behandlung von Tumoren in bewegten Organen mittels robotergefuehrter in Echtzeit

  20. Uncertainties associated with treatments of hepatic lesions in stereotactic body radiation therapy (SBRT) using respiratory tracking

    International Nuclear Information System (INIS)

    Charoy, Marie

    2014-01-01

    Oscar Lambret Center treated with Cyberknife R , since June 2007, liver lesions in stereotactic conditions with respiratory tracking using external LEDs correlated with seeds implanted near the target. Clinical results show excellent local control but there are still uncertainties in the preparation and delivery of treatment. The aims of this thesis are to identify and quantify these uncertainties, to define solutions and/or alternatives and to assess their added value. As a first step, the method of the target definition by the radiation oncologist is evaluated. Improvement of the method currently used in routine is considered, including the choice of the most appropriate imaging and the intervention of a second operator, expert in imaging (radiologist). The organ at risk and target movements induced by the respiratory motion are not taken into account in the treatment planning step, performed on the 3D images (the so-called planning CT). The dosimetric impact associated with this type of planning is evaluated using 4D Monte Carlo simulations that take into account patient and linear accelerator movements and the synchrony between both movements. The question of 4D planning as prospect of improvement is then investigated. Movements and deformations of the liver due to respiration are also implicated in the uncertainties involved in the treatment. The correlation model of external markers with the target, used for respiratory tracking, ignores eventual deformations and rotations within the liver. A study of the impact on the target tracking is performed. All these studies were conducted using real patient data sets. (author) [fr

  1. Six-dimensional correction of intra-fractional prostate motion with CyberKnife stereotactic body radiation therapy

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    Sean eCollins

    2011-12-01

    Full Text Available AbstractLarge fraction radiation therapy offers a shorter course of treatment and radiobiological advantages for prostate cancer treatment. The CyberKnife is an attractive technology for delivering large fraction doses based on the ability to deliver highly conformal radiation therapy to moving targets. In addition to intra-fractional translational motion (left-right, superior-inferior and anterior-posterior, prostate rotation (pitch, roll and yaw can increase geographical miss risk. We describe our experience with six-dimensional (6D intrafraction prostate motion correction using CyberKnife stereotactic body radiation therapy (SBRT. Eighty-eight patients were treated by SBRT alone or with supplemental external radiation therapy. Trans-perineal placement of four gold fiducials within the prostate accommodated X-ray guided prostate localization and beam adjustment. Fiducial separation and non-overlapping positioning permitted the orthogonal imaging required for 6D tracking. Fiducial placement accuracy was assessed using the CyberKnife fiducial extraction algorithm. Acute toxicities were assessed using Common Toxicity Criteria (CTC v3. There were no Grade 3, or higher, complications and acute morbidity was minimal. Ninety-eight percent of patients completed treatment employing 6D prostate motion tracking with intrafractional beam correction. Suboptimal fiducial placement limited treatment to 3D tracking in 2 patients. Our experience may guide others in performing 6D correction of prostate motion with CyberKnife SBRT.

  2. Long-term effect of stereotactic body radiation therapy for primary hepatocellular carcinoma ineligible for local ablation therapy or surgical resection. Stereotactic radiotherapy for liver cancer

    International Nuclear Information System (INIS)

    Kwon, Jung Hyun; Bae, Si Hyun; Kim, Ji Yoon; Choi, Byung Ock; Jang, Hong Seok; Jang, Jeong Won; Choi, Jong Young; Yoon, Seung Kew; Chung, Kyu Won

    2010-01-01

    We evaluated the long-term effect of stereotactic body radiation therapy (SBRT) for primary small hepatocellular carcinoma (HCC) ineligible for local therapy or surgery. Forty-two HCC patients with tumors ≤ 100 cc and ineligible for local ablation therapy or surgical resection were treated with SBRT: 30-39 Gy with a prescription isodose range of 70-85% (median 80%) was delivered daily in three fractions. Median tumor volume was 15.4 cc (3.0-81.8) and median follow-up duration 28.7 months (8.4-49.1). Complete response (CR) for the in-field lesion was initially achieved in 59.6% and partial response (PR) in 26.2% of patients. Hepatic out-of-field progression occurred in 18 patients (42.9%) and distant metastasis developed in 12 (28.6%) patients. Overall in-field CR and overall CR were achieved in 59.6% and 33.3%, respectively. Overall 1-year and 3-year survival rates were 92.9% and 58.6%, respectively. In-field progression-free survival at 1 and 3 years was 72.0% and 67.5%, respectively. Patients with smaller tumor had better in-field progression-free survival and overall survival rates (<32 cc vs. ≥32 cc, P < 0.05). No major toxicity was encountered but one patient died with extrahepatic metastasis and radiation-induced hepatic failure. SBRT is a promising noninvasive-treatment for small HCC that is ineligible for local treatment or surgical resection

  3. Stereotactic body radiation therapy for early-stage non-small-cell lung cancer. The Japanese experience

    International Nuclear Information System (INIS)

    Hiraoka, Masahiro; Nagata, Yasushi

    2004-01-01

    Stereotactic body radiation therapy is a new treatment modality for early-stage non-small-cell lung cancer, and is being intensively investigated in the United States, the European Union, and Japan. We started a feasibility study of this therapy in July 1998, using a stereotactic body frame. The eligibility criteria for primary lung cancer were: solitary tumor less than 4 cm; inoperable, or the patient refused operation; histologically confirmed malignancy; no necessity for oxygen support; performance status equal to or less than 2, and the tumor was not close to the spinal cord. A total dose of 48 Gy was delivered in four fractions in 2 weeks in most patients. Lung toxicity was minimal. No grade II toxicities for spinal cord, bronchus, pulmonary artery, or esophagus were observed. Overall survival for 29 patients with stage IA, and 14 patients with stage IB disease was 87% and 80%, respectively. No local recurrence was observed in a follow-up of 3-50 months. Regional lymph node recurrence developed in 1 patient, and distant metastases developed in 4 patients. We retrospectively analyzed 241 patients from 13 Japanese institutions. The local recurrence rate was 20% when the biological equivalent dose (BED) was less than 100 Gy, and 6.5% when the BED was over 100 Gy. Overall survival at 3 years was 42% when the BED was less than 100 Gy, and 46% when it was over 100 Gy. In tumors which received a BED of more than 100 Gy, overall survival at 3 years was 91% for operable patients, and 50% for inoperable patients. Long-term results, in terms of local control, regional recurrence, survival, and complications, are not yet evaluated. However, this treatment modality is highly expected to be a standard treatment for inoperable patients, and it may be an alternative to lobectomy for operative patients. A prospective trial, which is now ongoing, will, answer these questions. (author)

  4. Emerging Therapies for Stage III Non-Small Cell Lung Cancer: Stereotactic Body Radiation Therapy and Immunotherapy

    Directory of Open Access Journals (Sweden)

    Sameera S. Kumar

    2017-09-01

    Full Text Available The current standard of care for locally advanced non-small cell lung cancer (NSCLC includes radiation, chemotherapy, and surgery in certain individualized cases. In unresectable NSCLC, chemoradiation has been the standard of care for the past three decades. Local and distant failure remains high in this group of patients, so dose escalation has been studied in both single institution and national clinical trials. Though initial studies showed a benefit to dose escalation, phase III studies examining dose escalation using standard fractionation or hyperfractionation have failed to show a benefit. Over the last 17 years, stereotactic body radiation therapy (SBRT has shown a high degree of safety and local control for stage I lung cancers and other localized malignancies. More recently, phase I/II studies using SBRT for dose escalation after conventional chemoradiation in locally advanced NSCLC have been promising with good apparent safety. Immunotherapy also offers opportunities to address distant disease and preclinical data suggest immunotherapy in tandem with SBRT may be a rational way to induce an “abscopal effect” although there are little clinical data as yet. By building on the proven concept of conventional chemoradiation for patients with locally advanced NSCLC with a subsequent radiation dose intensification to residual disease with SBRT concurrent with immunotherapy, we hope address the issues of metastatic and local failures. This “quadmodality” approach is still in its infancy but appears to be a safe and rational approach to the improving the outcome of NSCLC therapy.

  5. Stereotactic Body Radiation Therapy Delivery in a Genetically Engineered Mouse Model of Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Du, Shisuo; Lockamy, Virginia [Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Zhou, Lin [Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan (China); Xue, Christine; LeBlanc, Justin [Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Glenn, Shonna [Xstrahl, Inc, Suwanee, Georgia (United States); Shukla, Gaurav; Yu, Yan; Dicker, Adam P.; Leeper, Dennis B. [Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Lu, You [Department of Thoracic Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan (China); Lu, Bo, E-mail: bo.lu@jefferson.edu [Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania (United States)

    2016-11-01

    Purpose: To implement clinical stereotactic body radiation therapy (SBRT) using a small animal radiation research platform (SARRP) in a genetically engineered mouse model of lung cancer. Methods and Materials: A murine model of multinodular Kras-driven spontaneous lung tumors was used for this study. High-resolution cone beam computed tomography (CBCT) imaging was used to identify and target peripheral tumor nodules, whereas off-target lung nodules in the contralateral lung were used as a nonirradiated control. CBCT imaging helps localize tumors, facilitate high-precision irradiation, and monitor tumor growth. SBRT planning, prescription dose, and dose limits to normal tissue followed the guidelines set by RTOG protocols. Pathologic changes in the irradiated tumors were investigated using immunohistochemistry. Results: The image guided radiation delivery using the SARRP system effectively localized and treated lung cancer with precision in a genetically engineered mouse model of lung cancer. Immunohistochemical data confirmed the precise delivery of SBRT to the targeted lung nodules. The 60 Gy delivered in 3 weekly fractions markedly reduced the proliferation index, Ki-67, and increased apoptosis per staining for cleaved caspase-3 in irradiated lung nodules. Conclusions: It is feasible to use the SARRP platform to perform dosimetric planning and delivery of SBRT in mice with lung cancer. This allows for preclinical studies that provide a rationale for clinical trials involving SBRT, especially when combined with immunotherapeutics.

  6. Survival Outcomes of Patients Treated with Hypofractionated Stereotactic Body Radiation Therapy for Parotid Gland Tumors: a Retrospective Analysis

    International Nuclear Information System (INIS)

    Karam, Sana D.; Snider, James W.; Wang, Hongkun; Wooster, Margaux; Lominska, Christopher; Deeken, John; Newkirk, Kenneth; Davidson, Bruce; Harter, K. William

    2012-01-01

    Background: to review a single-institution experience with the management of parotid malignancies treated by fractionated stereotactic body radiosurgery (SBRT). Findings: Between 2003 and 2011, 13 patients diagnosed with parotid malignancies were treated with adjuvant or definitive SBRT to a median dose of 33 Gy (range 25–40 Gy). There were 11 male and two female patients with a median age of 80. Ten patients declined conventional radiation treatment and three patients had received prior unrelated radiation therapy to neighboring structures with unavailable radiation records. Six patients were treated with definitive intent while seven patients were treated adjuvantly for adverse surgical or pathologic features. Five patients had clinical or pathologic evidence of lymph node disease. Conclusion: at a median follow-up of 14 months only one patient failed locally, and four failed distantly. The actuarial 2-year overall survival, progression-free survival, and local-regional control rates were 46, 84, and 47%, respectively. Statistical analysis revealed surgery as a positive predictor of overall survival while presence of gross disease was a negatively correlated factor (p < 0.05).

  7. SU-E-J-165: Dosimetric Impact of Liver Rotations in Stereotactic Body Radiation Therapy

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    Pinnaduwage, D; Paulsson, A; Sudhyadhom, A; Chen, J; Chang, A; Anwar, M; Gottschalk, A; Yom, S S.; Descovich, M [University of California San Francisco, San Francisco, CA (United States)

    2015-06-15

    Purpose: Often in liver stereotactic body radiotherapy a single fiducial is implanted near the tumor for image-guided treatment delivery. In such cases, rotational corrections are calculated based on the spine. This study quantifies rotational differences between the spine and liver, and investigates the corresponding dosimetric impact. Methods: Seven patients with 3 intrahepatic fiducials and 4DCT scans were identified. The planning CT was separately co-registered with 4 phases of the 4DCT (0%, 50%, 100% inhale and 50% exhale) by 1) rigid registration of the spine, and 2) point-based registration of the 3 fiducials. Rotation vectors were calculated for each registration. Translational differences in fiducial positions between the 2 registrations methods were investigated. Dosimetric impact due to liver rotations and deformations was assessed using critical structures delineated on the 4DCT phases. For dose comparisons, a single fiducial was translationally aligned following spine alignment to represent what is typically done in the clinic. Results: On average, differences between spine and liver rotations during the 0%, 50%, 100% inhale, and 50% exhale phases were 3.23°, 3.27°, 2.26° and 3.11° (pitch), 3.00°, 2.24°, 3.12° and 1.73° (roll), and 1.57°, 1.98°, 2.09° and 1.36° (yaw), respectively. The maximum difference in rotations was 12°, with differences of >3° seen in 14/28 (pitch), 10/28 (roll), and 6/28 (yaw) cases. Average fiducial displacements of 2.73 (craniocaudal), 1.04 (lateral) and 1.82 mm (vertical) were seen. Evaluating percent dose differences for 5 patients at the peaks of the respiratory cycle, the maximum dose to the duodenum, stomach, bowel and esophagus differed on average by 11.4%, 5.3%, 11.2% and 49.1% between the 2 registration methods. Conclusion: Lack of accounting for liver rotation during treatment might Result in clinically significant dose differences to critical structures. Both rotational and translational deviations

  8. A rapid, computational approach for assessing interfraction esophageal motion for use in stereotactic body radiation therapy planning

    Directory of Open Access Journals (Sweden)

    Michael L. Cardenas, MD

    2018-04-01

    Full Text Available 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[(Sijy / (Sijx]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

  9. Image-Guided Localization Accuracy of Stereoscopic Planar and Volumetric Imaging Methods for Stereotactic Radiation Surgery and Stereotactic Body Radiation Therapy: A Phantom Study

    International Nuclear Information System (INIS)

    Kim, Jinkoo; Jin, Jian-Yue; Walls, Nicole; Nurushev, Teamour; Movsas, Benjamin; Chetty, Indrin J.; Ryu, Samuel

    2011-01-01

    Purpose: To evaluate the positioning accuracies of two image-guided localization systems, ExacTrac and On-Board Imager (OBI), in a stereotactic treatment unit. Methods and Materials: An anthropomorphic pelvis phantom with eight internal metal markers (BBs) was used. The center of one BB was set as plan isocenter. The phantom was set up on a treatment table with various initial setup errors. Then, the errors were corrected using each of the investigated systems. The residual errors were measured with respect to the radiation isocenter using orthogonal portal images with field size 3 x 3 cm 2 . The angular localization discrepancies of the two systems and the correction accuracy of the robotic couch were also studied. A pair of pre- and post-cone beam computed tomography (CBCT) images was acquired for each angular correction. Then, the correction errors were estimated by using the internal BBs through fiducial marker-based registrations. Results: The isocenter localization errors (μ ±σ) in the left/right, posterior/anterior, and superior/inferior directions were, respectively, -0.2 ± 0.2 mm, -0.8 ± 0.2 mm, and -0.8 ± 0.4 mm for ExacTrac, and 0.5 ± 0.7 mm, 0.6 ± 0.5 mm, and 0.0 ± 0.5 mm for OBI CBCT. The registration angular discrepancy was 0.1 ± 0.2 o between the two systems, and the maximum angle correction error of the robotic couch was 0.2 o about all axes. Conclusion: Both the ExacTrac and the OBI CBCT systems showed approximately 1 mm isocenter localization accuracies. The angular discrepancy of two systems was minimal, and the robotic couch angle correction was accurate. These positioning uncertainties should be taken as a lower bound because the results were based on a rigid dosimetry phantom.

  10. Dose discrepancy between planning system estimation and measurement in spine stereotactic body radiation therapy: A case report

    International Nuclear Information System (INIS)

    Arumugam, Sankar; Xing, Aitang; Vial Philip; Berry Megan; Ochoa, Cesar; Beeksma, Bradley

    2017-01-01

    Stereotactic body radiation therapy (SBRT) to treat spinal metastases has shown excellent clinical outcomes for local control. High dose gradients wrapping around spinal cord make this treatment technically challenging. In this work, we present a spine SBRT case where a dosimetric error was identified during pre-treatment dosimetric quality assurance (QA). A patient with metastasis in T7 vertebral body consented to undergo SBRT. A dual arc volumetric modulated arc therapy plan was generated on the Pinnacle treatment planning system (TPS) with a 6 MV Elekta machine using gantry control point spacing of 4°. Standard pre-treatment QA measurements were performed, including ArcCHECK, ion chamber in CTV and spinal cord (SC) region and film measurements in multiple planes. While the dose measured at CTV region showed good agreement with TPS, the dose measured to the SC was significantly higher than reported by TPS in the original and repeat plans. Acceptable agreement was only achieved when the gantry control point spacing was reduced to 3°. A potentially harmful dose error was identified by pre-treatment QA. TPS parameter settings used safely in conventional treatments should be re-assessed for complex treatments.

  11. Analysis of the factors affecting the safety of robotic stereotactic body radiation therapy for hepatocellular carcinoma patients

    Directory of Open Access Journals (Sweden)

    Liu XJ

    2017-11-01

    Full Text Available Xiaojie Liu,1,* Yongchun Song,1,* Ping Liang,2 Tingshi Su,2 Huojun Zhang,3 Xianzhi Zhao,3 Zhiyong Yuan,1 Ping Wang1 1Department of Radiotherapy,Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, 2Cyberknife Center, Ruikang Hospital, Guangxi Traditional Chinese Medical University, Nanning, 3Department of Radiotherapy, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, People’s Republic of China *These authors contributed equally to this work Objective: The objective of this study was to investigate the safety of robotic stereotactic body radiation therapy (SBRT for hepatocellular carcinoma (HCC patients and its related factors.Methods: A total of 74 HCC patients with Child–Turcotte–Pugh (CTP Class A were included in a multi-institutional, single-arm Phase II trial (NCT 02363218 between February 2013 and August 2016. All patients received SBRT treatment at a dose of 45 Gy/3f. The liver function was compared before and after SBRT treatment by the analysis of adverse hepatic reactions and changes in CTP classification.Results: After SBRT treatment, eight patients presented with decreases in CTP classification and 13 patients presented with ≥ grade 2 hepatic adverse reactions. For patients presenting with ≥ grade 2 hepatic adverse reactions, the total liver volume of ≤1,162 mL and a normal liver volume (total liver volume – gross tumor volume [GTV] of ≤1,148 mL were found to be independent risk factors and statistically significant (P<0.05.Conclusion: The total liver volume and normal liver volume are associated with the occurrence of ≥ grade 2 hepatic adverse reactions after SBRT treatment on HCC patients. Therefore, if the fractionated scheme of 45 Gy/3f is applied in SBRT for HCC patients, a total liver volume >1,162 mL and a normal liver

  12. Prospective Longitudinal Assessment of Quality of Life for Liver Cancer Patients Treated With Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Klein, Jonathan, E-mail: jonathan.klein@rmp.uhn.on.ca [Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Dawson, Laura A. [Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Jiang, Haiyan [Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Kim, John; Dinniwell, Rob; Brierley, James; Wong, Rebecca [Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Lockwood, Gina [Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Ringash, Jolie [Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada)

    2015-09-01

    Purpose: To evaluate quality of life (QoL), an important outcome owing to poor long-term survival, after stereotactic body radiation therapy (SBRT) to the liver. Methods and Materials: Patients (n=222) with hepatocellular carcinoma (HCC), liver metastases, or intrahepatic cholangiocarcinoma and Child-Pugh A liver function received 24-60 Gy of 6-fraction image-guided SBRT. Prospective QoL assessment was completed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (QLQ-C30) and/or Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep, version 4) questionnaires at baseline and 1, 3, 6, and 12 months after treatment. Ten HCC patients with Child-Pugh B liver function were also treated. Results: The QLQ-C30 was available for 205 patients, and 196 completed the FACT-Hep. No difference in baseline QoL (P=.17) or overall survival (P=.088) was seen between the HCC, liver metastases, and intrahepatic cholangiocarcinoma patients. Appetite loss and fatigue measured by the QLQ-C30 clinically and statistically worsened by 1 month after treatment but recovered by 3 months. At 3 and 12 months after treatment, respectively, the FACT-Hep score had improved relative to baseline in 13%/19%, worsened in 36%/27%, and remained stable in 51%/54%. Using the QLQ-C30 Global Health score, QoL improved in 16%/23%, worsened in 34%/39%, and remained stable in 50%/38% at 3 and 12 months, respectively. Median survival was 17.0 months (95% confidence interval [CI] 12.3-19.8 months). Higher baseline scores on both FACT-Hep and QLQ-C30 Global Health were associated with improved survival. Hazard ratios for death, per 10-unit decrease in QoL, were 0.90 (95% CI 0.83-0.98; P=.001) and 0.88 (95% CI 0.82-0.95; P=.001), respectively. Tumor size was inversely correlated with survival. Conclusions: Liver SBRT temporarily worsens appetite and fatigue, but not overall QoL. Stereotactic body radiation therapy is well tolerated and warrants

  13. Prospective Longitudinal Assessment of Quality of Life for Liver Cancer Patients Treated With Stereotactic Body Radiation Therapy

    International Nuclear Information System (INIS)

    Klein, Jonathan; Dawson, Laura A.; Jiang, Haiyan; Kim, John; Dinniwell, Rob; Brierley, James; Wong, Rebecca; Lockwood, Gina; Ringash, Jolie

    2015-01-01

    Purpose: To evaluate quality of life (QoL), an important outcome owing to poor long-term survival, after stereotactic body radiation therapy (SBRT) to the liver. Methods and Materials: Patients (n=222) with hepatocellular carcinoma (HCC), liver metastases, or intrahepatic cholangiocarcinoma and Child-Pugh A liver function received 24-60 Gy of 6-fraction image-guided SBRT. Prospective QoL assessment was completed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (QLQ-C30) and/or Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep, version 4) questionnaires at baseline and 1, 3, 6, and 12 months after treatment. Ten HCC patients with Child-Pugh B liver function were also treated. Results: The QLQ-C30 was available for 205 patients, and 196 completed the FACT-Hep. No difference in baseline QoL (P=.17) or overall survival (P=.088) was seen between the HCC, liver metastases, and intrahepatic cholangiocarcinoma patients. Appetite loss and fatigue measured by the QLQ-C30 clinically and statistically worsened by 1 month after treatment but recovered by 3 months. At 3 and 12 months after treatment, respectively, the FACT-Hep score had improved relative to baseline in 13%/19%, worsened in 36%/27%, and remained stable in 51%/54%. Using the QLQ-C30 Global Health score, QoL improved in 16%/23%, worsened in 34%/39%, and remained stable in 50%/38% at 3 and 12 months, respectively. Median survival was 17.0 months (95% confidence interval [CI] 12.3-19.8 months). Higher baseline scores on both FACT-Hep and QLQ-C30 Global Health were associated with improved survival. Hazard ratios for death, per 10-unit decrease in QoL, were 0.90 (95% CI 0.83-0.98; P=.001) and 0.88 (95% CI 0.82-0.95; P=.001), respectively. Tumor size was inversely correlated with survival. Conclusions: Liver SBRT temporarily worsens appetite and fatigue, but not overall QoL. Stereotactic body radiation therapy is well tolerated and warrants

  14. Effectiveness of a simple and real-time baseline shift monitoring system during stereotactic body radiation therapy of lung tumors.

    Science.gov (United States)

    Uchida, Yukihiro; Tachibana, Hidenobu; Kamei, Yoshiyuki; Kashihara, Kenichi

    2017-11-01

    This study aimed to clinically validate a simple real-time baseline shift monitoring system in a prospective study of consecutive patients undergoing stereotactic body radiation therapy (SBRT) of lung tumors, and to investigate baseline shift due to intrafraction motion of the patient's body during lung SBRT. Ten consecutive patients with peripheral lung tumors were treated by SBRT consisting of four fractions of 12 Gy each, with a total dose of 48 Gy. During treatment, each patient's geometric displacement in the anterior-posterior and left-right directions (the baseline shift) was measured using a real-time monitoring webcam system. Displacement between the start and end of treatment was measured using an X-ray fluoroscopic imaging system. The displacement measurements of the two systems were compared, and the measurements of baseline shift acquired by the monitoring system during treatment were analyzed for all patients. There was no significant deviation between the monitoring system and the X-ray imaging system, with the accuracy of measurement being within 1 mm. Measurements using the monitoring system showed that 7 min of treatment generated displacements of more than 1 mm in 50% of the patients. Baseline shift of a patient's body may be measured accurately in real time, using a monitoring system without X-ray exposure. The manubrium of the sternum is a good location for measuring the baseline shift of a patient's body at all times. The real-time monitoring system may be useful for measuring the baseline shift of a patient's body independently of a gating system. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  15. Survey of Stereotactic Body Radiation Therapy in Japan by the Japan 3-D Conformal External Beam Radiotherapy Group

    International Nuclear Information System (INIS)

    Nagata, Yasushi; Hiraoka, Masahiro; Mizowaki, Takashi; Narita, Yuichiro; Matsuo, Yukinori; Norihisa, Yoshiki; Onishi, Hiroshi; Shirato, Hiroki

    2009-01-01

    Purpose: To recognize the current status of stereotactic body radiotherapy (SBRT) in Japan, using a nationwide survey conducted by the Japan 3-D Conformal External Beam Radiotherapy Group. Methods and Materials: The questionnaire was sent by mail to 117 institutions. Ninety-four institutions (80%) responded by the end of November 2005. Fifty-three institutions indicated that they have already started SBRT, and 38 institutions had been reimbursed by insurance. Results: A total of 1111 patients with histologically confirmed lung cancer were treated. Among these patients, 637 had T1N0M0 and 272 had T2N0M0 lung cancer. Metastatic lung cancer was found in 702 and histologically unconfirmed lung tumor in 291 patients. Primary liver cancer was found in 207 and metastatic liver cancer in 76 patients. The most frequent schedule used for primary lung cancer was 48Gy in 4 fractions at 22 institutions (52%), followed by 50Gy in 5 fractions at 11 institutions (26%) and 60Gy in 8 fractions at 4 institutions (10%). The tendency was the same for metastatic lung cancer. The average number of personnel involved in SBRT was 1.8 radiation oncologists, including 1.1 certified radiation oncologists, 2.8 technologists, 0.7 nurses, and 0.6 certified quality assurance personnel and 0.3 physicists. The most frequent amount of time for treatment planning was 61-120min, for quality assurance was 50-60min, and for treatment was 30min. There were 14 (0.6% of all cases) reported Grade 5 complications: 11 cases of radiation pneumonitis, 2 cases of hemoptysis, and 1 case of radiation esophagitis. Conclusion: The current status of SBRT in Japan was surveyed.

  16. Kilovoltage Imaging of Implanted Fiducials to Monitor Intrafraction Motion With Abdominal Compression During Stereotactic Body Radiation Therapy for Gastrointestinal Tumors

    International Nuclear Information System (INIS)

    Yorke, Ellen; Xiong, Ying; Han, Qian; Zhang, Pengpeng; Mageras, Gikas; Lovelock, Michael; Pham, Hai; Xiong, Jian-Ping; Goodman, Karyn A.

    2016-01-01

    Purpose: To assess intrafraction respiratory motion using a commercial kilovoltage imaging system for abdominal tumor patients with implanted fiducials and breathing constrained by pneumatic compression during stereotactic body radiation therapy (SBRT). Methods and Materials: A pneumatic compression belt limited respiratory motion in 19 patients with radiopaque fiducials in or near their tumor during SBRT for abdominal tumors. Kilovoltage images were acquired at 5- to 6-second intervals during treatment using a commercial system. Intrafractional fiducial displacements were measured using in-house software. The dosimetric effect of the observed displacements was calculated for 3 sessions for each patient. Results: Intrafraction displacement patterns varied between patients and between individual treatment sessions. Averaged over 19 patients, 73 sessions, 7.6% of craniocaudal displacements exceeded 0.5 cm, and 1.2% exceeded 0.75 cm. The calculated single-session dose to 95% of gross tumor volume differed from planned by an average of −1.2% (range, −11.1% to 4.8%) but only for 4 patients was the total 3-session calculated dose to 95% of gross tumor volume more than 3% different from planned. Conclusions: Our pneumatic compression limited intrafractional abdominal target motion, maintained target position established at setup, and was moderately effective in preserving coverage. Commercially available intrafractional imaging is useful for surveillance but can be made more effective and reliable.

  17. Multi-institutional application of Failure Mode and Effects Analysis (FMEA) to CyberKnife Stereotactic Body Radiation Therapy (SBRT).

    Science.gov (United States)

    Veronese, Ivan; De Martin, Elena; Martinotti, Anna Stefania; Fumagalli, Maria Luisa; Vite, Cristina; Redaelli, Irene; Malatesta, Tiziana; Mancosu, Pietro; Beltramo, Giancarlo; Fariselli, Laura; Cantone, Marie Claire

    2015-06-13

    A multidisciplinary and multi-institutional working group applied the Failure Mode and Effects Analysis (FMEA) approach to assess the risks for patients undergoing Stereotactic Body Radiation Therapy (SBRT) treatments for lesions located in spine and liver in two CyberKnife® Centres. The various sub-processes characterizing the SBRT treatment were identified to generate the process trees of both the treatment planning and delivery phases. This analysis drove to the identification and subsequent scoring of the potential failure modes, together with their causes and effects, using the risk probability number (RPN) scoring system. Novel solutions aimed to increase patient safety were accordingly considered. The process-tree characterising the SBRT treatment planning stage was composed with a total of 48 sub-processes. Similarly, 42 sub-processes were identified in the stage of delivery to liver tumours and 30 in the stage of delivery to spine lesions. All the sub-processes were judged to be potentially prone to one or more failure modes. Nineteen failures (i.e. 5 in treatment planning stage, 5 in the delivery to liver lesions and 9 in the delivery to spine lesions) were considered of high concern in view of the high RPN and/or severity index value. The analysis of the potential failures, their causes and effects allowed to improve the safety strategies already adopted in the clinical practice with additional measures for optimizing quality management workflow and increasing patient safety.

  18. Kilovoltage Imaging of Implanted Fiducials to Monitor Intrafraction Motion With Abdominal Compression During Stereotactic Body Radiation Therapy for Gastrointestinal Tumors

    Energy Technology Data Exchange (ETDEWEB)

    Yorke, Ellen, E-mail: yorke@mskcc.org [Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Xiong, Ying [Department of Radiation Oncology, China-Japan Friendship Hospital, Beijing (China); Han, Qian [Department of Radiotherapy, Henan Provincial People' s Hospital, Zhengzhou (China); Zhang, Pengpeng; Mageras, Gikas; Lovelock, Michael; Pham, Hai; Xiong, Jian-Ping [Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Goodman, Karyn A. [Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (United States)

    2016-07-01

    Purpose: To assess intrafraction respiratory motion using a commercial kilovoltage imaging system for abdominal tumor patients with implanted fiducials and breathing constrained by pneumatic compression during stereotactic body radiation therapy (SBRT). Methods and Materials: A pneumatic compression belt limited respiratory motion in 19 patients with radiopaque fiducials in or near their tumor during SBRT for abdominal tumors. Kilovoltage images were acquired at 5- to 6-second intervals during treatment using a commercial system. Intrafractional fiducial displacements were measured using in-house software. The dosimetric effect of the observed displacements was calculated for 3 sessions for each patient. Results: Intrafraction displacement patterns varied between patients and between individual treatment sessions. Averaged over 19 patients, 73 sessions, 7.6% of craniocaudal displacements exceeded 0.5 cm, and 1.2% exceeded 0.75 cm. The calculated single-session dose to 95% of gross tumor volume differed from planned by an average of −1.2% (range, −11.1% to 4.8%) but only for 4 patients was the total 3-session calculated dose to 95% of gross tumor volume more than 3% different from planned. Conclusions: Our pneumatic compression limited intrafractional abdominal target motion, maintained target position established at setup, and was moderately effective in preserving coverage. Commercially available intrafractional imaging is useful for surveillance but can be made more effective and reliable.

  19. Quantifying Health Utilities in Patients Undergoing Stereotactic Body Radiation Treatment for Liver Metastases for Use in Future Economic Evaluations.

    Science.gov (United States)

    Warren, B; Munoz-Schuffenegger, P; Chan, K K W; Chu, W; Helou, J; Erler, D; Chung, H

    2017-09-01

    Stereotactic body radiation therapy (SBRT) is increasingly used as an option for those with liver metastases. In order to facilitate future economic impact of health technologies, health utility scores may be used. The EuroQOL-5D-3L (EQ-5D) preference-based healthy utility instrument was used to evaluate the impact of treatment with SBRT on health utility scores. Between August 2013 and October 2014, 31 patients treated with 3-5 fractions of SBRT for liver metastases were enrolled in this study. The EQ-5D instrument was administered at baseline, during and up to 6 months post-SBRT. Mean EQ-5D score at baseline was 0.857, which remained stable across the entire study time period. Transient increases in difficulties with mobility (9.7% reported at baseline to 16.1% on the last day of treatment) and usual activities (3.2% reported at baseline to 34.5% on day two) were found during the course of treatment; these returned to baseline levels subsequently. The mean visual analogue score at baseline was 65.8 and remained unchanged throughout treatment and follow-up. The stability of health utility scores and problems reported by patients undergoing treatment indicate that SBRT for liver metastases does not impart a significant adverse effect on quality of life. These results may be used for future economic evaluation of SBRT. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  20. SU-E-J-89: Motion Effects On Organ Dose in Respiratory Gated Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Wang, T; Zhu, L [Georgia Institute of Technology, Atlanta, GA (Georgia); Khan, M; Landry, J; Rajpara, R; Hawk, N [Emory University, Atlanta, GA (United States)

    2014-06-01

    Purpose: Existing reports on gated radiation therapy focus mainly on optimizing dose delivery to the target structure. This work investigates the motion effects on radiation dose delivered to organs at risk (OAR) in respiratory gated stereotactic body radiation therapy (SBRT). A new algorithmic tool of dose analysis is developed to evaluate the optimality of gating phase for dose sparing on OARs while ensuring adequate target coverage. Methods: Eight patients with pancreatic cancer were treated on a phase I prospective study employing 4DCT-based SBRT. For each patient, 4DCT scans are acquired and sorted into 10 respiratory phases (inhale-exhale- inhale). Treatment planning is performed on the average CT image. The average CT is spatially registered to other phases. The resultant displacement field is then applied on the plan dose map to estimate the actual dose map for each phase. Dose values of each voxel are fitted to a sinusoidal function. Fitting parameters of dose variation, mean delivered dose and optimal gating phase for each voxel over respiration cycle are mapped on the dose volume. Results: The sinusoidal function accurately models the dose change during respiratory motion (mean fitting error 4.6%). In the eight patients, mean dose variation is 3.3 Gy on OARs with maximum of 13.7 Gy. Two patients have about 100cm{sup 3} volumes covered by more than 5 Gy deviation. The mean delivered dose maps are similar to plan dose with slight deformation. The optimal gating phase highly varies across the patient, with phase 5 or 6 on about 60% of the volume, and phase 0 on most of the rest. Conclusion: A new algorithmic tool is developed to conveniently quantify dose deviation on OARs from plan dose during the respiratory cycle. The proposed software facilitates the treatment planning process by providing the optimal respiratory gating phase for dose sparing on each OAR.

  1. Dosimetric Implications of an Injection of Hyaluronic Acid for Preserving the Rectal Wall in Prostate Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Chapet, Olivier, E-mail: olivier.chapet@chu-lyon.fr [Department of Radiation Oncology, Centre Hospitalier Lyon Sud, Pierre Benite (France); Udrescu, Corina [Department of Radiation Oncology, Centre Hospitalier Lyon Sud, Pierre Benite (France); Department of Medical Physics, Centre Hospitalier Lyon Sud, Pierre Benite (France); Tanguy, Ronan [Department of Radiation Oncology, Centre Hospitalier Lyon Sud, Pierre Benite (France); Ruffion, Alain [Department of Urology, Centre Hospitalier Lyon Sud, Pierre Benite (France); Fenoglietto, Pascal [Department of Radiation Oncology, Centre Val d' Aurelle, Montpellier (France); Sotton, Marie-Pierre [Department of Medical Physics, Centre Hospitalier Lyon Sud, Pierre Benite (France); Devonec, Marian [Department of Urology, Centre Hospitalier Lyon Sud, Pierre Benite (France); Colombel, Marc [Department of Urology, Hopital Edouard Herriot, Lyon (France); Jalade, Patrice [Department of Medical Physics, Centre Hospitalier Lyon Sud, Pierre Benite (France); Azria, David [Department of Radiation Oncology, Centre Val d' Aurelle, Montpellier (France)

    2014-02-01

    Purpose: This study assessed the contribution of ahyaluronic acid (HA) injection between the rectum and the prostate to reducing the dose to the rectal wall in stereotactic body radiation therapy (SBRT). Methods and Materials: As part of a phase 2 study of hypofractionated radiation therapy (62 Gy in 20 fractions), the patients received a transperineal injection of 10 cc HA between the rectum and the prostate. A dosimetric computed tomographic (CT) scan was systematically performed before (CT1) and after (CT2) the injection. Two 9-beam intensity modulated radiation therapy-SBRT plans were optimized for the first 10 patients on both CTs according to 2 dosage levels: 5 × 6.5 Gy (PlanA) and 5 × 8.5 Gy (PlanB). Rectal wall parameters were compared with a dose–volume histogram, and the prostate–rectum separation was measured at 7 levels of the prostate on the center line of the organ. Results: For both plans, the average volume of the rectal wall receiving the 90% isodose line (V90%) was reduced up to 90% after injection. There was no significant difference (P=.32) between doses received by the rectal wall on CT1 and CT2 at the base of the prostate. This variation became significant from the median plane to the apex of the prostate (P=.002). No significant differences were found between PlanA without HA and PlanB with HA for each level of the prostate (P=.77, at the isocenter of the prostate). Conclusions: HA injection significantly reduced the dose to the rectal wall and allowed a dose escalation from 6.5 Gy to 8.5 Gy without increasing the dose to the rectum. A phase 2 study is under way in our department to assess the rate of acute and late rectal toxicities when SBRT (5 × 8.5 Gy) is combined with an injection of HA.

  2. Dosimetric Implications of an Injection of Hyaluronic Acid for Preserving the Rectal Wall in Prostate Stereotactic Body Radiation Therapy

    International Nuclear Information System (INIS)

    Chapet, Olivier; Udrescu, Corina; Tanguy, Ronan; Ruffion, Alain; Fenoglietto, Pascal; Sotton, Marie-Pierre; Devonec, Marian; Colombel, Marc; Jalade, Patrice; Azria, David

    2014-01-01

    Purpose: This study assessed the contribution of ahyaluronic acid (HA) injection between the rectum and the prostate to reducing the dose to the rectal wall in stereotactic body radiation therapy (SBRT). Methods and Materials: As part of a phase 2 study of hypofractionated radiation therapy (62 Gy in 20 fractions), the patients received a transperineal injection of 10 cc HA between the rectum and the prostate. A dosimetric computed tomographic (CT) scan was systematically performed before (CT1) and after (CT2) the injection. Two 9-beam intensity modulated radiation therapy-SBRT plans were optimized for the first 10 patients on both CTs according to 2 dosage levels: 5 × 6.5 Gy (PlanA) and 5 × 8.5 Gy (PlanB). Rectal wall parameters were compared with a dose–volume histogram, and the prostate–rectum separation was measured at 7 levels of the prostate on the center line of the organ. Results: For both plans, the average volume of the rectal wall receiving the 90% isodose line (V90%) was reduced up to 90% after injection. There was no significant difference (P=.32) between doses received by the rectal wall on CT1 and CT2 at the base of the prostate. This variation became significant from the median plane to the apex of the prostate (P=.002). No significant differences were found between PlanA without HA and PlanB with HA for each level of the prostate (P=.77, at the isocenter of the prostate). Conclusions: HA injection significantly reduced the dose to the rectal wall and allowed a dose escalation from 6.5 Gy to 8.5 Gy without increasing the dose to the rectum. A phase 2 study is under way in our department to assess the rate of acute and late rectal toxicities when SBRT (5 × 8.5 Gy) is combined with an injection of HA

  3. MO-G-BRE-09: Validating FMEA Against Incident Learning Data: A Study in Stereotactic Body Radiation Therapy

    International Nuclear Information System (INIS)

    Yang, F; Cao, N; Young, L; Howard, J; Sponseller, P; Logan, W; Arbuckle, T; Korssjoen, T; Meyer, J; Ford, E

    2014-01-01

    Purpose: Though FMEA (Failure Mode and Effects Analysis) is becoming more widely adopted for risk assessment in radiation therapy, to our knowledge it has never been validated against actual incident learning data. The objective of this study was to perform an FMEA analysis of an SBRT (Stereotactic Body Radiation Therapy) treatment planning process and validate this against data recorded within an incident learning system. Methods: FMEA on the SBRT treatment planning process was carried out by a multidisciplinary group including radiation oncologists, medical physicists, and dosimetrists. Potential failure modes were identified through a systematic review of the workflow process. Failure modes were rated for severity, occurrence, and detectability on a scale of 1 to 10 and RPN (Risk Priority Number) was computed. Failure modes were then compared with historical reports identified as relevant to SBRT planning within a departmental incident learning system that had been active for two years. Differences were identified. Results: FMEA identified 63 failure modes. RPN values for the top 25% of failure modes ranged from 60 to 336. Analysis of the incident learning database identified 33 reported near-miss events related to SBRT planning. FMEA failed to anticipate 13 of these events, among which 3 were registered with severity ratings of severe or critical in the incident learning system. Combining both methods yielded a total of 76 failure modes, and when scored for RPN the 13 events missed by FMEA ranked within the middle half of all failure modes. Conclusion: FMEA, though valuable, is subject to certain limitations, among them the limited ability to anticipate all potential errors for a given process. This FMEA exercise failed to identify a significant number of possible errors (17%). Integration of FMEA with retrospective incident data may be able to render an improved overview of risks within a process

  4. Stereotactic Radiosurgery and Stereotactic Body Radiotherapy (SBRT)

    Science.gov (United States)

    ... The radiation oncologist and, in some cases, a neurosurgeon lead the treatment team and oversee the treatment; ... In the case of the Gamma Knife, the neurosurgeon and/or radiation oncologist may help position the ...

  5. Stereotactic Body Radiation Therapy for Re-irradiation of Persistent or Recurrent Non-Small Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Trovo, Marco, E-mail: marcotrovo33@hotmail.com [Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Pordenone (Italy); Minatel, Emilio; Durofil, Elena [Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Pordenone (Italy); Polesel, Jerry [Department of Epidemiology and Biostatistics, Centro di Riferimento Oncologico of Aviano, Pordenone (Italy); Avanzo, Michele [Department of Medical Physics, Centro di Riferimento Oncologico of Aviano, Pordenone (Italy); Baresic, Tania [Department of Nuclear Medicine, Centro di Riferimento Oncologico of Aviano, Pordenone (Italy); Bearz, Alessandra [Department of Medical Oncology, Centro di Riferimento Oncologico of Aviano, Pordenone (Italy); Del Conte, Alessandro [Department of Medical Oncology, Pordenone General Hospital, Aviano, Pordenone (Italy); Franchin, Giovanni; Gobitti, Carlo; Rumeileh, Imad Abu; Trovo, Mauro G. [Department of Radiation Oncology, Centro di Riferimento Oncologico of Aviano, Pordenone (Italy)

    2014-04-01

    Purpose: To retrospectively assess toxicity and outcome of re-irradiation with stereotactic body radiation therapy (SBRT) in patients with recurrent or persistent non-small cell lung cancer (NSCLC), who were previously treated with radical radiation therapy (50-60 Gy). The secondary endpoint was to investigate whether there are dosimetric parameter predictors of severe radiation toxicity. Methods and Materials: The analysis was conducted in 17 patients with “in-field” recurrent/persistent centrally located NSCLC, who underwent re-irradiation with SBRT. SBRT consisted of 30 Gy in 5 to 6 fractions; these prescriptions would be equivalent for the tumor to 37.5 to 40 Gy, bringing the total 2-Gy-per-fraction cumulative dose to 87 to 100 Gy, considering the primary radiation therapy treatment. Actuarial analyses and survival were calculated by the Kaplan-Meier method, and P values were estimated by the log-rank test, starting from the date of completion of SBRT. Dosimetric parameters from the subgroups with and without grade ≥3 pulmonary toxicity were compared using a 2-tailed Student t test. Results: The median follow-up was 18 months (range, 4-57 months). Only 2 patients had local failure, corresponding to a local control rate of 86% at 1 year. The Kaplan-Meier estimates of overall survival (OS) rates at 1 and 2 years were 59% and 29%, respectively; the median OS was 19 months. Four patients (23%) experienced grade 3 radiation pneumonitis, and 1 patient developed fatal pneumonitis. One patient died of fatal hemoptysis 2 months after the completion of SBRT. Unexpectedly, heart maximum dose, D5 (minimum dose to at least 5% of the heart volume), and D10 were correlated with risk of radiation pneumonitis (P<.05). Conclusions: Re-irradiation with SBRT for recurrent/persistent centrally located NSCLC achieves excellent results in terms of local control. However, the high rate of severe toxicity reported in our study is of concern.

  6. Stereotactic Body Radiation Therapy for Re-irradiation of Persistent or Recurrent Non-Small Cell Lung Cancer

    International Nuclear Information System (INIS)

    Trovo, Marco; Minatel, Emilio; Durofil, Elena; Polesel, Jerry; Avanzo, Michele; Baresic, Tania; Bearz, Alessandra; Del Conte, Alessandro; Franchin, Giovanni; Gobitti, Carlo; Rumeileh, Imad Abu; Trovo, Mauro G.

    2014-01-01

    Purpose: To retrospectively assess toxicity and outcome of re-irradiation with stereotactic body radiation therapy (SBRT) in patients with recurrent or persistent non-small cell lung cancer (NSCLC), who were previously treated with radical radiation therapy (50-60 Gy). The secondary endpoint was to investigate whether there are dosimetric parameter predictors of severe radiation toxicity. Methods and Materials: The analysis was conducted in 17 patients with “in-field” recurrent/persistent centrally located NSCLC, who underwent re-irradiation with SBRT. SBRT consisted of 30 Gy in 5 to 6 fractions; these prescriptions would be equivalent for the tumor to 37.5 to 40 Gy, bringing the total 2-Gy-per-fraction cumulative dose to 87 to 100 Gy, considering the primary radiation therapy treatment. Actuarial analyses and survival were calculated by the Kaplan-Meier method, and P values were estimated by the log-rank test, starting from the date of completion of SBRT. Dosimetric parameters from the subgroups with and without grade ≥3 pulmonary toxicity were compared using a 2-tailed Student t test. Results: The median follow-up was 18 months (range, 4-57 months). Only 2 patients had local failure, corresponding to a local control rate of 86% at 1 year. The Kaplan-Meier estimates of overall survival (OS) rates at 1 and 2 years were 59% and 29%, respectively; the median OS was 19 months. Four patients (23%) experienced grade 3 radiation pneumonitis, and 1 patient developed fatal pneumonitis. One patient died of fatal hemoptysis 2 months after the completion of SBRT. Unexpectedly, heart maximum dose, D5 (minimum dose to at least 5% of the heart volume), and D10 were correlated with risk of radiation pneumonitis (P<.05). Conclusions: Re-irradiation with SBRT for recurrent/persistent centrally located NSCLC achieves excellent results in terms of local control. However, the high rate of severe toxicity reported in our study is of concern

  7. Stereotactic Body Radiation Therapy for Locally Advanced Pancreatic Cancer: A Systematic Review and Pooled Analysis of 19 Trials

    International Nuclear Information System (INIS)

    Petrelli, Fausto; Comito, Tiziana; Ghidini, Antonio; Torri, Valter; Scorsetti, Marta; Barni, Sandro

    2017-01-01

    Purpose: Although surgery is the standard of care for resectable pancreatic cancer (PC), standard-dose chemoradiation therapy and chemotherapy alone are suitable for patients with unresectable disease. Stereotactic body radiation therapy (SBRT) is an alternative, focused local therapy that delivers high radiation doses within a few fractions to the cancer, sparing the surrounding critical tissue. We performed a systematic review and pooled analysis of published trials to evaluate the efficacy and safety of this emerging treatment modality. Methods and Materials: We searched the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, SCOPUS, the Web of Science, and CINAHL for publications regarding SBRT for locally advanced PC. The 1-year overall survival (OS) rate was the primary endpoint, and the median OS, 2-year OS rate, 1-year locoregional control (LRC) rate, and grade 3 to 4 toxicities were the secondary endpoints. A multivariate random-effects meta-analysis was performed to calculate the aggregated OS rates at 1 and 2 years and the 1-year LRC rate. Results: A total of 19 studies, encompassing 1009 patients, were included in the present analysis. The pooled 1-year OS was 51.6% in 13 trials with data available. The median OS ranged from 5.7 to 47 months (median 17). The LRC rate at 1 year was 72.3%. Overall, the occurrence of severe adverse events did not exceed 10%. LRC appeared to correlate with the total SBRT dose and the number of fractions. Conclusions: The advantages of SBRT in terms of treatment time, satisfactory OS, and LRC indicate that it is an effective option for inoperable PC. However, a definitive validation of this treatment modality in large randomized studies is required, owing to the nonrandomized nature of the included studies and the limitations of small single-center series that include mixed populations.

  8. Radiation-induced liver disease after stereotactic body radiotherapy for small hepatocellular carcinoma: clinical and dose-volumetric parameters

    International Nuclear Information System (INIS)

    Jung, Jinhong; Choi, Eun Kyung; Kim, Jong Hoon; Yoon, Sang Min; Kim, So Yeon; Cho, Byungchul; Park, Jin-hong; Kim, Su Ssan; Song, Si Yeol; Lee, Sang-wook; Ahn, Seung Do

    2013-01-01

    To investigate the clinical and dose–volumetric parameters that predict the risk of radiation-induced liver disease (RILD) for patients with small, unresectable hepatocellular carcinoma (HCC) treated with stereotactic body radiotherapy (SBRT). Between March 2007 and December 2009, 92 patients with HCC treated with SBRT were reviewed for RILD within 3 months of completing treatment. RILD was evaluated according to the Common Terminology Criteria for Adverse Events, version 3.0. A dose of 10–20 Gy (median, 15 Gy) per fraction was given over 3–4 consecutive days for a total dose of 30–60 Gy (median, 45 Gy). The following clinical and dose–volumetric parameters were examined: age, gender, Child-Pugh class, presence of hepatitis B virus, gross tumor volume, normal liver volume, radiation dose, fraction size, mean dose to the normal liver, and normal liver volumes receiving from < 5 Gy to < 60 Gy (in increments of 5 Gy). Seventeen (18.5%) of the 92 patients developed grade 2 or worse RILD after SBRT (49 patients in grade 1, 11 in grade 2, and 6 in ≥ grade 3). On univariate analysis, Child-Pugh class was identified as a significant clinical parameter, while normal liver volume and normal liver volumes receiving from < 15 Gy to < 60 Gy were the significant dose–volumetric parameters. Upon multivariate analysis, only Child-Pugh class was a significant parameter for predicting grade 2 or worse RILD. The Child-Pugh B cirrhosis was found to have a significantly greater susceptibility to the development of grade 2 or worse RILD after SBRT in patients with small, unresectable HCC. Additional efforts aimed at testing other models to predict the risk of RILD in a large series of HCC patients treated with SBRT are needed

  9. Radiosensitivity Differences Between Liver Metastases Based on Primary Histology Suggest Implications for Clinical Outcomes After Stereotactic Body Radiation Therapy

    International Nuclear Information System (INIS)

    Ahmed, Kamran A.; Caudell, Jimmy J.; El-Haddad, Ghassan; Berglund, Anders E.; Welsh, Eric A.; Yue, Binglin; Hoffe, Sarah E.; Naghavi, Arash O.; Abuodeh, Yazan A.; Frakes, Jessica M.; Eschrich, Steven A.; Torres-Roca, Javier F.

    2016-01-01

    Purpose/Objectives: Evidence from the management of oligometastases with stereotactic body radiation therapy (SBRT) reveals differences in outcomes based on primary histology. We have previously identified a multigene expression index for tumor radiosensitivity (RSI) with validation in multiple independent cohorts. In this study, we assessed RSI in liver metastases and assessed our clinical outcomes after SBRT based on primary histology. Methods and Materials: Patients were identified from our prospective, observational protocol. The previously tested RSI 10 gene assay was run on samples and calculated using the published algorithm. An independent cohort of 33 patients with 38 liver metastases treated with SBRT was used for clinical correlation. Results: A total of 372 unique metastatic liver lesions were identified for inclusion from our prospective, institutional metadata pool. The most common primary histologies for liver metastases were colorectal adenocarcinoma (n=314, 84.4%), breast adenocarcinoma (n=12, 3.2%), and pancreas neuroendocrine (n=11, 3%). There were significant differences in RSI of liver metastases based on histology. The median RSIs for liver metastases in descending order of radioresistance were gastrointestinal stromal tumor (0.57), melanoma (0.53), colorectal neuroendocrine (0.46), pancreas neuroendocrine (0.44), colorectal adenocarcinoma (0.43), breast adenocarcinoma (0.35), lung adenocarcinoma (0.31), pancreas adenocarcinoma (0.27), anal squamous cell cancer (0.22), and small intestine neuroendocrine (0.21) (P<.0001). The 12-month and 24-month Kaplan-Meier rates of local control (LC) for colorectal lesions from the independent clinical cohort were 79% and 59%, compared with 100% for noncolorectal lesions (P=.019), respectively. Conclusions: In this analysis, we found significant differences based on primary histology. This study suggests that primary histology may be an important factor to consider in SBRT radiation dose selection.

  10. Increased Bowel Toxicity in Patients Treated With a Vascular Endothelial Growth Factor Inhibitor (VEGFI) After Stereotactic Body Radiation Therapy (SBRT)

    Energy Technology Data Exchange (ETDEWEB)

    Barney, Brandon M., E-mail: barney.brandon@mayo.edu [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Markovic, Svetomir N. [Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota (United States); Laack, Nadia N.; Miller, Robert C.; Sarkaria, Jann N. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Macdonald, O. Kenneth [Therapeutic Radiologists Incorporated, Kansas City, Kansas (United States); Bauer, Heather J.; Olivier, Kenneth R. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States)

    2013-09-01

    Purpose: Gastrointestinal injury occurs rarely with agents that affect the vascular endothelial growth factor receptor and with abdominal stereotactic body radiation therapy (SBRT). We explored the incidence of serious bowel injury (SBI) in patients treated with SBRT with or without vascular endothelial growth factor inhibitor (VEGFI) therapy. Methods and Materials: Seventy-six patients with 84 primary or metastatic intra-abdominal lesions underwent SBRT (median dose, 50 Gy in 5 fractions). Of the patients, 20 (26%) received VEGFI within 2 years after SBRT (bevacizumab, n=14; sorafenib, n=4; pazopanib, n=1; sunitinib, n=1). The incidence of SBI (Common Terminology Criteria for Adverse Events, version 4.0, grade 3-5 ulceration or perforation) after SBRT was obtained, and the relationship between SBI and VEGFI was examined. Results: In the combined population, 7 patients (9%) had SBI at a median of 4.6 months (range, 3-17 months) from SBRT. All 7 had received VEGFI before SBI and within 13 months of completing SBRT, and 5 received VEGFI within 3 months of SBRT. The 6-month estimate of SBI in the 26 patients receiving VEGFI within 3 months of SBRT was 38%. No SBIs were noted in the 63 patients not receiving VEGFI. The log–rank test showed a significant correlation between SBI and VEGFI within 3 months of SBRT (P=.0006) but not between SBI and radiation therapy bowel dose (P=.20). Conclusions: The combination of SBRT and VEGFI results in a higher risk of SBI than would be expected with either treatment independently. Local therapies other than SBRT may be considered if a patient is likely to receive a VEGFI in the near future.

  11. Radiosensitivity Differences Between Liver Metastases Based on Primary Histology Suggest Implications for Clinical Outcomes After Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Ahmed, Kamran A.; Caudell, Jimmy J. [Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States); El-Haddad, Ghassan [Department of Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States); Berglund, Anders E.; Welsh, Eric A. [Department of Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States); Yue, Binglin [Department of Biostastistics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States); Hoffe, Sarah E.; Naghavi, Arash O.; Abuodeh, Yazan A.; Frakes, Jessica M. [Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States); Eschrich, Steven A. [Department of Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States); Torres-Roca, Javier F., E-mail: Javier.torresroca@moffitt.org [Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida (United States)

    2016-08-01

    Purpose/Objectives: Evidence from the management of oligometastases with stereotactic body radiation therapy (SBRT) reveals differences in outcomes based on primary histology. We have previously identified a multigene expression index for tumor radiosensitivity (RSI) with validation in multiple independent cohorts. In this study, we assessed RSI in liver metastases and assessed our clinical outcomes after SBRT based on primary histology. Methods and Materials: Patients were identified from our prospective, observational protocol. The previously tested RSI 10 gene assay was run on samples and calculated using the published algorithm. An independent cohort of 33 patients with 38 liver metastases treated with SBRT was used for clinical correlation. Results: A total of 372 unique metastatic liver lesions were identified for inclusion from our prospective, institutional metadata pool. The most common primary histologies for liver metastases were colorectal adenocarcinoma (n=314, 84.4%), breast adenocarcinoma (n=12, 3.2%), and pancreas neuroendocrine (n=11, 3%). There were significant differences in RSI of liver metastases based on histology. The median RSIs for liver metastases in descending order of radioresistance were gastrointestinal stromal tumor (0.57), melanoma (0.53), colorectal neuroendocrine (0.46), pancreas neuroendocrine (0.44), colorectal adenocarcinoma (0.43), breast adenocarcinoma (0.35), lung adenocarcinoma (0.31), pancreas adenocarcinoma (0.27), anal squamous cell cancer (0.22), and small intestine neuroendocrine (0.21) (P<.0001). The 12-month and 24-month Kaplan-Meier rates of local control (LC) for colorectal lesions from the independent clinical cohort were 79% and 59%, compared with 100% for noncolorectal lesions (P=.019), respectively. Conclusions: In this analysis, we found significant differences based on primary histology. This study suggests that primary histology may be an important factor to consider in SBRT radiation dose selection.

  12. Stereotactic Body Radiation Therapy for Locally Advanced Pancreatic Cancer: A Systematic Review and Pooled Analysis of 19 Trials

    Energy Technology Data Exchange (ETDEWEB)

    Petrelli, Fausto, E-mail: faupe@libero.it [Oncology Unit, Department of Oncology, ASST Bergamo Ovest, Treviglio (Italy); Comito, Tiziana [Department of Radiosurgery and Radiotherapy, Istituto Clinico Humanitas Cancer Center and Research Hospital, Milan (Italy); Ghidini, Antonio [Oncology Unit, Igea Hospital, Milan (Italy); Torri, Valter [Department of Biomedical Sciences, Humanitas University and Radiotherapy and Radiosurgery Department-Humanitas Research Hospital, Milan (Italy); Scorsetti, Marta [Department of Radiosurgery and Radiotherapy, Istituto Clinico Humanitas Cancer Center and Research Hospital, Milan (Italy); Barni, Sandro [Oncology Unit, Department of Oncology, ASST Bergamo Ovest, Treviglio (Italy)

    2017-02-01

    Purpose: Although surgery is the standard of care for resectable pancreatic cancer (PC), standard-dose chemoradiation therapy and chemotherapy alone are suitable for patients with unresectable disease. Stereotactic body radiation therapy (SBRT) is an alternative, focused local therapy that delivers high radiation doses within a few fractions to the cancer, sparing the surrounding critical tissue. We performed a systematic review and pooled analysis of published trials to evaluate the efficacy and safety of this emerging treatment modality. Methods and Materials: We searched the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, SCOPUS, the Web of Science, and CINAHL for publications regarding SBRT for locally advanced PC. The 1-year overall survival (OS) rate was the primary endpoint, and the median OS, 2-year OS rate, 1-year locoregional control (LRC) rate, and grade 3 to 4 toxicities were the secondary endpoints. A multivariate random-effects meta-analysis was performed to calculate the aggregated OS rates at 1 and 2 years and the 1-year LRC rate. Results: A total of 19 studies, encompassing 1009 patients, were included in the present analysis. The pooled 1-year OS was 51.6% in 13 trials with data available. The median OS ranged from 5.7 to 47 months (median 17). The LRC rate at 1 year was 72.3%. Overall, the occurrence of severe adverse events did not exceed 10%. LRC appeared to correlate with the total SBRT dose and the number of fractions. Conclusions: The advantages of SBRT in terms of treatment time, satisfactory OS, and LRC indicate that it is an effective option for inoperable PC. However, a definitive validation of this treatment modality in large randomized studies is required, owing to the nonrandomized nature of the included studies and the limitations of small single-center series that include mixed populations.

  13. Is Stereotactic Body Radiation Therapy an Attractive Option for Unresectable Liver Metastases? A Preliminary Report From a Phase 2 Trial

    Energy Technology Data Exchange (ETDEWEB)

    Scorsetti, Marta; Arcangeli, Stefano; Tozzi, Angelo; Comito, Tiziana [Radiotherapy and Radiosurgery Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Milano (Italy); Alongi, Filippo, E-mail: filippo.alongi@humanitas.it [Radiotherapy and Radiosurgery Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Milano (Italy); Navarria, Pierina; Mancosu, Pietro; Reggiori, Giacomo [Radiotherapy and Radiosurgery Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Milano (Italy); Fogliata, Antonella [Medical Physics Unit, Oncology Institute of Southern Switzerland, Bellinzona (Switzerland); Torzilli, Guido [Surgery Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Milano (Italy); Tomatis, Stefano [Radiotherapy and Radiosurgery Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Rozzano, Milano (Italy); Cozzi, Luca [Medical Physics Unit, Oncology Institute of Southern Switzerland, Bellinzona (Switzerland)

    2013-06-01

    Purpose: To evaluate the feasibility of high-dose stereotactic body radiation therapy (SBRT) in the treatment of unresectable liver metastases. Methods and Materials: Patients with 1 to 3 liver metastases, with maximum individual tumor diameters less than 6 cm and a Karnofsky Performance Status of at least 70, were enrolled and treated by SBRT on a phase 2 clinical trial. Dose prescription was 75 Gy on 3 consecutive days. SBRT was delivered using the volumetric modulated arc therapy by RapidArc (Varian, Palo Alto, CA) technique. The primary end-point was in-field local control. Secondary end-points were toxicity and survival. Results: Between February 2010 and September 2011, a total of 61 patients with 76 lesions were treated. Among the patients, 21 (34.3%) had stable extrahepatic disease at study entry. The most frequent primary sites were colorectal (45.9%) and breast (18%). Of the patients, 78.7% had 1 lesion, 18.0% had 2 lesions, and 3.3% had 3 lesions. After a median of 12 months (range, 2-26 months), the in-field local response rate was 94%. The median overall survival rate was 19 months, and actuarial survival at 12 months was 83.5%. None of the patients experienced grade 3 or higher acute toxicity. No radiation-induced liver disease was detected. One patient experienced G3 late toxicity at 6 months, resulting from chest wall pain. Conclusions: SBRT for unresectable liver metastases can be considered an effective, safe, and noninvasive therapeutic option, with excellent rates of local control and a low treatment-related toxicity.

  14. Impact of inhomogeneity corrections on dose coverage in the treatment of lung cancer using stereotactic body radiation therapy

    International Nuclear Information System (INIS)

    Ding, George X.; Duggan, Dennis M.; Lu Bo; Hallahan, Dennis E.; Cmelak, Anthony; Malcolm, Arnold; Newton, Jared; Deeley, Matthew; Coffey, Charles W.

    2007-01-01

    The purpose of this study is to assess the real target dose coverage when radiation treatments were delivered to lung cancer patients based on treatment planning according to the RTOG-0236 Protocol. We compare calculated dosimetric results between the more accurate anisotropic analytical algorithm (AAA) and the pencil beam algorithm for stereotactic body radiation therapy treatment planning in lung cancer. Ten patients with non-small cell lung cancer were given 60 Gy in three fractions using 6 and 10 MV beams with 8-10 fields. The patients were chosen in accordance with the lung RTOG-0236 protocol. The dose calculations were performed using the pencil beam algorithm with no heterogeneity corrections (PB-NC) and then recalculated with the pencil beam with modified Batho heterogeneity corrections (PB-MB) and the AAA using an identical beam setup and monitor units. The differences in calculated dose to 95% or 99% of the PTV, between using the PB-NC and the AAA, were within 10% of prescribed dose (60 Gy). However, the minimum dose to 95% and 99% of PTV calculated using the PB-MB were consistently overestimated by up to 40% and 36% of the prescribed dose, respectively, compared to that calculated by the AAA. Using the AAA as reference, the calculated maximum doses were underestimated by up to 27% using the PB-NC and overestimated by 19% using the PB-MB. The calculations of dose to lung from PB-NC generally agree with that of AAA except in the small high-dose region where PB-NC underestimates. The calculated dose distributions near the interface using the AAA agree with those from Monte Carlo calculations as well as measured values. This study indicates that the real minimum PTV dose coverage cannot be guaranteed when the PB-NC is used to calculate the monitor unit settings in dose prescriptions

  15. Clinical applicability of biologically effective dose calculation for spinal cord in fractionated spine stereotactic body radiation therapy

    International Nuclear Information System (INIS)

    Lee, Seung Heon; Lee, Kyu Chan; Choi, Jinho; Ahn, So Hyun; Lee, Seok Ho; Sung, Ki Hoon; Kil, Se Hee

    2015-01-01

    The aim of the study was to investigate whether biologically effective dose (BED) based on linear-quadratic model can be used to estimate spinal cord tolerance dose in spine stereotactic body radiation therapy (SBRT) delivered in 4 or more fractions. Sixty-three metastatic spinal lesions in 47 patients were retrospectively evaluated. The most frequently prescribed dose was 36 Gy in 4 fractions. In planning, we tried to limit the maximum dose to the spinal cord or cauda equina less than 50% of prescription or 45 Gy 2/2 . BED was calculated using maximum point dose of spinal cord. Maximum spinal cord dose per fraction ranged from 2.6 to 6.0 Gy (median 4.3 Gy). Except 4 patients with 52.7, 56.4, 62.4, and 67.9 Gy 2/2 , equivalent total dose in 2-Gy fraction of the patients was not more than 50 Gy 2/2 (12.1–67.9, median 32.0). The ratio of maximum spinal cord dose to prescription dose increased up to 82.2% of prescription dose as epidural spinal cord compression grade increased. No patient developed grade 2 or higher radiation-induced spinal cord toxicity during follow-up period of 0.5 to 53.9 months. In fractionated spine SBRT, BED can be used to estimate spinal cord tolerance dose, provided that the dose per fraction to the spinal cord is moderate, e.g. < 6.0 Gy. It appears that a maximum dose of up to 45–50 Gy 2/2 to the spinal cord is tolerable in 4 or more fractionation regimen

  16. Consensus Contouring Guidelines for Postoperative Stereotactic Body Radiation Therapy for Metastatic Solid Tumor Malignancies to the Spine

    International Nuclear Information System (INIS)

    Redmond, Kristin J.; Robertson, Scott; Lo, Simon S.; Soltys, Scott G.; Ryu, Samuel; McNutt, Todd; Chao, Samuel T.; Yamada, Yoshiya; Ghia, Amol; Chang, Eric L.; Sheehan, Jason; Sahgal, Arjun

    2017-01-01

    Purpose: To develop consensus contouring guidelines for postoperative stereotactic body radiation therapy (SBRT) for spinal metastases. Methods and Materials: Ten spine SBRT specialists representing 10 international centers independently contoured the clinical target volume (CTV), planning target volume (PTV), spinal cord, and spinal cord planning organ at risk volume (PRV) for 10 representative clinical scenarios in postoperative spine SBRT for metastatic solid tumor malignancies. Contours were imported into the Computational Environment for Radiotherapy Research. Agreement between physicians was calculated with an expectation minimization algorithm using simultaneous truth and performance level estimation with κ statistics. Target volume definition guidelines were established by finding optimized confidence level consensus contours using histogram agreement analyses. Results: Nine expert radiation oncologists and 1 neurosurgeon completed contours for all 10 cases. The mean sensitivity and specificity were 0.79 (range, 0.71-0.89) and 0.94 (range, 0.90-0.99) for the CTV and 0.79 (range, 0.70-0.95) and 0.92 (range, 0.87-0.99) for the PTV), respectively. Mean κ agreement, which demonstrates the probability that contours agree by chance alone, was 0.58 (range, 0.43-0.70) for CTV and 0.58 (range, 0.37-0.76) for PTV (P<.001 for all cases). Optimized consensus contours were established for all patients with 80% confidence interval. Recommendations for CTV include treatment of the entire preoperative extent of bony and epidural disease, plus immediately adjacent bony anatomic compartments at risk of microscopic disease extension. In particular, a “donut-shaped” CTV was consistently applied in cases of preoperative circumferential epidural extension, regardless of extent of residual epidural extension. Otherwise more conformal anatomic-based CTVs were determined and described. Spinal instrumentation was consistently excluded from the CTV. Conclusions: We provide

  17. Dosimetric Comparison of Real-Time MRI-Guided Tri-Cobalt-60 Versus Linear Accelerator-Based Stereotactic Body Radiation Therapy Lung Cancer Plans.

    Science.gov (United States)

    Wojcieszynski, Andrzej P; Hill, Patrick M; Rosenberg, Stephen A; Hullett, Craig R; Labby, Zacariah E; Paliwal, Bhudatt; Geurts, Mark W; Bayliss, R Adam; Bayouth, John E; Harari, Paul M; Bassetti, Michael F; Baschnagel, Andrew M

    2017-06-01

    Magnetic resonance imaging-guided radiation therapy has entered clinical practice at several major treatment centers. Treatment of early-stage non-small cell lung cancer with stereotactic body radiation therapy is one potential application of this modality, as some form of respiratory motion management is important to address. We hypothesize that magnetic resonance imaging-guided tri-cobalt-60 radiation therapy can be used to generate clinically acceptable stereotactic body radiation therapy treatment plans. Here, we report on a dosimetric comparison between magnetic resonance imaging-guided radiation therapy plans and internal target volume-based plans utilizing volumetric-modulated arc therapy. Ten patients with early-stage non-small cell lung cancer who underwent radiation therapy planning and treatment were studied. Following 4-dimensional computed tomography, patient images were used to generate clinically deliverable plans. For volumetric-modulated arc therapy plans, the planning tumor volume was defined as an internal target volume + 0.5 cm. For magnetic resonance imaging-guided plans, a single mid-inspiratory cycle was used to define a gross tumor volume, then expanded 0.3 cm to the planning tumor volume. Treatment plan parameters were compared. Planning tumor volumes trended larger for volumetric-modulated arc therapy-based plans, with a mean planning tumor volume of 47.4 mL versus 24.8 mL for magnetic resonance imaging-guided plans ( P = .08). Clinically acceptable plans were achievable via both methods, with bilateral lung V20, 3.9% versus 4.8% ( P = .62). The volume of chest wall receiving greater than 30 Gy was also similar, 22.1 versus 19.8 mL ( P = .78), as were all other parameters commonly used for lung stereotactic body radiation therapy. The ratio of the 50% isodose volume to planning tumor volume was lower in volumetric-modulated arc therapy plans, 4.19 versus 10.0 ( P guided tri-cobalt-60 radiation therapy is capable of delivering lung high

  18. Robotic stereotactic body radiation therapy for elderly medically inoperable early-stage non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Karam SD

    2013-08-01

    Full Text Available Sana D Karam,1 Zachary D Horne,1 Robert L Hong,1,2 Nimrah Baig,1 Gregory J Gagnon,4 Don McRae,2 David Duhamel,3 Nadim M Nasr1,21Department of Radiation Oncology, Georgetown University Hospital, Washington, DC, USA; 2Department of Radiation Oncology, Virginia Hospital Center, Arlington, VA, USA; 3Department of Pulmonary/Critical Care Medicine, Virginia Hospital Center, Arlington, VA, USA; 4Department of Radiation Oncology, Frederick Memorial Hospital, Frederick, MD, USAIntroduction: Stereotactic body radiation therapy (SBRT is being increasingly applied in the treatment of non-small cell lung cancer (NSCLC because of its high local efficacy. This study aims to examine survival outcomes in elderly patients with inoperable stage I NSCLC treated with SBRT.Methods: A total of 31 patients with single lesions treated with fractionated SBRT from 2008 to 2011 were retrospectively analyzed. A median prescribed dose of 48 Gy was delivered to the prescription isodose line, over a median of four treatments. The median biologically effective dose (BED was 105.6 (range 37.50–180, and the median age was 73 (65–90 years. No patient received concurrent chemotherapy.Results: With a median follow up of 13 months (range, 4–40 months, the actuarial median overall survival (OS and progression-free survival (PFS were 32 months, and 19 months, respectively. The actuarial median local control (LC time was not reached. The survival outcomes at median follow up of 13 months were 80%, 68%, and 70% for LC, PFS, and OS, respectively. Univariate analysis revealed a BED of >100 Gy was associated with improved LC rates (P = 0.02, while squamous cell histology predicted for worse LC outcome at median follow up time of 13 months (P = 0.04. Increased tumor volume was a worse prognostic indicator of both LC and OS outcomes (P < 0.05. Finally, female gender was a better prognostic factor for OS than male gender (P = 0.006. There were no prognostic indicators of PFS that reached

  19. Stereotactic Body Radiation Therapy for Early-Stage Non-Small-Cell Lung Cancer: The Pattern of Failure Is Distant

    International Nuclear Information System (INIS)

    Bradley, Jeffrey D.; El Naqa, Issam; Drzymala, Robert E.; Trovo, Marco; Jones, Griffin; Denning, Mary Dee

    2010-01-01

    Background: Stereotactic body radiation therapy (SBRT) represents a substantial paradigm shift in the treatment of patients with medically inoperable Stage I/II non-small-cell lung cancer. We reviewed our experience using either three- or five-fraction SBRT for peripheral or central tumors, respectively. Methods and Materials: A total of 91 patients signed an institutional review board-approved consent form, were treated with SBRT, and have had ≥6 months of follow-up. Patients were referred for SBRT because of underlying comorbidities (poor performance status in 31 or poor lung function in 52) or refusal of surgery (8 patients). Of the cancers, 83 were peripheral and eight were central. Peripheral cancers received a mean dose of 18 Gy x three fractions. Cancers within 2 cm of the bronchus, esophagus, or brachial plexus were treated with 9 Gy x five fractions. Results: The median follow-up duration for these patients was 18 months (range, 6-42 months). TNM staging was as follows: 58 patients with T1N0M0, 22 with T2N0M0, 2 with T3N0M0 (chest wall), and 6 with T1N0M1 cancers. The median tumor diameter was 2 cm (range, 1-5 cm). The median forced expiratory volume in 1 s was 46% (range, 17-133%) and the median carbon monoxide diffusing capacity (DLCO) was 49% (range, 15-144%). Two-year local tumor control was achieved in 86% of patients. The predominant pattern of failure was the development of distant metastasis or second lung cancer. The development of distant metastasis was the only significant prognostic factor for overall survival on multivariate analysis. Conclusions: Local tumor control was shown to be high using SBRT for non-small-cell lung cancer. Overall survival is highly coerrelated with the development of distant metastasis.

  20. Guaranteed epsilon-optimal treatment plans with the minimum number of beams for stereotactic body radiation therapy

    International Nuclear Information System (INIS)

    Yarmand, Hamed; Winey, Brian; Craft, David

    2013-01-01

    Stereotactic body radiation therapy (SBRT) is characterized by delivering a high amount of dose in a short period of time. In SBRT the dose is delivered using open fields (e.g., beam’s-eye-view) known as ‘apertures’. Mathematical methods can be used for optimizing treatment planning for delivery of sufficient dose to the cancerous cells while keeping the dose to surrounding organs at risk (OARs) minimal. Two important elements of a treatment plan are quality and delivery time. Quality of a plan is measured based on the target coverage and dose to OARs. Delivery time heavily depends on the number of beams used in the plan as the setup times for different beam directions constitute a large portion of the delivery time. Therefore the ideal plan, in which all potential beams can be used, will be associated with a long impractical delivery time. We use the dose to OARs in the ideal plan to find the plan with the minimum number of beams which is guaranteed to be epsilon-optimal (i.e., a predetermined maximum deviation from the ideal plan is guaranteed). Since the treatment plan optimization is inherently a multi-criteria-optimization problem, the planner can navigate the ideal dose distribution Pareto surface and select a plan of desired target coverage versus OARs sparing, and then use the proposed technique to reduce the number of beams while guaranteeing epsilon-optimality. We use mixed integer programming (MIP) for optimization. To reduce the computation time for the resultant MIP, we use two heuristics: a beam elimination scheme and a family of heuristic cuts, known as ‘neighbor cuts’, based on the concept of ‘adjacent beams’. We show the effectiveness of the proposed technique on two clinical cases, a liver and a lung case. Based on our technique we propose an algorithm for fast generation of epsilon-optimal plans. (paper)

  1. Stereotactic body radiation therapy for low- and low-intermediate risk prostate cancer: Is there a dose effect?

    Directory of Open Access Journals (Sweden)

    Alan Jay Katz

    2011-12-01

    Full Text Available This study examines the efficacy and toxicity of two stereotactic body radiation therapy (SBRT dose regimens for treatment of early prostate cancer. Forty-one patients treated with 35 Gy were matched with 41 patients treated with 36.25 Gy. Both patient groups received SBRT in 5 fractions over 5 consecutive days using the CyberKnife. Each group had 37 low-risk patients and 4 intermediate-risk patients. No statistically significant differences were present for age, prostate volume, PSA, Gleason score, stage, or risk between the groups. The dose was prescribed to the 83-87% isodose line to cover the prostate and a 5-mm margin all around, except 3 mm posteriorly. The overall median follow-up is 51 months (range, 45-58 months with a median 54 months and 48 months follow-up for the 35-Gy and 36.25-Gy dose groups, respectively. One biochemical failure occurred in each group yielding a 97.5% freedom from biochemical failure. The PSA response has been favorable for all patients with a mean PSA of 0.1 ng/ml at 4-years. Overall toxicity has been mild with 5% late grade 2 rectal toxicity in both dose groups. Late grade 1 urinary toxicity was equivalent between groups; grade 2 urinary toxicity was 5% (2/41 patients and 10% (4/41 patients in the 35-Gy and 36.25-Gy dose groups (p = 0.6969, respectively. Overall, the highly favorable PSA response, limited biochemical failures, limited toxicity, and limited impact on quality of life in these low- to low-intermediate-risk patients are supportive of excellent long-term results for CyberKnife delivered SBRT.

  2. Stereotactic body radiation therapy with or without transarterial chemoembolization for patients with primary hepatocellular carcinoma: preliminary analysis

    Directory of Open Access Journals (Sweden)

    Yoon Seung

    2008-11-01

    Full Text Available Abstract Background The objectives of this retrospective study was to evaluate the efficacy of stereotactic body radiation therapy (SBRT for small non-resectable hepatocellular carcinoma (HCC and SBRT combined with transarterial chemoembolization (TACE for advanced HCC with portal vein tumor thrombosis (PVTT. Methods Thirty one patients with HCC who were treated with SBRT were used for the study. We studied 32 HCC lesions, where 23 lesions (22 patients were treated targeting small non-resectable primary HCC, and 9 lesions (9 patients targeting PVTT using the Cyberknife. All the 9 patients targeting PVTT received TACE for the advanced HCC. Tumor volume was 3.6–57.3 cc (median, 25.2 cc and SBRT dose was 30–39 Gy (median, 36 Gy in 3 fractions for consecutive days for 70–85% of the planned target volume. Results The median follow up was 10.5 months. The overall response rate was 71.9% [small HCC: 82.6% (19/23, advanced HCC with PVTT: 44.4% (4/9], with the complete and partial response rates of 31.3% [small HCC: 26.1% (6/23, advanced HCC with PVTT: 11.1% (1/9], and 50.0% [small HCC: 56.5% (13/23, advanced HCC with PVTT: 33.3% (3/9], respectively. The median survival period of small HCC and advanced HCC with PVTT patients was 12 months and 8 months, respectively. No patient experienced Grade 4 toxicity. Conclusion SBRT for small HCC and SBRT combined with TACE for advanced HCC with PVTT showed feasible treatment modalities with minimal side effects in selected patients with primary HCC.

  3. Towards fast online intrafraction replanning for free-breathing stereotactic body radiation therapy with the MR-linac

    Science.gov (United States)

    Kontaxis, C.; Bol, G. H.; Stemkens, B.; Glitzner, M.; Prins, F. M.; Kerkmeijer, L. G. W.; Lagendijk, J. J. W.; Raaymakers, B. W.

    2017-09-01

    The hybrid MRI-radiotherapy machines, like the MR-linac (Elekta AB, Stockholm, Sweden) installed at the UMC Utrecht (Utrecht, The Netherlands), will be able to provide real-time patient imaging during treatment. In order to take advantage of the system’s capabilities and enable online adaptive treatments, a new generation of software should be developed, ranging from motion estimation to treatment plan adaptation. In this work we present a proof of principle adaptive pipeline designed for high precision stereotactic body radiation therapy (SBRT) suitable for sites affected by respiratory motion, like renal cell carcinoma (RCC). We utilized our research MRL treatment planning system (MRLTP) to simulate a single fraction 25 Gy free-breathing SBRT treatment for RCC by performing inter-beam replanning for two patients and one volunteer. The simulated pipeline included a combination of (pre-beam) 4D-MRI and (online) 2D cine-MR acquisitions. The 4DMRI was used to generate the mid-position reference volume, while the cine-MRI, via an in-house motion model, provided three-dimensional (3D) deformable vector fields (DVFs) describing the anatomical changes during treatment. During the treatment fraction, at an inter-beam interval, the mid-position volume of the patient was updated and the delivered dose was accurately reconstructed on the underlying motion calculated by the model. Fast online replanning, targeting the latest anatomy and incorporating the previously delivered dose was then simulated with MRLTP. The adaptive treatment was compared to a conventional mid-position SBRT plan with a 3 mm planning target volume margin reconstructed on the same motion trace. We demonstrate that our system produced tighter dose distributions and thus spared the healthy tissue, while delivering more dose to the target. The pipeline was able to account for baseline variations/drifts that occurred during treatment ensuring target coverage at the end of the treatment fraction.

  4. Poster — Thur Eve — 32: Stereotactic Body Radiation Therapy for Peripheral Lung Lesion: Treatment Planning and Quality Assurance

    Energy Technology Data Exchange (ETDEWEB)

    Wan, Shuying; Oliver, Michael; Wang, Xiaofang [Northeast Cancer Centre, Health Sciences North, Sudbury, Ontario (Canada)

    2014-08-15

    Stereotactic body radiation therapy (SBRT), due to its high precision for target localizing, has become widely used to treat tumours at various locations, including the lungs. Lung SBRT program was started at our institution a year ago. Eighteen patients with peripheral lesions up to 3 cm diameter have been treated with 48 Gy in 4 fractions. Based on four-dimensional computed tomography (4DCT) simulation, internal target volume (ITV) was delineated to encompass the respiratory motion of the lesion. A margin of 5 mm was then added to create the planning target volume (PTV) for setup uncertainties. There was no expansion from gross tumour volume (GTV) to clinical target volume (CTV). Pinnacle 9.6 was used as the primary treatment planning system. Volumetric modulated arc therapy (VMAT) technique, with one or two coplanar arcs, generally worked well. For quality assurance (QA), each plan was exported to Eclipse 10 and dose calculation was repeated. Dose volume histograms (DVHs) of the targets and organs at risk (OARs) were then compared between the two treatment planning systems. Winston-Lutz tests were carried out as routine machine QA. Patient-specific QA included ArcCheck measurement with an insert, where an ionization chamber was placed at the centre to measure dose at the isocenter. For the first several patients, and subsequently for the plans with extremely strong modulation, Gafchromic film dosimetry was also employed. For each patient, a mock setup was scheduled prior to treatments. Daily pre- and post-CBCT were acquired for setup and assessment of intra-fractional motion, respectively.

  5. Preliminary investigation of stereotactic body radiation therapy for medically inoperable stage I/II non-small cell lung cancer

    International Nuclear Information System (INIS)

    Guo Jindong; Lu Changxing; Wang Jiaming; Liu Jun; Li Hongxuan; Wang Changlu; Gao Lanting; Zhao Lei

    2011-01-01

    Objective: To evaluate the therapeutic efficacy and treatment-related toxicity of stereotactic body radiation therapy (SBRT) in patients with medically inoperable stage I/II non-small cell lung cancer (NSCLC). Methods: SBRT was applied to 30 patients, including clinically staged T 1 , T 2 (≤5 cm) or T 3 (chest wall primary tumors only), N 0 , M 0 ,biopsy-confirmed NSCLC. All patients were precluded from lobotomy because of physical condition or comorbidity. No patients developed tumors of any T-stage in the proximal zone. SBRT was performed with the total dose of 50 Gy to 70 Gy in 10 - 11 fractions during 12 - 15 days. prescription line was set onthe edge of the PTV. Results: The follow-up rate was 100%. The number of patients who completed the 1-, and 2-year follow-up were 15, and 10, respectively. All 30 patients completed therapy as planned. The complete response (CR), partial response (PR) and stable disease (SD) rates were 37%, 53% and 3%, respectively. With a median follow-up of 16 months (range, 4-36 months), Kaplan-Meier local control at 2 years was 94%. The 2-year overall survival was 84% and the 2-year cancer specific survival was 90%. Seven patients(23%) developed Grade 2 pneumonitis, no grade > 2 acute or late lung toxicity was observed. No one developed chest wall pain. Conclusions: It is feasible to deliver 50 Gy to 70 Gy of SBRT in 10 - 11 fractions for medically inoperable patients with stage I / II NSCLC. It was associated with low incidence of toxicities and provided sustained local tumor control.The preliminary investigation indicated the cancer specific survival probability of SBRT was high. It is necessary to perform similar investigation in a larger number of patients with long-term follow-up. (authors)

  6. SU-E-T-551: Monitor Unit Optimization in Stereotactic Body Radiation Therapy for Stage I Lung Cancer

    International Nuclear Information System (INIS)

    Huang, B-T; Lu, J-Y

    2015-01-01

    Purpose: The study aims to reduce the monitor units (MUs) in the stereotactic body radiation therapy (SBRT) treatment for lung cancer by adjusting the optimizing parameters. Methods: Fourteen patients suffered from stage I Non-Small Cell Lung Cancer (NSCLC) were enrolled. Three groups of parameters were adjusted to investigate their effects on MU numbers and organs at risk (OARs) sparing: (1) the upper objective of planning target volume (UOPTV); (2) strength setting in the MU constraining objective; (3) max MU setting in the MU constraining objective. Results: We found that the parameters in the optimizer influenced the MU numbers in a priority, strength and max MU dependent manner. MU numbers showed a decreasing trend with the UOPTV increasing. MU numbers with low, medium and high priority for the UOPTV were 428±54, 312±48 and 258±31 MU/Gy, respectively. High priority for UOPTV also spared the heart, cord and lung while maintaining comparable PTV coverage than the low and medium priority group. It was observed that MU numbers tended to decrease with the strength increasing and max MU setting decreasing. With maximum strength, the MU numbers reached its minimum while maintaining comparable or improved dose to the normal tissues. It was also found that the MU numbers continued to decline at 85% and 75% max MU setting but no longer to decrease at 50% and 25%. Combined with high priority for UOPTV and MU constraining objectives, the MU numbers can be decreased as low as 223±26 MU/Gy. Conclusion:: The priority of UOPTV, MU constraining objective in the optimizer impact on the MU numbers in SBRT treatment for lung cancer. Giving high priority to the UOPTV, setting the strength to maximum value and the max MU to 50% in the MU objective achieves the lowest MU numbers while maintaining comparable or improved OAR sparing

  7. Quality assurance for respiratory-gated stereotactic body radiation therapy in lung using real-time position management system

    International Nuclear Information System (INIS)

    Nakaguchi, Yuji; Maruyama, Masato; Araki, Fujio; Kouno, Tomohiro

    2012-01-01

    In this study, we investigated comprehensive quality assurance (QA) for respiratory-gated stereotactic body radiation therapy (SBRT) in the lungs using a real-time position management system (RPM). By using the phantom study, we evaluated dose liberality and reproducibility, and dose distributions for low monitor unite (MU), and also checked the absorbed dose at isocenter and dose profiles for the respiratory-gated exposure using RPM. Furthermore, we evaluated isocenter dose and dose distributions for respiratory-gated SBRT plans in the lungs using RPM. The maximum errors for the dose liberality were 4% for 2 MU, 1% for 4-10 MU, and 0.5% for 15 MU and 20 MU. The dose reproducibility was 2% for 1 MU and within 0.1% for 5 MU or greater. The accuracy for dose distributions was within 2% for 2 MU or greater. The dose error along a central axis for respiratory cycles of 2, 4, and 6 sec was within 1%. As for geometric accuracy, 90% and 50% isodose areas for the respiratory-gated exposure became almost 1 mm and 2 mm larger than without gating, respectively. For clinical lung-SBRT plans, the point dose at isocenter agreed within 2.1% with treatment planning system (TPS). And the pass rates of all plans for TPS were more than 96% in the gamma analysis (3 mm/3%). The geometrical accuracy and the dose accuracy of TPS calculation algorithm are more important for the dose evaluation at penumbra region for respiratory-gated SBRT in lung using RPM. (author)

  8. Treatment Outcomes in Stage I Lung Cancer: A Comparison of Surgery and Stereotactic Body Radiation Therapy (SBRT)

    Science.gov (United States)

    Puri, Varun; Crabtree, Traves D.; Bell, Jennifer M.; Broderick, Stephen R; Morgensztern, Daniel; Colditz, Graham A.; Kreisel, Daniel; Krupnick, A. Sasha; Patterson, G. Alexander; Meyers, Bryan F.; Patel, Aalok; Robinson, Clifford G.

    2015-01-01

    Introduction The relative roles of surgery and stereotactic body radiation therapy in stage I non-small cell lung cancer (NSCLC) are evolving particularly for marginally operable patients. Since there is limited prospective comparative data for these treatment modalities, we evaluated their relative use and outcomes at the population level using a national database. Methods Patient variables and treatment-related outcomes were abstracted for patients with clinical stage I NSCLC from the National Cancer Database. Patients receiving surgery were compared to those undergoing SBRT in exploratory unmatched and subsequent propensity matched analyses. Results Between 1998 and 2010, 117618 patients underwent surgery or SBRT for clinical stage I NSCLC. Of these, 111731 (95%) received surgery while 5887 (5%) underwent SBRT. Patients in the surgery group were younger, more likely to be males, and had higher Charlson comorbidity scores. SBRT patients were more likely to have T1 (vs.T2) tumors and receive treatment at academic centers. Thirty-day surgical mortality was 2596/109485 (2.4%). Median overall survival favored the surgery group in both unmatched (68.4 months vs. 33.3 months, p<.001) and matched analysis based on patient characteristics (62.3 months vs. 33.1months, p<.001). Disease specific survival was unavailable from the dataset. Conclusion In a propensity matched comparison, patients selected for surgery have improved survival compared with SBRT. In the absence of information on cause of death and with limited variables to characterize comorbidity, it is not possible to assess the relative contribution of patient selection or better cancer control towards the improved survival. Rigorous prospective studies are needed to optimize patient selection for SBRT in the high-risk surgical population. PMID:26334753

  9. Towards fast online intrafraction replanning for free-breathing stereotactic body radiation therapy with the MR-linac.

    Science.gov (United States)

    Kontaxis, C; Bol, G H; Stemkens, B; Glitzner, M; Prins, F M; Kerkmeijer, L G W; Lagendijk, J J W; Raaymakers, B W

    2017-08-21

    The hybrid MRI-radiotherapy machines, like the MR-linac (Elekta AB, Stockholm, Sweden) installed at the UMC Utrecht (Utrecht, The Netherlands), will be able to provide real-time patient imaging during treatment. In order to take advantage of the system's capabilities and enable online adaptive treatments, a new generation of software should be developed, ranging from motion estimation to treatment plan adaptation. In this work we present a proof of principle adaptive pipeline designed for high precision stereotactic body radiation therapy (SBRT) suitable for sites affected by respiratory motion, like renal cell carcinoma (RCC). We utilized our research MRL treatment planning system (MRLTP) to simulate a single fraction 25 Gy free-breathing SBRT treatment for RCC by performing inter-beam replanning for two patients and one volunteer. The simulated pipeline included a combination of (pre-beam) 4D-MRI and (online) 2D cine-MR acquisitions. The 4DMRI was used to generate the mid-position reference volume, while the cine-MRI, via an in-house motion model, provided three-dimensional (3D) deformable vector fields (DVFs) describing the anatomical changes during treatment. During the treatment fraction, at an inter-beam interval, the mid-position volume of the patient was updated and the delivered dose was accurately reconstructed on the underlying motion calculated by the model. Fast online replanning, targeting the latest anatomy and incorporating the previously delivered dose was then simulated with MRLTP. The adaptive treatment was compared to a conventional mid-position SBRT plan with a 3 mm planning target volume margin reconstructed on the same motion trace. We demonstrate that our system produced tighter dose distributions and thus spared the healthy tissue, while delivering more dose to the target. The pipeline was able to account for baseline variations/drifts that occurred during treatment ensuring target coverage at the end of the treatment fraction.

  10. Stereotactic body radiation therapy for primary and metastatic liver tumors: A single institution phase i-ii study

    Energy Technology Data Exchange (ETDEWEB)

    Mendez Romero, Alejandra; Wunderink, Wouter [Erasmus MC - Daniel den Hoed Cancer Center, Rotterdam (Netherlands). Dept. of Radiation Oncology; Hussain, Shahid M. [Univ. of Nebraska Medical Center, Omaha, NE (US). Dept. of Radiology] (and others)

    2006-09-15

    The feasibility, toxicity and tumor response of stereotactic body radiation therapy (SBRT) for treatment of primary and metastastic liver tumors was investigated. From October 2002 until June 2006, 25 patients not suitable for other local treatments were entered in the study. In total 45 lesions were treated, 34 metastases and 11 hepatocellular carcinoma (HCC). Median follow-up was 12.9 months (range 0.5-31). Median lesion size was 3.2 cm (range 0.5-7.2) and median volume 22.2 cm{sup 3} (range 1.1-322). Patients with metastases, HCC without cirrhosis, and HCC < 4 cm with cirrhosis were mostly treated with 3x12.5 Gy. Patients with HCC =4cm and cirrhosis received 5x5 Gy or 3x10 Gy. The prescription isodose was 65%. Acute toxicity was scored following the Common Toxicity Criteria and late toxicity with the SOMA/LENT classification. Local failures were observed in two HCC and two metastases. Local control rates at 1 and 2 years for the whole group were 94% and 82%. Acute toxicity grade =3 was seen in four patients; one HCC patient with Child B developed a liver failure together with an infection and died (grade 5), two metastases patients presented elevation of gamma glutamyl transferase (grade 3) and another asthenia (grade 3). Late toxicity was observed in one metastases patient who developed a portal hypertension syndrome with melena (grade 3). SBRT was feasible, with acceptable toxicity and encouraging local control. Optimal dose-fractionation schemes for HCC with cirrhosis have to be found. Extreme caution should be used for patients with Child B because of a high toxicity risk.

  11. Stereotactic body radiation therapy with or without transarterial chemoembolization for patients with primary hepatocellular carcinoma: preliminary analysis

    International Nuclear Information System (INIS)

    Choi, Byung Ock; Choi, Ihl Bohng; Jang, Hong Seok; Kang, Young Nam; Jang, Ji Sun; Bae, Si Hyun; Yoon, Seung Kew; Chai, Gyu Young; Kang, Ki Mun

    2008-01-01

    The objectives of this retrospective study was to evaluate the efficacy of stereotactic body radiation therapy (SBRT) for small non-resectable hepatocellular carcinoma (HCC) and SBRT combined with transarterial chemoembolization (TACE) for advanced HCC with portal vein tumor thrombosis (PVTT). Thirty one patients with HCC who were treated with SBRT were used for the study. We studied 32 HCC lesions, where 23 lesions (22 patients) were treated targeting small non-resectable primary HCC, and 9 lesions (9 patients) targeting PVTT using the Cyberknife. All the 9 patients targeting PVTT received TACE for the advanced HCC. Tumor volume was 3.6–57.3 cc (median, 25.2 cc) and SBRT dose was 30–39 Gy (median, 36 Gy) in 3 fractions for consecutive days for 70–85% of the planned target volume. The median follow up was 10.5 months. The overall response rate was 71.9% [small HCC: 82.6% (19/23), advanced HCC with PVTT: 44.4% (4/9)], with the complete and partial response rates of 31.3% [small HCC: 26.1% (6/23), advanced HCC with PVTT: 11.1% (1/9)], and 50.0% [small HCC: 56.5% (13/23), advanced HCC with PVTT: 33.3% (3/9)], respectively. The median survival period of small HCC and advanced HCC with PVTT patients was 12 months and 8 months, respectively. No patient experienced Grade 4 toxicity. SBRT for small HCC and SBRT combined with TACE for advanced HCC with PVTT showed feasible treatment modalities with minimal side effects in selected patients with primary HCC

  12. Predictive factors of symptomatic radiation pneumonitis in primary and metastatic lung tumors treated with stereotactic ablative body radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kang Pyo; Lee, Jeong Shim; Cho, Yeona; Chung, Seung Yeun; Lee, Jason Joon Bock; Lee, Chang Geol; Cho, Jae Ho [Dept. of Radiation Oncology, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2017-06-15

    Although stereotactic ablative body radiotherapy (SABR) is widely used therapeutic technique, predictive factors of radiation pneumonitis (RP) after SABR remain undefined. We aimed to investigate the predictive factors affecting RP in patients with primary or metastatic lung tumors who received SABR. From 2012 to 2015, we reviewed 59 patients with 72 primary or metastatic lung tumors treated with SABR, and performed analyses of clinical and dosimetric variables related to symptomatic RP. SABR was delivered as 45–60 Gy in 3–4 fractions, which were over 100 Gy in BED when the α/β value was assumed to be 10. Tumor volume and other various dose volume factors were analyzed using median value as a cutoff value. RP was graded per the Common Terminology Criteria for Adverse Events v4.03. At the median follow-up period of 11 months, symptomatic RP was observed in 13 lesions (12 patients, 18.1%), including grade 2 RP in 11 lesions and grade 3 in 2 lesions. Patients with planning target volume (PTV) of ≤14.35 mL had significantly lower rates of symptomatic RP when compared to others (8.6% vs. 27%; p = 0.048). Rates of symptomatic RP in patients with internal gross tumor volume (iGTV) >4.21 mL were higher than with ≤4.21 mL (29.7% vs. 6.1%; p = 0.017). The incidence of symptomatic RP following treatment with SABR was acceptable with grade 2 RP being observed in most patients. iGTV over 4.21 mL and PTV of over 14.35 mL were significant predictive factors related to symptomatic RP.

  13. SU-E-T-573: Normal Tissue Dose Effect of Prescription Isodose Level Selection in Lung Stereotactic Body Radiation Therapy

    International Nuclear Information System (INIS)

    Zhang, Q; Lei, Y; Zheng, D; Zhu, X; Wahl, A; Lin, C; Zhou, S; Zhen, W

    2015-01-01

    Purpose: To evaluate dose fall-off in normal tissue for lung stereotactic body radiation therapy (SBRT) cases planned with different prescription isodose levels (IDLs), by calculating the dose dropping speed (DDS) in normal tissue on plans computed with both Pencil Beam (PB) and Monte-Carlo (MC) algorithms. Methods: The DDS was calculated on 32 plans for 8 lung SBRT patients. For each patient, 4 dynamic conformal arc plans were individually optimized for prescription isodose levels (IDL) ranging from 60% to 90% of the maximum dose with 10% increments to conformally cover the PTV. Eighty non-overlapping rind structures each of 1mm thickness were created layer by layer from each PTV surface. The average dose in each rind was calculated and fitted with a double exponential function (DEF) of the distance from the PTV surface, which models the steep- and moderate-slope portions of the average dose curve in normal tissue. The parameter characterizing the steep portion of the average dose curve in the DEF quantifies the DDS in the immediate normal tissue receiving high dose. Provided that the prescription dose covers the whole PTV, a greater DDS indicates better normal tissue sparing. The DDS were compared among plans with different prescription IDLs, for plans computed with both PB and MC algorithms. Results: For all patients, the DDS was found to be the lowest for 90% prescription IDL and reached a highest plateau region for 60% or 70% prescription. The trend was the same for both PB and MC plans. Conclusion: Among the range of prescription IDLs accepted by lung SBRT RTOG protocols, prescriptions to 60% and 70% IDLs were found to provide best normal tissue sparing

  14. Sensitivity of 3D Dose Verification to Multileaf Collimator Misalignments in Stereotactic Body Radiation Therapy of Spinal Tumor.

    Science.gov (United States)

    Xin-Ye, Ni; Ren, Lei; Yan, Hui; Yin, Fang-Fang

    2016-12-01

    This study aimed to detect the sensitivity of Delt 4 on ordinary field multileaf collimator misalignments, system misalignments, random misalignments, and misalignments caused by gravity of the multileaf collimator in stereotactic body radiation therapy. (1) Two field sizes, including 2.00 cm (X) × 6.00 cm (Y) and 7.00 cm (X) × 6.00 cm (Y), were set. The leaves of X1 and X2 in the multileaf collimator were simultaneously opened. (2) Three cases of stereotactic body radiation therapy of spinal tumor were used. The dose of the planning target volume was 1800 cGy with 3 fractions. The 4 types to be simulated included (1) the leaves of X1 and X2 in the multileaf collimator were simultaneously opened, (2) only X1 of the multileaf collimator and the unilateral leaf were opened, (3) the leaves of X1 and X2 in the multileaf collimator were randomly opened, and (4) gravity effect was simulated. The leaves of X1 and X2 in the multileaf collimator shifted to the same direction. The difference between the corresponding 3-dimensional dose distribution measured by Delt 4 and the dose distribution in the original plan made in the treatment planning system was analyzed with γ index criteria of 3.0 mm/3.0%, 2.5 mm/2.5%, 2.0 mm/2.0%, 2.5 mm/1.5%, and 1.0 mm/1.0%. (1) In the field size of 2.00 cm (X) × 6.00 cm (Y), the γ pass rate of the original was 100% with 2.5 mm/2.5% as the statistical standard. The pass rate decreased to 95.9% and 89.4% when the X1 and X2 directions of the multileaf collimator were opened within 0.3 and 0.5 mm, respectively. In the field size of 7.00 (X) cm × 6.00 (Y) cm with 1.5 mm/1.5% as the statistical standard, the pass rate of the original was 96.5%. After X1 and X2 of the multileaf collimator were opened within 0.3 mm, the pass rate decreased to lower than 95%. The pass rate was higher than 90% within the 3 mm opening. (2) For spinal tumor, the change in the planning target volume V 18 under various modes calculated using treatment planning system

  15. Dosimetric analysis of varying cord planning organ at risk volume in spine stereotactic body radiation therapy

    Directory of Open Access Journals (Sweden)

    Dawn Owen, MD, PhD

    2016-01-01

    Conclusion: Current guidelines may overestimate the risk of myelopathy from spine SBRT. The current study's population included both radiation-naïve and retreatment cases, but no myelopathy was observed despite exceeding recommended spine limits.

  16. Characterization of 3D printing techniques: Toward patient specific quality assurance spine-shaped phantom for stereotactic body radiation therapy.

    Directory of Open Access Journals (Sweden)

    Min-Joo Kim

    Full Text Available Development and comparison of spine-shaped phantoms generated by two different 3D-printing technologies, digital light processing (DLP and Polyjet has been purposed to utilize in patient-specific quality assurance (QA of stereotactic body radiation treatment. The developed 3D-printed spine QA phantom consisted of an acrylic body phantom and a 3D-printed spine shaped object. DLP and Polyjet 3D printers using a high-density acrylic polymer were employed to produce spine-shaped phantoms based on CT images. Image fusion was performed to evaluate the reproducibility of our phantom, and the Hounsfield units (HUs were measured based on each CT image. Two different intensity-modulated radiotherapy plans based on both CT phantom image sets from the two printed spine-shaped phantoms with acrylic body phantoms were designed to deliver 16 Gy dose to the planning target volume (PTV and were compared for target coverage and normal organ-sparing. Image fusion demonstrated good reproducibility of the developed phantom. The HU values of the DLP- and Polyjet-printed spine vertebrae differed by 54.3 on average. The PTV Dmax dose for the DLP-generated phantom was about 1.488 Gy higher than that for the Polyjet-generated phantom. The organs at risk received a lower dose for the 3D printed spine-shaped phantom image using the DLP technique than for the phantom image using the Polyjet technique. Despite using the same material for printing the spine-shaped phantom, these phantoms generated by different 3D printing techniques, DLP and Polyjet, showed different HU values and these differently appearing HU values according to the printing technique could be an extra consideration for developing the 3D printed spine-shaped phantom depending on the patient's age and the density of the spinal bone. Therefore, the 3D printing technique and materials should be carefully chosen by taking into account the condition of the patient in order to accurately produce 3D printed

  17. Characterization of 3D printing techniques: Toward patient specific quality assurance spine-shaped phantom for stereotactic body radiation therapy.

    Science.gov (United States)

    Kim, Min-Joo; Lee, Seu-Ran; Lee, Min-Young; Sohn, Jason W; Yun, Hyong Geon; Choi, Joon Yong; Jeon, Sang Won; Suh, Tae Suk

    2017-01-01

    Development and comparison of spine-shaped phantoms generated by two different 3D-printing technologies, digital light processing (DLP) and Polyjet has been purposed to utilize in patient-specific quality assurance (QA) of stereotactic body radiation treatment. The developed 3D-printed spine QA phantom consisted of an acrylic body phantom and a 3D-printed spine shaped object. DLP and Polyjet 3D printers using a high-density acrylic polymer were employed to produce spine-shaped phantoms based on CT images. Image fusion was performed to evaluate the reproducibility of our phantom, and the Hounsfield units (HUs) were measured based on each CT image. Two different intensity-modulated radiotherapy plans based on both CT phantom image sets from the two printed spine-shaped phantoms with acrylic body phantoms were designed to deliver 16 Gy dose to the planning target volume (PTV) and were compared for target coverage and normal organ-sparing. Image fusion demonstrated good reproducibility of the developed phantom. The HU values of the DLP- and Polyjet-printed spine vertebrae differed by 54.3 on average. The PTV Dmax dose for the DLP-generated phantom was about 1.488 Gy higher than that for the Polyjet-generated phantom. The organs at risk received a lower dose for the 3D printed spine-shaped phantom image using the DLP technique than for the phantom image using the Polyjet technique. Despite using the same material for printing the spine-shaped phantom, these phantoms generated by different 3D printing techniques, DLP and Polyjet, showed different HU values and these differently appearing HU values according to the printing technique could be an extra consideration for developing the 3D printed spine-shaped phantom depending on the patient's age and the density of the spinal bone. Therefore, the 3D printing technique and materials should be carefully chosen by taking into account the condition of the patient in order to accurately produce 3D printed patient-specific QA

  18. One- vs. Three-Fraction Pancreatic Stereotactic Body Radiation Therapy for Pancreatic Carcinoma: Single Institution Retrospective Review

    Directory of Open Access Journals (Sweden)

    Philip Anthony Sutera

    2017-11-01

    Full Text Available Background/introductionEarly reports of stereotactic body radiation therapy (SBRT for pancreatic ductal adenocarcinoma (PDAC used single fraction, but eventually shifted to multifraction regimens. We conducted a single institution review of our patients treated with single- or multifraction SBRT to determine whether any outcome differences existed.Methods and materialsPatients treated with SBRT in any setting for PDAC at our facility were included, from 2004 to 2014. Overall survival (OS, local control (LC, regional control (RC, distant metastasis (DM, and late grade 3 or greater radiation toxicities from the time of SBRT were calculated using Kaplan–Meier estimation to either the date of last follow-up/death or local/regional/distant failure.ResultsWe identified 289 patients (291 lesions with pathologically confirmed PDAC. Median age was 69 (range, 33–90 years. Median gross tumor volume was 12.3 (8.6–21.3 cm3 and planning target volume 17.9 (12–27 cm3. Single fraction was used in 90 (30.9% and multifraction in 201 (69.1% lesions. At a median follow-up of 17.3 months (IQR 10.1–29.3 months, the median survival for the entire cohort 17.8 months with a 2-year OS of 35.3%. Univariate analysis showed multifraction schemes to have a higher 2-year OS 30.5% vs. 37.5% (p = 0.019, it did not hold significance on MVA. Multifractionation schemes were found to have a higher LC on MVA (HR = 0.53, 95% CI, 0.33–0.85, p = 0.009. At 2 years, late grade 3+ toxicity was 2.5%. Post-SBRT CA19-9 was found on MVA to be a prognostic factor for OS (HR = 1.01, 95% CI, 1.01–1.01, p = 0.009, RC (HR = 1.01, 95% CI 1.01–1.01, p = 0.02, and DM (HR = 1.01, 95% CI, 1.01–1.01, p = 0.001.ConclusionOur single institution retrospective review is the largest to date comparing single and multifraction SBRT and the first to show multifraction regimen SBRT to have a higher LC than single fractionation. Additionally, we

  19. Utilization of Patient-Reported Outcomes to Guide Symptom Management during Stereotactic Body Radiation Therapy for Clinically Localized Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Malika Danner

    2017-10-01

    Full Text Available IntroductionUtilization of patient-reported outcomes (PROs to guide symptom management during radiation therapy is increasing. This study focuses on the use of the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP as a tool to assess urinary and bowel bother during stereotactic body radiation therapy (SBRT and its utility in guiding medical management.MethodsBetween September 2015 and January 2017, 107 patients with clinically localized prostate cancer were treated with 35–36.25 Gy via SBRT in five fractions. PROs were assessed using EPIC-CP 1 h prior to the first fraction and after each subsequent fraction. Symptom management medications were prescribed based on the physician clinical judgment or if patients reported a moderate to big problem. Clinical significance was assessed using a minimally important difference of 1/2 SD from baseline score.ResultsA median baseline EPIC-CP urinary symptom score of 1.5 significantly increased to 3.7 on the day of the final treatment (p < 0.0001. Prior to treatment, 9.3% of men felt that their overall urinary function was a moderate to big problem that increased to 28% by the end of the fifth treatment. A median baseline EPIC-CP bowel symptom score of 0.3 significantly increased to 1.4 on the day of the final treatment (p < 0.0001. Prior to treatment, 1.9% of men felt that their overall bowel function was a moderate to big problem that increased to 3.7% by the end of the fifth treatment. The percentage of patients requiring an increased dose of alpha-antagonist increased to 47% by the end of treatment, and an additional 28% of patients required a short steroid taper to manage moderate to big urinary problems. Similarly, the percentage of patients requiring antidiarrheals reached 12% by the fifth treatment.ConclusionDuring the course of SBRT, an increasing percentage of patients experienced clinically significant symptoms many of which required medical management

  20. WE-F-304-01: Overview of the Working Group On Stereotactic Body Radiation Therapy (WGSBRT)

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    Yorke, E. [Memorial Sloan-Kettering Cancer Center (United States)

    2015-06-15

    Stereotactic Body Radiation Therapy (SBRT) was introduced clinically more than twenty years ago, and many subsequent publications have reported safety and efficacy data. The AAPM Working Group on Biological Effects of Hypofractionated Radiotherapy/SBRT (WGSBRT) extracted published treatment outcomes data from extensive literature searches to summarize and construct tumor control probability (TCP) and normal tissue complication probability (NTCP) models for six anatomical regions: Cranial, Head and Neck, Thoracic, Abdominal, Pelvic, and Spinal. In this session, we present the WGSBRT’s work for cranial sites, and recurrent head and neck cancer. From literature-based data and associated models, guidelines to aid with safe and effective hypofractionated radiotherapy treatment are being determined. Further, the ability of existing and proposed radiobiological models to fit these data is considered as to the ability to distinguish between the linear-quadratic and alternative radiobiological models such as secondary cell death from vascular damage, immunogenic, or bystander effects. Where appropriate, specific model parameters are estimated. As described in “The lessons of QUANTEC,” (1), lack of adequate reporting standards continues to limit the amount of useful quantitative information that can be extracted from peer-reviewed publications. Recommendations regarding reporting standards are considered, to enable such reviews to achieve more complete characterization of clinical outcomes. 1 Jackson A, Marks LB, Bentzen SM, Eisbruch A, Yorke ED, Ten Haken RK, Constine LS, Deasy JO. The lessons of QUANTEC: recommendations for reporting and gathering data on dose-volume dependencies of treatment outcome. Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3 Suppl):S155–60. Learning Objectives: Describe the techniques, types of cancer and dose schedules used in treating recurrent H&N cancers with SBRT List the radiobiological models that compete with the linear-quadratic model

  1. WE-F-304-01: Overview of the Working Group On Stereotactic Body Radiation Therapy (WGSBRT)

    International Nuclear Information System (INIS)

    Yorke, E.

    2015-01-01

    Stereotactic Body Radiation Therapy (SBRT) was introduced clinically more than twenty years ago, and many subsequent publications have reported safety and efficacy data. The AAPM Working Group on Biological Effects of Hypofractionated Radiotherapy/SBRT (WGSBRT) extracted published treatment outcomes data from extensive literature searches to summarize and construct tumor control probability (TCP) and normal tissue complication probability (NTCP) models for six anatomical regions: Cranial, Head and Neck, Thoracic, Abdominal, Pelvic, and Spinal. In this session, we present the WGSBRT’s work for cranial sites, and recurrent head and neck cancer. From literature-based data and associated models, guidelines to aid with safe and effective hypofractionated radiotherapy treatment are being determined. Further, the ability of existing and proposed radiobiological models to fit these data is considered as to the ability to distinguish between the linear-quadratic and alternative radiobiological models such as secondary cell death from vascular damage, immunogenic, or bystander effects. Where appropriate, specific model parameters are estimated. As described in “The lessons of QUANTEC,” (1), lack of adequate reporting standards continues to limit the amount of useful quantitative information that can be extracted from peer-reviewed publications. Recommendations regarding reporting standards are considered, to enable such reviews to achieve more complete characterization of clinical outcomes. 1 Jackson A, Marks LB, Bentzen SM, Eisbruch A, Yorke ED, Ten Haken RK, Constine LS, Deasy JO. The lessons of QUANTEC: recommendations for reporting and gathering data on dose-volume dependencies of treatment outcome. Int J Radiat Oncol Biol Phys. 2010 Mar 1;76(3 Suppl):S155–60. Learning Objectives: Describe the techniques, types of cancer and dose schedules used in treating recurrent H&N cancers with SBRT List the radiobiological models that compete with the linear-quadratic model

  2. Continuous Positive Airway Pressure for Motion Management in Stereotactic Body Radiation Therapy to the Lung: A Controlled Pilot Study

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    Goldstein, Jeffrey D. [Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv (Israel); Lawrence, Yaacov R. [Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv (Israel); Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel); Appel, Sarit; Landau, Efrat; Ben-David, Merav A.; Rabin, Tatiana; Benayun, Maoz; Dubinski, Sergey; Weizman, Noam; Alezra, Dror; Gnessin, Hila; Goldstein, Adam M.; Baidun, Khader [Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv (Israel); Segel, Michael J.; Peled, Nir [Department of Pulmonary Medicine, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv (Israel); Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel); Symon, Zvi, E-mail: symonz@sheba.health.gov.il [Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Tel Aviv (Israel); Sackler School of Medicine, Tel Aviv University, Tel Aviv (Israel)

    2015-10-01

    Objective: To determine the effect of continuous positive airway pressure (CPAP) on tumor motion, lung volume, and dose to critical organs in patients receiving stereotactic body radiation therapy (SBRT) for lung tumors. Methods and Materials: After institutional review board approval in December 2013, patients with primary or secondary lung tumors referred for SBRT underwent 4-dimensional computed tomographic simulation twice: with free breathing and with CPAP. Tumor excursion was calculated by subtracting the vector of the greatest dimension of the gross tumor volume (GTV) from the internal target volume (ITV). Volumetric and dosimetric determinations were compared with the Wilcoxon signed-rank test. CPAP was used during treatment if judged beneficial. Results: CPAP was tolerated well in 10 of the 11 patients enrolled. Ten patients with 18 lesions were evaluated. The use of CPAP decreased tumor excursion by 0.5 ± 0.8 cm, 0.4 ± 0.7 cm, and 0.6 ± 0.8 cm in the superior–inferior, right–left, and anterior–posterior planes, respectively (P≤.02). Relative to free breathing, the mean ITV reduction was 27% (95% confidence interval [CI] 16%-39%, P<.001). CPAP significantly augmented lung volume, with a mean absolute increase of 915 ± 432 cm{sup 3} and a relative increase of 32% (95% CI 21%-42%, P=.003), contributing to a 22% relative reduction (95% CI 13%-32%, P=.001) in mean lung dose. The use of CPAP was also associated with a relative reduction in mean heart dose by 29% (95% CI 23%-36%, P=.001). Conclusion: In this pilot study, CPAP significantly reduced lung tumor motion compared with free breathing. The smaller ITV, the planning target volume (PTV), and the increase in total lung volume associated with CPAP contributed to a reduction in lung and heart dose. CPAP was well tolerated, reproducible, and simple to implement in the treatment room and should be evaluated further as a novel strategy for motion management in radiation therapy.

  3. Continuous Positive Airway Pressure for Motion Management in Stereotactic Body Radiation Therapy to the Lung: A Controlled Pilot Study

    International Nuclear Information System (INIS)

    Goldstein, Jeffrey D.; Lawrence, Yaacov R.; Appel, Sarit; Landau, Efrat; Ben-David, Merav A.; Rabin, Tatiana; Benayun, Maoz; Dubinski, Sergey; Weizman, Noam; Alezra, Dror; Gnessin, Hila; Goldstein, Adam M.; Baidun, Khader; Segel, Michael J.; Peled, Nir; Symon, Zvi

    2015-01-01

    Objective: To determine the effect of continuous positive airway pressure (CPAP) on tumor motion, lung volume, and dose to critical organs in patients receiving stereotactic body radiation therapy (SBRT) for lung tumors. Methods and Materials: After institutional review board approval in December 2013, patients with primary or secondary lung tumors referred for SBRT underwent 4-dimensional computed tomographic simulation twice: with free breathing and with CPAP. Tumor excursion was calculated by subtracting the vector of the greatest dimension of the gross tumor volume (GTV) from the internal target volume (ITV). Volumetric and dosimetric determinations were compared with the Wilcoxon signed-rank test. CPAP was used during treatment if judged beneficial. Results: CPAP was tolerated well in 10 of the 11 patients enrolled. Ten patients with 18 lesions were evaluated. The use of CPAP decreased tumor excursion by 0.5 ± 0.8 cm, 0.4 ± 0.7 cm, and 0.6 ± 0.8 cm in the superior–inferior, right–left, and anterior–posterior planes, respectively (P≤.02). Relative to free breathing, the mean ITV reduction was 27% (95% confidence interval [CI] 16%-39%, P<.001). CPAP significantly augmented lung volume, with a mean absolute increase of 915 ± 432 cm 3 and a relative increase of 32% (95% CI 21%-42%, P=.003), contributing to a 22% relative reduction (95% CI 13%-32%, P=.001) in mean lung dose. The use of CPAP was also associated with a relative reduction in mean heart dose by 29% (95% CI 23%-36%, P=.001). Conclusion: In this pilot study, CPAP significantly reduced lung tumor motion compared with free breathing. The smaller ITV, the planning target volume (PTV), and the increase in total lung volume associated with CPAP contributed to a reduction in lung and heart dose. CPAP was well tolerated, reproducible, and simple to implement in the treatment room and should be evaluated further as a novel strategy for motion management in radiation therapy

  4. Stereotactic body radiation therapy for liver metastases from colorectal cancer: analysis of safety, feasibility, and early outcomes

    Directory of Open Access Journals (Sweden)

    Marie-Adele Sorel Kress

    2012-02-01

    Full Text Available Introduction: Colorectal cancer (CRC is the 3rd leading cause of cancer-related death in the U.S. Many patients with CRC develop hepatic metastases as the sole site of metastases. Historical treatment options were limited to resection or conventional radiation therapy. Stereotactic body radiation therapy (SBRT has emerged as a rational treatment approach. This study reviews our experience with SBRT for patients with liver metastases from CRC.Material and Methods: Fourteen histologically confirmed hepatic CRC metastases in 11 consecutive patients were identified between November, 2004 and June, 2009 at Georgetown University. All patients underwent CT-based treatment planning; a few also had MRI or PET/CT. All patients had fiducial markers placed under CT guidance and were treated using the CyberKnife system. Treatment response and toxicities were examined; survival and local control were evaluated.Results: Most patients were treated to a single hepatic lesion (n=8, with a few treated to 2 lesions (n=3. Median treatment volume was 99.7 cm3, and lesions were treated to a median BED10 of 49.7 Gy (range: 28 – 100.8 Gy. Median follow-up was 21 months; median survival was 16.1 months, with 2-year actuarial survival of 25.7%. One-year local control was 72%. Among patients with post-treatment imaging, 8 had stable disease (80% and 2 had progressive disease (20% at first follow-up. The most common grade 1-2 acute toxicities included nausea and alterations in liver function tests; there was one grade 3 toxicity (elevated bilirubin, and no grade 4-5 toxicities.Discussion: SBRT is safe and feasible for the treatment of limited hepatic metastases from CRC. Our results compare favorably with outcomes from previous studies of SBRT. Further studies are needed to better define patient eligibility, study the role of combined modality treatment, optimize treatment parameters, and characterize quality of life after treatment.

  5. Local Control and Toxicity in a Large Cohort of Central Lung Tumors Treated With Stereotactic Body Radiation Therapy

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    Modh, Ankit; Rimner, Andreas [Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Williams, Eric [Department of Medical Physics Memorial Sloan Kettering Cancer Center, New York, New York (United States); Foster, Amanda; Shah, Mihir [Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Shi, Weiji; Zhang, Zhigang [Department of Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Gelblum, Daphna Y. [Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Rosenzweig, Kenneth E. [Department of Radiation Oncology, Mount Sinai Medical Center, New York, New York (United States); Yorke, Ellen D.; Jackson, Andrew [Department of Medical Physics Memorial Sloan Kettering Cancer Center, New York, New York (United States); Wu, Abraham J., E-mail: wua@mskcc.org [Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (United States)

    2014-12-01

    Purpose: Stereotactic body radiation therapy (SBRT) in central lung tumors has been associated with higher rates of severe toxicity. We sought to evaluate toxicity and local control in a large cohort and to identify predictive dosimetric parameters. Methods and Materials: We identified patients who received SBRT for central tumors according to either of 2 definitions. Local failure (LF) was estimated using a competing risks model, and multivariate analysis (MVA) was used to assess factors associated with LF. We reviewed patient toxicity and applied Cox proportional hazard analysis and log-rank tests to assess whether dose-volume metrics of normal structures correlated with pulmonary toxicity. Results: One hundred twenty-five patients received SBRT for non-small cell lung cancer (n=103) or metastatic lesions (n=22), using intensity modulated radiation therapy. The most common dose was 45 Gy in 5 fractions. Median follow-up was 17.4 months. Incidence of toxicity ≥ grade 3 was 8.0%, including 5.6% pulmonary toxicity. Sixteen patients (12.8%) experienced esophageal toxicity ≥ grade 2, including 50% of patients in whom PTV overlapped the esophagus. There were 2 treatment-related deaths. Among patients receiving biologically effective dose (BED) ≥80 Gy (n=108), 2-year LF was 21%. On MVA, gross tumor volume (GTV) was significantly associated with LF. None of the studied dose-volume metrics of the lungs, heart, proximal bronchial tree (PBT), or 2 cm expansion of the PBT (“no-fly-zone” [NFZ]) correlated with pulmonary toxicity ≥grade 2. There were no differences in pulmonary toxicity between central tumors located inside the NFZ and those outside the NFZ but with planning target volume (PTV) intersecting the mediastinum. Conclusions: Using moderate doses, SBRT for central lung tumors achieves acceptable local control with low rates of severe toxicity. Dosimetric analysis showed no significant correlation between dose to the lungs, heart, or NFZ and

  6. Toxicity After Central versus Peripheral Lung Stereotactic Body Radiation Therapy: A Propensity Score Matched-Pair Analysis

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    Mangona, Victor S. [Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan (United States); Aneese, Andrew M. [Oakland University William Beaumont School of Medicine, Rochester, Michigan (United States); Marina, Ovidiu; Hymas, Richard V. [Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan (United States); Ionascu, Dan; Robertson, John M. [Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan (United States); Oakland University William Beaumont School of Medicine, Rochester, Michigan (United States); Gallardo, Lori J. [Oakland University William Beaumont School of Medicine, Rochester, Michigan (United States); Department of Radiology, Beaumont Health System, Royal Oak, Michigan (United States); Grills, Inga Siiner, E-mail: igrills@beaumont.edu [Department of Radiation Oncology, Beaumont Health System, Royal Oak, Michigan (United States); Oakland University William Beaumont School of Medicine, Rochester, Michigan (United States)

    2015-01-01

    Purpose: To compare toxicity after stereotactic body radiation therapy (SBRT) for “central” tumors—within 2 cm of the proximal bronchial tree or with planning tumor volume (PTV) touching mediastinum—versus noncentral (“peripheral”) lung tumors. Methods and Materials: From November 2005 to January 2011, 229 tumors (110 central, 119 peripheral; T1-3N0M0 non–small-cell lung cancer and limited lung metastases) in 196 consecutive patients followed prospectively at a single institution received moderate-dose SBRT (48-60 Gy in 4-5 fractions [biologic effective dose=100-132 Gy, α/β=10]) using 4-dimensional planning, online image-guided radiation therapy, and institutional dose constraints. Clinical adverse events (AEs) were graded prospectively at clinical and radiographic follow-up using Common Terminology Criteria for Adverse Events version 3.0. Pulmonary function test (PFT) decline was graded as 2 (25%-49.9% decline), 3 (50.0%-74.9% decline), or 4 (≥75.0% decline). Central/peripheral location was assessed retrospectively on planning CT scans. Groups were compared after propensity score matching. Characteristics were compared with χ{sup 2} and 2-tailed t tests, adverse events with χ{sup 2} test-for-trend, and cumulative incidence using competing risks analysis (Gray's test). Results: With 79 central and 79 peripheral tumors matched, no differences in AEs were observed after 17 months median follow-up. Two-year cumulative incidences of grade ≥2 pain, musculoskeletal, pulmonary, and skin AEs were 14%, 5%, 6%, and 10% (central) versus 19%, 10%, 10%, and 3% (peripheral), respectively (P=.31, .38, .70, and .09). Grade ≥2 cardiovascular, gastrointestinal, and central nervous system AEs were rare (<1%). Two-year incidences of grade ≥2 clinical AEs (28% vs 25%, P=.79), grade ≥2 PFT decline (36% vs 34%, P=.94), grade ≥3 clinical AEs (3% vs 7%, P=.48), and grade ≥3 PFT decline (0 vs 10%, P=.11) were similar for central versus peripheral

  7. Local Hypothermia as a Radioprotector of the Rectal Wall During Prostate Stereotactic Body Radiation Therapy

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    Hrycushko, Brian A., E-mail: Brian.Hrycushko@utsouthwestern.edu [Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas (United States); Chopra, Rajiv [Department of Radiology, UT Southwestern Medical Center, Dallas, Texas (United States); Sayre, James W. [Department of Biostatistics, University of California, Los Angeles, Los Angeles, California (United States); Department of Radiology, University of California, Los Angeles, Los Angeles, California (United States); Richardson, James A. [Department of Pathology, UT Southwestern Medical Center, Dallas, Texas (United States); Department of Molecular Biology, UT Southwestern Medical Center, Dallas, Texas (United States); Folkert, Michael R.; Timmerman, Robert D.; Medin, Paul M. [Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas (United States)

    2017-05-01

    Purpose: To compare the single-fraction dose-related incidence of rectal obstruction and/or bleeding in normothermic and hypothermic rectums of a rat model. Methods and Materials: A 1.9-cm length of rectum was irradiated with a single fraction in 57 Sprague-Dawley rats using a dedicated image-guided small animal irradiator and Monte Carlo–based treatment planning system. All rats had a rectal temperature control apparatus placed during irradiation and were stratified to achieve either a normothermic (37°C) or hypothermic (15°C) rectal wall temperature. Radiation was delivered to a 1-cm-diameter cylindrical volume about the cooling device and rectal wall. The radiation dose was escalated from 16 Gy up to 37 Gy to assess the dose response in each arm. The primary endpoint of this study was rectal obstruction and/or bleeding during a follow-up of 180 to 186 days. Histologic scoring was performed on all study rats. Results: Probit analysis showed a dose associated with a 50% incidence of rectal obstruction of 24.6 Gy and 40.8 Gy for normothermic and hypothermic arms, respectively. The occurrence of obstruction and/or bleeding correlated with the posttreatment histologic score for normothermic rats; however, there was no difference in histologic score between normothermic and hypothermic rats at the highest dose levels evaluated. Conclusions: A significant radioprotective effect was observed using local hypothermia during a single large dose of radiation for the functional endpoint of rectal obstruction and/or bleeding. A confirmatory study in a large animal model with anatomic and physiologic similarities to humans is suggested.

  8. Local Hypothermia as a Radioprotector of the Rectal Wall During Prostate Stereotactic Body Radiation Therapy

    International Nuclear Information System (INIS)

    Hrycushko, Brian A.; Chopra, Rajiv; Sayre, James W.; Richardson, James A.; Folkert, Michael R.; Timmerman, Robert D.; Medin, Paul M.

    2017-01-01

    Purpose: To compare the single-fraction dose-related incidence of rectal obstruction and/or bleeding in normothermic and hypothermic rectums of a rat model. Methods and Materials: A 1.9-cm length of rectum was irradiated with a single fraction in 57 Sprague-Dawley rats using a dedicated image-guided small animal irradiator and Monte Carlo–based treatment planning system. All rats had a rectal temperature control apparatus placed during irradiation and were stratified to achieve either a normothermic (37°C) or hypothermic (15°C) rectal wall temperature. Radiation was delivered to a 1-cm-diameter cylindrical volume about the cooling device and rectal wall. The radiation dose was escalated from 16 Gy up to 37 Gy to assess the dose response in each arm. The primary endpoint of this study was rectal obstruction and/or bleeding during a follow-up of 180 to 186 days. Histologic scoring was performed on all study rats. Results: Probit analysis showed a dose associated with a 50% incidence of rectal obstruction of 24.6 Gy and 40.8 Gy for normothermic and hypothermic arms, respectively. The occurrence of obstruction and/or bleeding correlated with the posttreatment histologic score for normothermic rats; however, there was no difference in histologic score between normothermic and hypothermic rats at the highest dose levels evaluated. Conclusions: A significant radioprotective effect was observed using local hypothermia during a single large dose of radiation for the functional endpoint of rectal obstruction and/or bleeding. A confirmatory study in a large animal model with anatomic and physiologic similarities to humans is suggested.

  9. SU-E-P-40: Dosimetric Characteristics of Field Aperture Margin Design in Stereotactic Body Radiation Therapy (SBRT)

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    Zhu, J

    2015-06-15

    Purpose: To characterize the dosimetric effects of field aperture margin design in Stereotactic Body Radiation Therapy (SBRT). Methods: Three artificial spherical PTVs, with diameter of 10mm, 20mm and 30mm, were created on CT images of a human body thoracic phantom. Seven non-coplanar isocentric fields were used for treatment planning. For each PTV, treatment plans with margins 0mm, 1mm, 2mm and 3mm were planned. Dosimetric comparison among plans was done considering the following parameters: prescribed isodose line for target coverage, maximum dose, mean dose as well as dose spillages of V80, V50, and V20. Results: Corresponding to aperture margins of 0mm, 1mm,2m and 3mm used in the treatment planning, the percentage of isodose line chosen for dose prescription increases from 65% to 93% for 10mm PTV, 70% to 92% for 20mm PTV, and 75% to 92% for 30mm PTV. The maximum dose decrease accordingly from 155.7% to 109.5% for 10mm PTV, 145% to 111.6% for 20mm PTV, 137% to 112.2% for 30mm PTV. The mean dose decrease from 138.% to 104.4% for 10mm PTV, 122.8% to 106.1% for 20mm PTV, 121.3% to 106% for 30mm PTV. Dose spillages (mm3) increase (V80−2.6 to 4.02, V50−4.55 to 9.3, V20–87.86 to 101.71) for 10 mm PTV, (V80−6.78 to 9.89, V50–13.46 to 20.4, V20-119.16 to 219.1) for 20 mm PTV, (V80–22.01 to 28.59, V50–41.56 to 52.66, V20-532.71 to 551.84) for 30 mm PTV. Conclusion: In SBRT treatment planning, tight field aperture margin requires prescribing dose to lower isodose line that leading to higher dose inhomogeneity and higher mean dose to PTV. Loose margin allows prescribing dose to higher isodose line, therefore improves the dose homogeneity. However, it increases dose spillages. Clinician could try different margins according to the PTV size and location of surrounding critical organs to optimize the dose delivered to the patient.

  10. Stereotactic Body Radiation Therapy for Prostate Cancer: What is the Appropriate Patient-Reported Outcome for Clinical Trial Design?

    Directory of Open Access Journals (Sweden)

    Jennifer Ai-Lian Woo

    2015-03-01

    Full Text Available Purpose: Stereotactic body radiation therapy (SBRT is increasingly utilized as primary treatment for clinically localized prostate cancer. Consensus regarding the appropriate patient-reported outcome (PRO endpoints for clinical trials for early stage prostate cancer RT is lacking. To aid in trial design, this study presents PROs over 36 months following SBRT for clinically localized prostate cancer. Methods: 174 hormone-naïve patients were treated with 35-36.25 Gy SBRT in 5 fractions. Patients completed the EPIC-26 questionnaire at baseline and all follow-ups; the proportion of patients developing a clinically significant decline in each EPIC domain was determined. The minimally important difference (MID was defined as a change of one-half SD from the baseline. Per RTOG 0938, we examined the percentage of patients who reported decline in EPIC urinary summary score of >2 points and EPIC bowel summary score of >5 points from baseline to one year. Results: 174 patients received SBRT with minimum follow-up of 36 months. The proportion of patients reporting a clinically significant decline in EPIC urinary/bowel scores was 34%/30%, 40%/32.2%, and 32.8%/21.5% at 6, 12, and 36 months. The percentage of patients reporting decline in the EPIC urinary summary score of >2 points was 43.2%, 51.6% and 41.8% at 6, 12, and 36 months. The percentage of patients reporting decline in EPIC bowel domain summary score of >5 points was 29.6% 29% and 22.4% at 6, 12, and 36 months. Conclusion: Our treatment protocol meets the RTOG 0938 criteria for advancing to a Phase III trial compared to conventionally fractionated RT. Between 12-36 months, the proportion of patients reporting decrease in both EPIC urinary and bowel scores declined, suggesting late improvement in these domains. Further investigation is needed to elucidate 1 which domains bear the greatest influence on post-treatment QOL, and 2 at what time point PRO endpoint(s should be assessed.

  11. Interrater Reliability of the Categorization of Late Radiographic Changes After Lung Stereotactic Body Radiation Therapy

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    Faruqi, Salman [Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON (Canada); Giuliani, Meredith E., E-mail: meredith.giuliani@rmp.uhn.on.ca [Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON (Canada); Raziee, Hamid; Yap, Mei Ling [Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON (Canada); Roberts, Heidi [Department of Radiology, University Health Network, Toronto, Ontario (Canada); Le, Lisa W. [Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Brade, Anthony; Cho, John; Sun, Alexander; Bezjak, Andrea; Hope, Andrew J. [Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON (Canada)

    2014-08-01

    Purpose: Radiographic changes after lung stereotactic body radiation therapy (SBRT) have been categorized into 4 groups: modified conventional pattern (A), mass-like fibrosis; (B), scar-like fibrosis (C), and no evidence of increased density (D). The purpose of this study was to assess the interrater reliability of this categorization system in patients with early-stage non-small cell lung cancer (NSCLC). Methods and Materials: Seventy-seven patients were included in this study, all treated with SBRT for early-stage (T1/2) NSCLC at a single institution, with a minimum follow-up of 6 months. Six experienced clinicians familiar with post-SBRT radiographic changes scored the serial posttreatment CT images independently in a blinded fashion. The proportion of patients categorized as A, B, C, or D at each interval was determined. Krippendorff's alpha (KA), Multirater kappa (M-kappa), and Gwet's AC1 (AC1) scores were used to establish interrater reliability. A leave-one-out analysis was performed to demonstrate the variability among raters. Interrater agreement of the first and last 20 patients scored was calculated to explore whether a training effect existed. Results: The number of ratings ranged from 450 at 6 months to 84 at 48 months of follow-up. The proportion of patients in each category was as follows: A, 45%; B, 16%; C, 13%; and D, 26%. KA and M-kappa ranged from 0.17 to 0.34. AC1 measure range was 0.22 to 0.48. KA increased from 0.24 to 0.36 at 12 months with training. The percent agreement for pattern A peaked at 12 month with a 54% chance of having >50% raters in agreement and decreased over time, whereas that for patterns B and C increased over time to a maximum of 20% and 22%, respectively. Conclusion: This post-SBRT radiographic change categorization system has modest interrater agreement, and there is a suggestion of a training effect. Patterns of fibrosis evolve after SBRT and alternative categorization systems should be evaluated.

  12. Stereotactic Body Radiation Therapy for Locally Advanced and Borderline Resectable Pancreatic Cancer Is Effective and Well Tolerated

    Energy Technology Data Exchange (ETDEWEB)

    Chuong, Michael D. [Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida (United States); Springett, Gregory M. [Gastrointestinal Tumor Program, H. Lee Moffitt Cancer Center, Tampa, Florida (United States); Freilich, Jessica M.; Park, Catherine K. [Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida (United States); Weber, Jill M. [Gastrointestinal Tumor Program, H. Lee Moffitt Cancer Center, Tampa, Florida (United States); Mellon, Eric A. [Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida (United States); Hodul, Pamela J.; Malafa, Mokenge P.; Meredith, Kenneth L. [Gastrointestinal Tumor Program, H. Lee Moffitt Cancer Center, Tampa, Florida (United States); Hoffe, Sarah E. [Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida (United States); Shridhar, Ravi, E-mail: ravi.shridhar@moffitt.org [Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida (United States)

    2013-07-01

    Purpose: Stereotactic body radiation therapy (SBRT) provides high rates of local control (LC) and margin-negative (R0) resections for locally advanced pancreatic cancer (LAPC) and borderline resectable pancreatic cancer (BRPC), respectively, with minimal toxicity. Methods and Materials: A single-institution retrospective review was performed for patients with nonmetastatic pancreatic cancer treated with induction chemotherapy followed by SBRT. SBRT was delivered over 5 consecutive fractions using a dose painting technique including 7-10 Gy/fraction to the region of vessel abutment or encasement and 5-6 Gy/fraction to the remainder of the tumor. Restaging scans were performed at 4 weeks, and resectable patients were considered for resection. The primary endpoints were overall survival (OS) and progression-free survival (PFS). Results: Seventy-three patients were evaluated, with a median follow-up time of 10.5 months. Median doses of 35 Gy and 25 Gy were delivered to the region of vessel involvement and the remainder of the tumor, respectively. Thirty-two BRPC patients (56.1%) underwent surgery, with 31 undergoing an R0 resection (96.9%). The median OS, 1-year OS, median PFS, and 1-year PFS for BRPC versus LAPC patients was 16.4 months versus 15 months, 72.2% versus 68.1%, 9.7 versus 9.8 months, and 42.8% versus 41%, respectively (all P>.10). BRPC patients who underwent R0 resection had improved median OS (19.3 vs 12.3 months; P=.03), 1-year OS (84.2% vs 58.3%; P=.03), and 1-year PFS (56.5% vs 25.0%; P<.0001), respectively, compared with all nonsurgical patients. The 1-year LC in nonsurgical patients was 81%. We did not observe acute grade ≥3 toxicity, and late grade ≥3 toxicity was minimal (5.3%). Conclusions: SBRT safely facilitates margin-negative resection in patients with BRPC pancreatic cancer while maintaining a high rate of LC in unresectable patients. These data support the expanded implementation of SBRT for pancreatic cancer.

  13. Impact of Pretreatment Tumor Growth Rate on Outcome of Early-Stage Lung Cancer Treated With Stereotactic Body Radiation Therapy

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    Atallah, Soha; Cho, B.C. John; Allibhai, Zishan; Taremi, Mojgan; Giuliani, Meredith [Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Le, Lisa W. [Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Brade, Anthony; Sun, Alexander; Bezjak, Andrea [Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada); Hope, Andrew J., E-mail: andrew.hope@rmp.uhn.on.ca [Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario (Canada); Department of Radiation Oncology, University of Toronto, Toronto, Ontario (Canada)

    2014-07-01

    Purpose: To determine the influence of pretreatment tumor growth rate on outcomes in patients with early-stage non-small cell lung cancer (NSCLC) treated with stereotactic body radiation therapy (SBRT). Methods and Materials: A review was conducted on 160 patients with T1-T2N0M0 NSCLC treated with SBRT at single institution. The patient's demographic and clinical data, time interval (t) between diagnostic and planning computed tomography (CT), vital status, disease status, and cause of death were extracted from a prospectively kept database. Differences in gross tumor volume between diagnostic CT (GTV1) and planning CT (GTV2) were recorded, and growth rate was calculated by use of specific growth rate (SGR). Kaplan-Meier curves were constructed for overall survival (OS). Differences between groups were compared with a log-rank test. Multivariate analyses were performed by use of the Cox proportional hazard model with SGR and other relevant clinical factors. Cumulative incidence was calculated for local, regional, and distant failures by use of the competing risk approach and was compared with Gray's test. Results: The median time interval between diagnostic and planning CT was 82 days. The patients were divided into 2 groups, and the median SGR was used as a cut-off. The median survival times were 38.6 and 27.7 months for the low and high SGR groups, respectively (P=.03). Eastern Cooperative Oncology Group performance status (P=.01), sex (P=.04), SGR (P=.03), and GTV2 (P=.002) were predictive for OS in multivariable Cox regression analysis and, except sex, were similarly predictive for failure-free survival (FFS). The 3-year cumulative incidences of regional failure were 19.2% and 6.0% for the high and low SGR groups, respectively (P=.047). Conclusion: High SGR was correlated with both poorer OS and FFS in patients with early-stage NSCLC treated with SBRT. If validated, this measurement may be useful in identifying patients most likely to benefit from

  14. The Time Course of Dynamic Computed Tomographic Appearance of Radiation Injury to the Cirrhotic Liver Following Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma.

    Directory of Open Access Journals (Sweden)

    Tomoki Kimura

    Full Text Available This study aimed to evaluate the dynamic computed tomographic (CT appearance of focal radiation injury to cirrhotic liver tissue around the tumor following stereotactic body radiation therapy (SBRT for hepatocellular carcinoma (HCC. Seventy-seven patients with 92 HCCs were observed for >6 months. Sixty-four and 13 patients belonged to Child-Pugh class A and B, respectively. The median SBRT dose was 48 Gy/4fr. Dynamic CT scans were performed in non-enhanced, arterial, portal, and venous phases. The median follow-up period was 18 months. Dynamic CT appearances were classified into 3 types: type 1, hyperdensity in all enhanced phases; type 2, hypodensity in arterial and portal phases; type 3, isodensity in all enhanced phases. Half of the type 2 or 3 appearances significantly changed to type 1, particularly in patients belonging to Child-Pugh class A. After 3-6 months, Child-Pugh class B was a significant factor in type 3 patients. Thus, dynamic CT appearances were classified into 3 patterns and significantly changed over time into the enhancement group (type 1 in most patients belonging to Child-Pugh class A. Child-Pugh class B was a significant factor in the non-enhancement group (type 3.

  15. Using machine learning to predict radiation pneumonitis in patients with stage I non-small cell lung cancer treated with stereotactic body radiation therapy

    Science.gov (United States)

    Valdes, Gilmer; Solberg, Timothy D.; Heskel, Marina; Ungar, Lyle; Simone, Charles B., II

    2016-08-01

    To develop a patient-specific ‘big data’ clinical decision tool to predict pneumonitis in stage I non-small cell lung cancer (NSCLC) patients after stereotactic body radiation therapy (SBRT). 61 features were recorded for 201 consecutive patients with stage I NSCLC treated with SBRT, in whom 8 (4.0%) developed radiation pneumonitis. Pneumonitis thresholds were found for each feature individually using decision stumps. The performance of three different algorithms (Decision Trees, Random Forests, RUSBoost) was evaluated. Learning curves were developed and the training error analyzed and compared to the testing error in order to evaluate the factors needed to obtain a cross-validated error smaller than 0.1. These included the addition of new features, increasing the complexity of the algorithm and enlarging the sample size and number of events. In the univariate analysis, the most important feature selected was the diffusion capacity of the lung for carbon monoxide (DLCO adj%). On multivariate analysis, the three most important features selected were the dose to 15 cc of the heart, dose to 4 cc of the trachea or bronchus, and race. Higher accuracy could be achieved if the RUSBoost algorithm was used with regularization. To predict radiation pneumonitis within an error smaller than 10%, we estimate that a sample size of 800 patients is required. Clinically relevant thresholds that put patients at risk of developing radiation pneumonitis were determined in a cohort of 201 stage I NSCLC patients treated with SBRT. The consistency of these thresholds can provide radiation oncologists with an estimate of their reliability and may inform treatment planning and patient counseling. The accuracy of the classification is limited by the number of patients in the study and not by the features gathered or the complexity of the algorithm.

  16. Emerging technologies in stereotactic body radiotherapy.

    Science.gov (United States)

    Ma, Lijun; Wang, Lei; Tseng, Chia-Lin; Sahgal, Arjun

    2017-09-01

    Stereotactic body radiation therapy (SBRT) stems from the initial developments of intra-cranial stereotactic radiosurgery (SRS). Despite similarity in their names and clinical goals of delivering a sufficiently high tumoricidal dose, maximal sparing of the surrounding normal tissues and a short treatment course, SBRT technologies have transformed from the early days of body frame-based treatments with X-ray verification to primarily image-guided procedures with cone-beam CT or stereoscopic X-ray systems and non-rigid body immo-bilization. As a result of the incorporation of image-guidance systems and multi-leaf col-limators into mainstream linac systems, and treatment planning systems that have also evolved to allow for routine dose calculations to permit intensity modulated radiotherapy and volumetric modulated arc therapy (VMAT), SBRT has disseminated rapidly in the community to manage many disease sites that include oligometastases, spine lesions, lung, prostate, liver, renal cell, pelvic tumors, and head and neck tumors etc. In this article, we review the physical principles and paradigms that led to the widespread adoption of SBRT practice as well as technical caveats specific to individual SBRT technologies. From the perspective of treatment delivery, we categorically described (I) C-arm linac-based SBRT technologies; (II) robotically manipulated X-band CyberKnife® technology; and (III) emerging specialized systems for SBRT that include integrated MRI-linear accelerators and the imaged-guided Gamma Knife Perfexion Icon system with expanded multi-isocenter treatments of skull-based tumors, head-and-neck and cervical-spine lesions.

  17. A method of surface marker location optimization for tumor motion estimation in lung stereotactic body radiation therapy

    International Nuclear Information System (INIS)

    Lu, Bo; Park, Justin C.; Fan, Qiyong; Kahler, Darren; Liu, Chihray; Chen, Yunmei

    2015-01-01

    Purpose: Accurately localizing lung tumor localization is essential for high-precision radiation therapy techniques such as stereotactic body radiation therapy (SBRT). Since direct monitoring of tumor motion is not always achievable due to the limitation of imaging modalities for treatment guidance, placement of fiducial markers on the patient’s body surface to act as a surrogate for tumor position prediction is a practical alternative for tracking lung tumor motion during SBRT treatments. In this work, the authors propose an innovative and robust model to solve the multimarker position optimization problem. The model is able to overcome the major drawbacks of the sparse optimization approach (SOA) model. Methods: The principle-component-analysis (PCA) method was employed as the framework to build the authors’ statistical prediction model. The method can be divided into two stages. The first stage is to build the surrogate tumor matrix and calculate its eigenvalues and associated eigenvectors. The second stage is to determine the “best represented” columns of the eigenvector matrix obtained from stage one and subsequently acquire the optimal marker positions as well as numbers. Using 4-dimensional CT (4DCT) and breath hold CT imaging data, the PCA method was compared to the SOA method with respect to calculation time, average prediction accuracy, prediction stability, noise resistance, marker position consistency, and marker distribution. Results: The PCA and SOA methods which were both tested were on all 11 patients for a total of 130 cases including 4DCT and breath-hold CT scenarios. The maximum calculation time for the PCA method was less than 1 s with 64 752 surface points, whereas the average calculation time for the SOA method was over 12 min with 400 surface points. Overall, the tumor center position prediction errors were comparable between the two methods, and all were less than 1.5 mm. However, for the extreme scenarios (breath hold), the

  18. Retrospective Cohort Study of Bronchial Doses and Radiation-Induced Atelectasis After Stereotactic Body Radiation Therapy of Lung Tumors Located Close to the Bronchial Tree

    International Nuclear Information System (INIS)

    Karlsson, Kristin; Nyman, Jan; Baumann, Pia; Wersäll, Peter; Drugge, Ninni; Gagliardi, Giovanna; Johansson, Karl-Axel; Persson, Jan-Olov; Rutkowska, Eva; Tullgren, Owe; Lax, Ingmar

    2013-01-01

    Purpose: To evaluate the dose–response relationship between radiation-induced atelectasis after stereotactic body radiation therapy (SBRT) and bronchial dose. Methods and Materials: Seventy-four patients treated with SBRT for tumors close to main, lobar, or segmental bronchi were selected. The association between incidence of atelectasis and bronchial dose parameters (maximum point-dose and minimum dose to the high-dose bronchial volume [ranging from 0.1 cm 3 up to 2.0 cm 3 ]) was statistically evaluated with survival analysis models. Results: Prescribed doses varied between 4 and 20 Gy per fraction in 2-5 fractions. Eighteen patients (24.3%) developed atelectasis considered to be radiation-induced. Statistical analysis showed a significant correlation between the incidence of radiation-induced atelectasis and minimum dose to the high-dose bronchial volumes, of which 0.1 cm 3 (D 0.1cm3 ) was used for further analysis. The median value of D 0.1cm3 (α/β = 3 Gy) was EQD 2,LQ = 147 Gy 3 (range, 20-293 Gy 3 ). For patients who developed atelectasis the median value was EQD 2,LQ = 210 Gy 3 , and for patients who did not develop atelectasis, EQD 2,LQ = 105 Gy 3 . Median time from treatment to development of atelectasis was 8.0 months (range, 1.1-30.1 months). Conclusion: In this retrospective study a significant dose–response relationship between the incidence of atelectasis and the dose to the high-dose volume of the bronchi is shown

  19. Quantification and Minimization of Uncertainties of Internal Target Volume for Stereotactic Body Radiation Therapy of Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ge Hong [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Department of Radiation Oncology, Henan Cancer Hospital, the Affiliated Cancer Hospital of Zhengzhou University, Henan (China); Cai Jing; Kelsey, Chris R. [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Yin Fangfang, E-mail: fangfang.yin@duke.edu [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States)

    2013-02-01

    Purpose: To quantify uncertainties in delineating an internal target volume (ITV) and to understand how these uncertainties may be individually minimized for stereotactic body radiation therapy (SBRT) of early stage non-small cell lung cancer (NSCLC). Methods and Materials: Twenty patients with NSCLC who were undergoing SBRT were imaged with free-breathing 3-dimensional computed tomography (3DCT) and 10-phase 4-dimensional CT (4DCT) for delineating gross tumor volume (GTV){sub 3D} and ITV{sub 10Phase} (ITV3). The maximum intensity projection (MIP) CT was also calculated from 10-phase 4DCT for contouring ITV{sub MIP} (ITV1). Then, ITV{sub COMB} (ITV2), ITV{sub 10Phase+GTV3D} (ITV4), and ITV{sub 10Phase+ITVCOMB} (ITV5) were generated by combining ITV{sub MIP} and GTV{sub 3D}, ITV{sub 10phase} and GTV{sub 3D}, and ITV{sub 10phase} and ITV{sub COMB}, respectively. All 6 volumes (GTV{sub 3D} and ITV1 to ITV5) were delineated in the same lung window by the same radiation oncologist. The percentage of volume difference (PVD) between any 2 different volumes was determined and was correlated to effective tumor diameter (ETD), tumor motion ranges, R{sub 3D}, and the amplitude variability of the recorded breathing signal (v) to assess their volume variations. Results: The mean (range) tumor motion (R{sub SI}, R{sub AP}, R{sub ML}, and R{sub 3D}) and breathing variability (v) were 7.6 mm (2-18 mm), 4.0 mm (2-8 mm), 3.3 mm (0-7.5 mm), 9.9 mm (4.1-18.7 mm), and 0.17 (0.07-0.37), respectively. The trend of volume variation was GTV{sub 3D}

  20. Clinical Results of Mean GTV Dose Optimized Robotic-Guided Stereotactic Body Radiation Therapy for Lung Tumors

    Directory of Open Access Journals (Sweden)

    Rene Baumann

    2018-05-01

    Full Text Available IntroductionWe retrospectively evaluated the efficacy and toxicity of gross tumor volume (GTV mean dose optimized stereotactic body radiation therapy (SBRT for primary and secondary lung tumors with and without robotic real-time motion compensation.Materials and methodsBetween 2011 and 2017, 208 patients were treated with SBRT for 111 primary lung tumors and 163 lung metastases with a median GTV of 8.2 cc (0.3–174.0 cc. Monte Carlo dose optimization was performed prioritizing GTV mean dose at the potential cost of planning target volume (PTV coverage reduction while adhering to safe normal tissue constraints. The median GTV mean biological effective dose (BED10 was 162.0 Gy10 (34.2–253.6 Gy10 and the prescribed PTV BED10 ranged 23.6–151.2 Gy10 (median, 100.8 Gy10. Motion compensation was realized through direct tracking (44.9%, fiducial tracking (4.4%, and internal target volume (ITV concepts with small (≤5 mm, 33.2% or large (>5 mm, 17.5% motion. The local control (LC, progression-free survival (PFS, overall survival (OS, and toxicity were analyzed.ResultsMedian follow-up was 14.5 months (1–72 months. The 2-year actuarial LC, PFS, and OS rates were 93.1, 43.2, and 62.4%, and the median PFS and OS were 18.0 and 39.8 months, respectively. In univariate analysis, prior local irradiation (hazard ratio (HR 0.18, confidence interval (CI 0.05–0.63, p = 0.01, GTV/PTV (HR 1.01–1.02, CI 1.01–1.04, p < 0.02, and PTV prescription, mean GTV, and maximum plan BED10 (HR 0.97–0.99, CI 0.96–0.99, p < 0.01 were predictive for LC while the tracking method was not (p = 0.97. For PFS and OS, multivariate analysis showed Karnofsky Index (p < 0.01 and tumor stage (p ≤ 0.02 to be significant factors for outcome prediction. Late radiation pneumonitis or chronic rip fractures grade 1–2 were observed in 5.3% of the patients. Grade ≥3 side effects did not occur.ConclusionRobotic SBRT is a safe and

  1. Volume of Lytic Vertebral Body Metastatic Disease Quantified Using Computed Tomography–Based Image Segmentation Predicts Fracture Risk After Spine Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Thibault, Isabelle [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Department of Radiation Oncology, Centre Hospitalier de L' Universite de Québec–Université Laval, Quebec, Quebec (Canada); Whyne, Cari M. [Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Department of Surgery, University of Toronto, Toronto, Ontario (Canada); Zhou, Stephanie; Campbell, Mikki [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Atenafu, Eshetu G. [Department of Biostatistics, University Health Network, University of Toronto, Toronto, Ontario (Canada); Myrehaug, Sten; Soliman, Hany; Lee, Young K. [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Ebrahimi, Hamid [Orthopaedic Biomechanics Laboratory, Sunnybrook Research Institute, Department of Surgery, University of Toronto, Toronto, Ontario (Canada); Yee, Albert J.M. [Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Sahgal, Arjun, E-mail: arjun.sahgal@sunnybrook.ca [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada)

    2017-01-01

    Purpose: To determine a threshold of vertebral body (VB) osteolytic or osteoblastic tumor involvement that would predict vertebral compression fracture (VCF) risk after stereotactic body radiation therapy (SBRT), using volumetric image-segmentation software. Methods and Materials: A computational semiautomated skeletal metastasis segmentation process refined in our laboratory was applied to the pretreatment planning CT scan of 100 vertebral segments in 55 patients treated with spine SBRT. Each VB was segmented and the percentage of lytic and/or blastic disease by volume determined. Results: The cumulative incidence of VCF at 3 and 12 months was 14.1% and 17.3%, respectively. The median follow-up was 7.3 months (range, 0.6-67.6 months). In all, 56% of segments were determined lytic, 23% blastic, and 21% mixed, according to clinical radiologic determination. Within these 3 clinical cohorts, the segmentation-determined mean percentages of lytic and blastic tumor were 8.9% and 6.0%, 0.2% and 26.9%, and 3.4% and 15.8% by volume, respectively. On the basis of the entire cohort (n=100), a significant association was observed for the osteolytic percentage measures and the occurrence of VCF (P<.001) but not for the osteoblastic measures. The most significant lytic disease threshold was observed at ≥11.6% (odds ratio 37.4, 95% confidence interval 9.4-148.9). On multivariable analysis, ≥11.6% lytic disease (P<.001), baseline VCF (P<.001), and SBRT with ≥20 Gy per fraction (P=.014) were predictive. Conclusions: Pretreatment lytic VB disease volumetric measures, independent of the blastic component, predict for SBRT-induced VCF. Larger-scale trials evaluating our software are planned to validate the results.

  2. Comparative Cost-Effectiveness of Stereotactic Body Radiation Therapy Versus Intensity-Modulated and Proton Radiation Therapy for Localized Prostate Cancer

    International Nuclear Information System (INIS)

    Parthan, Anju; Pruttivarasin, Narin; Davies, Diane; Taylor, Douglas C. A.; Pawar, Vivek; Bijlani, Akash; Lich, Kristen Hassmiller; Chen, Ronald C.

    2012-01-01

    Objective: To determine the cost-effectiveness of several external beam radiation treatment modalities for the treatment of patients with localized prostate cancer. Methods: A lifetime Markov model incorporated the probabilities of experiencing treatment-related long-term toxicity or death. Toxicity probabilities were derived from published sources using meta-analytical techniques. Utilities and costs in the model were obtained from publicly available secondary sources. The model calculated quality-adjusted life expectancy and expected lifetime cost per patient, and derived ratios of incremental cost per quality-adjusted life year (QALY) gained between treatments. Analyses were conducted from both payer and societal perspectives. One-way and probabilistic sensitivity analyses were performed. Results: Compared to intensity-modulated radiation therapy (IMRT) and proton beam therapy (PT), stereotactic body radiation therapy (SBRT) was less costly and resulted in more QALYs. Sensitivity analyses showed that the conclusions in the base-case scenario were robust with respect to variations in toxicity and cost parameters consistent with available evidence. At a threshold of $50,000/QALY, SBRT was cost-effective in 75% and 94% of probabilistic simulations compared to IMRT and PT, respectively, from a payer perspective. From a societal perspective, SBRT was cost-effective in 75% and 96% of simulations compared to IMRT and PT, respectively, at a threshold of $50,000/QALY. In threshold analyses, SBRT was less expensive with better outcomes compared to IMRT at toxicity rates 23% greater than the SBRT base-case rates. Conclusion: Based on the assumption that each treatment modality results in equivalent long-term efficacy, SBRT is a cost-effective strategy resulting in improved quality-adjusted survival compared to IMRT and PT for the treatment of localized prostate cancer.

  3. Comparative cost-effectiveness of stereotactic body radiation therapy versus intensity-modulated and proton radiation therapy for localized prostate cancer.

    Directory of Open Access Journals (Sweden)

    Anju eParthan

    2012-08-01

    Full Text Available Objective. To determine the cost-effectiveness of several external beam radiation treatment modalities for the treatment of patients with localized prostate cancer.Methods. A lifetime Markov model incorporated the probabilities of experiencing treatment-related long-term toxicity or death. Toxicity probabilities were derived from published sources using meta-analytical techniques. Utilities and costs in the model were obtained from publically available secondary sources. The model calculated quality-adjusted life expectancy and expected lifetime cost per patient, and derived ratios of incremental cost per quality-adjusted life year (QALY gained between treatments. Analyses were conducted from both a payer and societal perspectives. One-way and probabilistic sensitivity analyses were performed.Results. Compared to intensity modulated radiation therapy (IMRT and proton beam therapy (PT, stereotactic body radiation therapy (SBRT was less costly and resulted in more QALYs. Sensitivity analyses showed that the conclusions in the base-case scenario were robust with respect to variations in toxicity and cost parameters consistent with available evidence. At a threshold of $50,000/QALY, SBRT was cost effective in 75%, and 94% of probabilistic simulations compared to IMRT and PT, respectively, from a payer perspective. From a societal perspective, SBRT was cost-effective in 75%, and 96% of simulations compared to IMRT and PT, respectively, at a threshold of $50,000/QALY. In threshold analyses, SBRT was less expensive with better outcomes compared to IMRT at toxicity rates 23% greater than the SBRT base-case rates. Conclusions. Based on the assumption that each treatment modality results in equivalent long-term efficacy, SBRT is a cost-effective strategy resulting in improved quality-adjusted survival compared to IMRT and PT for the treatment of localized prostate cancer.

  4. Predictors of Toxicity Associated With Stereotactic Body Radiation Therapy to the Central Hepatobiliary Tract

    International Nuclear Information System (INIS)

    Osmundson, Evan C.; Wu, Yufan; Luxton, Gary; Bazan, Jose G.; Koong, Albert C.; Chang, Daniel T.

    2015-01-01

    Purpose: To identify dosimetric predictors of hepatobiliary (HB) toxicity associated with stereotactic body radiation therapy (SBRT) for liver tumors. Methods and Materials: We retrospectively reviewed 96 patients treated with SBRT for primary (53%) or metastatic (47%) liver tumors between March 2006 and November 2013. The central HB tract (cHBT) was defined by a 15-mm expansion of the portal vein from the splenic confluence to the first bifurcation of left and right portal veins. Patients were censored for toxicity upon local progression or additional liver-directed therapy. HB toxicities were graded according to Common Terminology Criteria for Adverse Events version 4.0. To compare different SBRT fractionations, doses were converted to biologically effective doses (BED) by using the standard linear quadratic model α/β = 10 (BED10). Results: Median follow-up was 12.7 months after SBRT. Median BED10 was 85.5 Gy (range: 37.5-151.2). The median number of fractions was 5 (range: 1-5), with 51 patients (53.1%) receiving 5 fractions and 29 patients (30.2%) receiving 3 fractions. In total, there were 23 (24.0%) grade 2+ and 18 (18.8%) grade 3+ HB toxicities. Nondosimetric factors predictive of grade 3+ HB toxicity included cholangiocarcinoma (CCA) histology (P<.0001), primary liver tumor (P=.0087), and biliary stent (P<.0001). Dosimetric parameters most predictive of grade 3+ HB toxicity were volume receiving above BED10 of 72 Gy (V BED10 72) ≥ 21 cm 3 (relative risk [RR]: 11.6, P<.0001), V BED10 66 ≥ 24 cm 3 (RR: 10.5, P<.0001), and mean BED10 (Dmean BED10 ) cHBT ≥14 Gy (RR: 9.2, P<.0001), with V BED10 72 and V BED10 66 corresponding to V40 and V37.7 for 5 fractions and V33.8 and V32.0 for 3 fractions, respectively. V BED10 72 ≥ 21 cm 3 , V BED10 66 ≥ 24 cm 3 , and Dmean BED10 cHBT ≥14 Gy were consistently predictive of grade 3+ toxicity on multivariate analysis. Conclusions: V BED10 72, V BED10 66, and Dmean BED10 to cHBT are

  5. Simple Factors Associated With Radiation-Induced Lung Toxicity After Stereotactic Body Radiation Therapy of the Thorax: A Pooled Analysis of 88 Studies

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    Zhao, Jing [Department of Radiation Oncology, GRU Cancer Center/Medical College of Georgia, Georgia Regents University, Augusta, Georgia (United States); Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan (China); Yorke, Ellen D. [Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Li, Ling [Department of Radiation Oncology, GRU Cancer Center/Medical College of Georgia, Georgia Regents University, Augusta, Georgia (United States); Department of Shanghai Cancer Hospital, Fudan University, Shanghai (China); Kavanagh, Brian D. [Department of Radiation Oncology, University of Colorado, Denver, Colorado (United States); Li, X. Allen [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin (United States); Das, Shiva [Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States); Miften, Moyed [Department of Radiation Oncology, University of Colorado, Denver, Colorado (United States); Rimner, Andreas [Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York (United States); Campbell, Jeffrey [Department of Radiation Oncology, GRU Cancer Center/Medical College of Georgia, Georgia Regents University, Augusta, Georgia (United States); Xue, Jinyu [Department of Radiation Oncology, MD Anderson Cancer Center at Cooper, Camden, New Jersey (United States); Jackson, Andrew [Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Grimm, Jimm [Bott Cancer Center, Holy Redeemer Hospital, Meadowbrook, Pennsylvania (United States); Milano, Michael T. [Department of Radiation Oncology, University of Rochester, Rochester, New York (United States); and others

    2016-08-01

    Purpose: To study the risk factors for radiation-induced lung toxicity (RILT) after stereotactic body radiation therapy (SBRT) of the thorax. Methods and Materials: Published studies on lung toxicity in patients with early-stage non–small cell lung cancer (NSCLC) or metastatic lung tumors treated with SBRT were pooled and analyzed. The primary endpoint was RILT, including pneumonitis and fibrosis. Data of RILT and risk factors were extracted from each study, and rates of grade 2 to 5 (G2+) and grade 3 to 5 (G3+) RILT were computed. Patient, tumor, and dosimetric factors were analyzed for their correlation with RILT. Results: Eighty-eight studies (7752 patients) that reported RILT incidence were eligible. The pooled rates of G2+ and G3+ RILT from all 88 studies were 9.1% (95% confidence interval [CI]: 7.15-11.4) and 1.8% (95% CI: 1.3-2.5), respectively. The median of median tumor sizes was 2.3 (range, 1.4-4.1) cm. Among the factors analyzed, older patient age (P=.044) and larger tumor size (the greatest diameter) were significantly correlated with higher rates of G2+ (P=.049) and G3+ RILT (P=.001). Patients with stage IA versus stage IB NSCLC had significantly lower risks of G2+ RILT (8.3% vs 17.1%, odds ratio = 0.43, 95% CI: 0.29-0.64, P<.0001). Among studies that provided detailed dosimetric data, the pooled analysis demonstrated a significantly higher mean lung dose (MLD) (P=.027) and V20 (P=.019) in patients with G2+ RILT than in those with grade 0 to 1 RILT. Conclusions: The overall rate of RILT is relatively low after thoracic SBRT. Older age and larger tumor size are significant adverse risk factors for RILT. Lung dosimetry, specifically lung V20 and MLD, also significantly affect RILT risk.

  6. Differences in rates of radiation-induced true and false rib fractures after stereotactic body radiation therapy for Stage I primary lung cancer

    International Nuclear Information System (INIS)

    Miura, Hideharu; Inoue, Toshihiko; Shiomi, Hiroya; Oh, Ryoong-Jin

    2015-01-01

    The purpose of this study was to analyze the dosimetry and investigate the clinical outcomes of radiation-induced rib fractures (RIRFs) after stereotactic body radiotherapy (SBRT). A total of 126 patients with Stage I primary lung cancer treated with SBRT, who had undergone follow-up computed tomography (CT) at least 12 months after SBRT and who had no previous overlapping radiation exposure were included in the study. We used the Mantel-Haenszel method and multiple logistic regression analysis to compare risk factors. We analyzed D(0.5 cm 3 ) (minimum absolute dose received by a 0.5-cm 3 volume) and identified each rib that received a biologically effective dose (BED) (BED3, using the linear-quadratic (LQ) formulation assuming an α/β = 3) of at least 50 Gy. Of the 126 patients, 46 (37%) suffered a total of 77 RIRFs. The median interval from SBRT to RIRF detection was 15 months (range, 3-56 months). The 3-year cumulative probabilities were 45% (95% CI, 34-56%) and 3% (95% CI, 0-6%), for Grades 1 and 2 RIRFs, respectively. Multivariate analysis showed that tumor location was a statistically significant risk factor for the development of Grade 1 RIRFs. Of the 77 RIRFs, 71 (92%) developed in the true ribs (ribs 1-7), and the remaining six developed in the false ribs (ribs 8-12). The BED3 associated with 10% and 50% probabilities of RIRF were 55 and 210 Gy to the true ribs and 240 and 260 Gy to the false ribs. We conclude that RIRFs develop more frequently in true ribs than in false ribs. (author)

  7. Intrafraction Motion in Stereotactic Body Radiation Therapy for Non-Small Cell Lung Cancer: Intensity Modulated Radiation Therapy Versus Volumetric Modulated Arc Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Rossi, Maddalena M.G.; Peulen, Heike M.U.; Belderbos, Josè S.A.; Sonke, Jan-Jakob, E-mail: j.sonke@nki.nl

    2016-06-01

    Purpose: Stereotactic body radiation therapy (SBRT) for early-stage inoperable non-small cell lung cancer (NSCLC) patients delivers high doses that require high-precision treatment. Typically, image guidance is used to minimize day-to-day target displacement, but intrafraction position variability is often not corrected. Currently, volumetric modulated arc therapy (VMAT) is replacing intensity modulated radiation therapy (IMRT) in many departments because of its shorter delivery time. This study aimed to evaluate whether intrafraction variation in VMAT patients is reduced in comparison with patients treated with IMRT. Methods and Materials: NSCLC patients (197 IMRT and 112 VMAT) treated with a frameless SBRT technique to a prescribed dose of 3 × 18 Gy were evaluated. Image guidance for both techniques was identical: pretreatment cone beam computed tomography (CBCT) (CBCT{sub precorr}) for setup correction followed immediately before treatment by postcorrection CBCT (CBCT{sub postcorr}) for verification. Then, after either a noncoplanar IMRT technique or a VMAT technique, a posttreatment (CBCT{sub postRT}) scan was acquired. The CBCT{sub postRT} and CBCT{sub postcorr} scans were then used to evaluate intrafraction motion. Treatment delivery times, systematic (Σ) and random (σ) intrafraction variations, and associated planning target volume (PTV) margins were calculated. Results: The median treatment delivery time was significantly reduced by 20 minutes (range, 32-12 minutes) using VMAT compared with noncoplanar IMRT. Intrafraction tumor motion was significantly larger for IMRT in all directions up to 0.5 mm systematic (Σ) and 0.7 mm random (σ). The required PTV margins for IMRT and VMAT differed by less than 0.3 mm. Conclusion: VMAT-based SBRT for NSCLC was associated with significantly shorter delivery times and correspondingly smaller intrafraction motion compared with noncoplanar IMRT. However, the impact on the required PTV margin was small.

  8. Fiducial-free CyberKnife stereotactic body radiation therapy (SBRT) for single vertebral body metastases: acceptable local control and normal tissue tolerance with 5 fraction approach

    Energy Technology Data Exchange (ETDEWEB)

    Gill, Beant; Oermann, Eric; Ju, Andrew; Suy, Simeng; Yu, Xia; Rabin, Jennifer [Department of Radiation Medicine, Georgetown University Hospital,, Washington, DC (United States); Kalhorn, Christopher; Nair, Mani N.; Voyadzis, Jean-Marc [Department of Neurosurgery, Georgetown University Hospital,, Washington, DC (United States); Unger, Keith; Collins, Sean P.; Harter, K. W.; Collins, Brian T., E-mail: collinsb@gunet.georgetown.edu [Department of Radiation Medicine, Georgetown University Hospital,, Washington, DC (United States)

    2012-04-26

    This retrospective analysis examines the local control and toxicity of five-fraction fiducial-free CyberKnife stereotactic body radiation therapy (SBRT) for single vertebral body (VB) metastases. All patients had favorable performance status (ECOG 0–1), oligometastatic disease, and no prior spine irradiation. A prescribed dose of 30–35 Gy was delivered in five fractions to the planning target volume (PTV) using the CyberKnife with X-sight spine tracking. Suggested maximum spinal cord and esophagus point doses were 30 and 40 Gy, respectively. A median 30 Gy (IQR, 30–35 Gy) dose was delivered to a median prescription isodose line of 70% (IQR, 65–77%) to 20 patients. At 34 months median follow-up (IQR, 25–40 months) for surviving patients, the 1- and 2-year Kaplan–Meier local control estimates were 80 and 73%, respectively. Two of the five local failures were infield in patients who had received irradiation to the gross tumor volume and three were paravertebral failures just outside the PTV in patients with prior corpectomy. No local failures occurred in patients who completed VB radiation alone. The 1- and 2-year Kaplan–Meier overall survival estimates were 80 and 57%, respectively. Most deaths were attributed to metastatic disease; one death was attributed to local recurrence. The mean maximum point doses were 26.4 Gy (SD, 5.1 Gy) to the spinal cord and 29.1 Gy (SD, 8.9 Gy) to the esophagus. Patients receiving maximum esophagus point doses greater than 35 Gy experienced acute dysphagia (Grade I/II). No spinal cord toxicity was documented. Five-fraction fiducial-free CyberKnife SBRT is an acceptable treatment option for newly diagnosed VB metastases with promising local control rates and minimal toxicity despite the close proximity of such tumors to the spinal cord and esophagus. A prospective study aimed at further enhancing local control by targeting the intact VB and escalating the total dose is planned.

  9. Preliminary Results of a Phase 1 Dose-Escalation Trial for Early-Stage Breast Cancer Using 5-Fraction Stereotactic Body Radiation Therapy for Partial-Breast Irradiation

    International Nuclear Information System (INIS)

    Rahimi, Asal; Thomas, Kimberly; Spangler, Ann; Rao, Roshni; Leitch, Marilyn; Wooldridge, Rachel; Rivers, Aeisha; Seiler, Stephen; Albuquerque, Kevin; Stevenson, Stella; Goudreau, Sally; Garwood, Dan; Haley, Barbara; Euhus, David; Heinzerling, John; Ding, Chuxiong; Gao, Ang; Ahn, Chul; Timmerman, Robert

    2017-01-01

    Purpose: To evaluate the tolerability of a dose-escalated 5-fraction stereotactic body radiation therapy for partial-breast irradiation (S-PBI) in treating early-stage breast cancer after partial mastectomy; the primary objective was to escalate dose utilizing a robotic stereotactic radiation system treating the lumpectomy cavity without exceeding the maximum tolerated dose. Methods and Materials: Eligible patients included those with ductal carcinoma in situ or invasive nonlobular epithelial histologies and stage 0, I, or II, with tumor size <3 cm. Patients and physicians completed baseline and subsequent cosmesis outcome questionnaires. Starting dose was 30 Gy in 5 fractions and was escalated by 2.5 Gy total for each cohort to 40 Gy. Results: In all, 75 patients were enrolled, with a median age of 62 years. Median follow-up for 5 cohorts was 49.9, 42.5, 25.7, 20.3, and 13.5 months, respectively. Only 3 grade 3 toxicities were experienced. There was 1 dose-limiting toxicity in the overall cohort. Ten patients experienced palpable fat necrosis (4 of which were symptomatic). Physicians scored cosmesis as excellent or good in 95.9%, 100%, 96.7%, and 100% at baseline and 6, 12, and 24 months after S-PBI, whereas patients scored the same periods as 86.5%, 97.1%, 95.1%, and 95.3%, respectively. The disagreement rates between MDs and patients during those periods were 9.4%, 2.9%, 1.6%, and 4.7%, respectively. There have been no recurrences or distant metastases. Conclusion: Dose was escalated to the target dose of 40 Gy in 5 fractions, with the occurrence of only 1 dose-limiting toxicity. Patients felt cosmetic results improved within the first year after surgery and stereotactic body radiation therapy. Our results show minimal toxicity with excellent cosmesis; however, further follow-up is warranted in future studies. This study is the first to show the safety, tolerability, feasibility, and cosmesis results of a 5-fraction dose-escalated S-PBI treatment for

  10. Preliminary Results of a Phase 1 Dose-Escalation Trial for Early-Stage Breast Cancer Using 5-Fraction Stereotactic Body Radiation Therapy for Partial-Breast Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Rahimi, Asal, E-mail: asal.rahimi@utsouthwestern.edu [University of Texas Southwestern Medical Center, Dallas, Texas (United States); Thomas, Kimberly; Spangler, Ann [University of Texas Southwestern Medical Center, Dallas, Texas (United States); Rao, Roshni; Leitch, Marilyn; Wooldridge, Rachel; Rivers, Aeisha [Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Seiler, Stephen [Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Albuquerque, Kevin; Stevenson, Stella [University of Texas Southwestern Medical Center, Dallas, Texas (United States); Goudreau, Sally [Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Garwood, Dan [University of Texas Southwestern Medical Center, Dallas, Texas (United States); Haley, Barbara [Department of Medical Oncology, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Euhus, David [Department of Surgery, Johns Hopkins University, Baltimore, Maryland (United States); Heinzerling, John [Department of Radiation Oncology, Levine Cancer Institute, Charlotte, North Carolina (United States); Ding, Chuxiong [University of Texas Southwestern Medical Center, Dallas, Texas (United States); Gao, Ang; Ahn, Chul [Department of Statistics, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Timmerman, Robert [University of Texas Southwestern Medical Center, Dallas, Texas (United States)

    2017-05-01

    Purpose: To evaluate the tolerability of a dose-escalated 5-fraction stereotactic body radiation therapy for partial-breast irradiation (S-PBI) in treating early-stage breast cancer after partial mastectomy; the primary objective was to escalate dose utilizing a robotic stereotactic radiation system treating the lumpectomy cavity without exceeding the maximum tolerated dose. Methods and Materials: Eligible patients included those with ductal carcinoma in situ or invasive nonlobular epithelial histologies and stage 0, I, or II, with tumor size <3 cm. Patients and physicians completed baseline and subsequent cosmesis outcome questionnaires. Starting dose was 30 Gy in 5 fractions and was escalated by 2.5 Gy total for each cohort to 40 Gy. Results: In all, 75 patients were enrolled, with a median age of 62 years. Median follow-up for 5 cohorts was 49.9, 42.5, 25.7, 20.3, and 13.5 months, respectively. Only 3 grade 3 toxicities were experienced. There was 1 dose-limiting toxicity in the overall cohort. Ten patients experienced palpable fat necrosis (4 of which were symptomatic). Physicians scored cosmesis as excellent or good in 95.9%, 100%, 96.7%, and 100% at baseline and 6, 12, and 24 months after S-PBI, whereas patients scored the same periods as 86.5%, 97.1%, 95.1%, and 95.3%, respectively. The disagreement rates between MDs and patients during those periods were 9.4%, 2.9%, 1.6%, and 4.7%, respectively. There have been no recurrences or distant metastases. Conclusion: Dose was escalated to the target dose of 40 Gy in 5 fractions, with the occurrence of only 1 dose-limiting toxicity. Patients felt cosmetic results improved within the first year after surgery and stereotactic body radiation therapy. Our results show minimal toxicity with excellent cosmesis; however, further follow-up is warranted in future studies. This study is the first to show the safety, tolerability, feasibility, and cosmesis results of a 5-fraction dose-escalated S-PBI treatment for

  11. The expanding role of stereotactic body radiation therapy in oligometastatic solid tumors: What do we know and where are we going?

    Science.gov (United States)

    Hong, Julian C; Salama, Joseph K

    2017-01-01

    The spectrum hypothesis posits that there are distinct clinical states of metastatic progression. Early data suggest that aggressive treatment of more biologically indolent metastatic disease, characterized by metastases limited in number and destination organ, may offer an opportunity to alter the disease course, potentially allowing for longer survival, delay of systemic therapy, or even cure. The development of stereotactic body radiation therapy (SBRT) has opened new avenues for the treatment of oligometastatic disease. Early data support the use of SBRT for treating oligometastases in a number of organs, with promising rates of treated metastasis control and overall survival. Ongoing investigation is required to definitively establish benefit, determine the appropriate treatment regimen, refine patient selection, and incorporate SBRT with systemic therapies. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Esophageal Metastasis to the Iris Effectively Palliated Using Stereotactic Body Radiation Therapy and Adjuvant Intravitreal Chemotherapy: Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Sughosh Dhakal

    2012-12-01

    Full Text Available We report a case of isolated iris metastasis from esophageal adenocarcinoma that was successfully managed with local application of stereotactic body radiation therapy (SBRT and adjunctive intravitreal therapy. A 53-year-old man with locally advanced esophageal adenocarcinoma achieved a complete clinical and radiographic response after surgery and chemotherapy. Four months later, he developed headache and decreased vision and was diagnosed with metastasis to the iris by slit-lamp examination. The decrease in vision was secondary to cystoid macular edema. The metastatic tumor and the patient’s symptoms resolved after treatment with SBRT and intravitreal injections of bevacizumab and triamcinolone. We conclude that SBRT combined with intravitreal chemotherapy is an effective and well-tolerated palliative treatment for metastasis of esophageal adenocarcinoma to the iris.

  13. Early Graphical Appearance of Radiation Pneumonitis Correlates With the Severity of Radiation Pneumonitis After Stereotactic Body Radiotherapy (SBRT) in Patients With Lung Tumors

    International Nuclear Information System (INIS)

    Takeda, Atsuya; Ohashi, Toshio; Kunieda, Etsuo

    2010-01-01

    Purpose: To investigate factors associated with Grade ≥3 radiation pneumonitis (RP) in patients with lung tumors treated with stereotactic body radiotherapy (SBRT). Methods and Materials: We retrospectively analyzed 128 patients with 133 lung tumors treated with SBRT. RP was graded according to the Common Terminology Criteria for Adverse Events version 3.0. Univariate analyses were used to identify predictive factors for RP. Results: The median follow-up period after SBRT was 12 months (range, 5-45 months). Incidences of Grades 0, 1, 2, and 3 RP were 27%, 52%, 16%, and 5%, respectively. No patients suffered Grade 4 or 5 RP. For all patients with Grade 2 or 3, symptoms occurred either simultaneously with or subsequent to graphical appearances. The latent period was the only significant factor associated with Grade ≥3 RP (p < 0.01). A latent period of 1 or 2 months indicated a 40% (6/15) risk for Grade 3. However, the risk for Grade 3 was 1.2% (1/82) 3 months after SBRT. No pretreatment clinical or dosimetric factors were significantly associated with Grade ≥3 RP. However, 4 of 7 patients with Grade 3 RP had severe pulmonary comorbidities. Conclusion: Only the latency period was a significant factor in the development of RP. No pretreatment clinical or dosimetric factors were significantly associated with Grade ≥3 RP. Patients, especially those with severe pulmonary comorbidities, should be carefully observed for the graphical appearance of RP within a few months during the follow-up period after SBRT.

  14. Propensity Score Matched Comparison of Intensity Modulated Radiation Therapy vs Stereotactic Body Radiation Therapy for Localized Prostate Cancer: A Survival Analysis from the National Cancer Database

    Directory of Open Access Journals (Sweden)

    Anthony Ricco

    2017-08-01

    Full Text Available PurposeNo direct comparisons between extreme hypofractionation and conventional fractionation have been reported in randomized trials for the treatment of localized prostate cancer. The goal of this study is to use a propensity score matched (PSM analysis with the National Cancer Database (NCDB for the comparison of stereotactic body radiation therapy (SBRT and intensity modulated radiation therapy (IMRT for organ confined prostate cancer.MethodsMen with localized prostate cancer treated with radiation dose ≥72 Gy for IMRT and ≥35 Gy for SBRT to the prostate only were abstracted from the NCDB. Men treated with previous surgery, brachytherapy, or proton therapy were excluded. Matching was performed to eliminate confounding variables via PSM. Simple 1–1 nearest neighbor matching resulted in a matched sample of 5,430 (2,715 in each group. Subset analyses of men with prostate-specific antigen (PSA > 10, GS = 7, and GS > 7 yielded matched samples of 1,020, 2,194, and 247, respectively.ResultsNo difference in survival was noted between IMRT and SBRT at 8 years (p = 0.65. Subset analyses of higher risk men with PSA > 10 or GS = 7 histology or GS > 7 histology revealed no difference in survival between IMRT and SBRT (p = 0.58, p = 0.68, and p = 0.62, respectively. Variables significant for survival for the matched group included: age (p < 0.0001, primary payor (p = 0.0001, Charlson/Deyo Score (p = 0.0002, PSA (p = 0.0013, Gleason score (p < 0.0001, and use of hormone therapy (p = 0.02.ConclusionUtilizing the NCDB, there is no difference in survival at 8 years comparing IMRT to SBRT in the treatment of localized prostate cancer. Subset analysis confirmed no difference in survival even for intermediate- and high-risk patients based on Gleason Score and PSA.

  15. Stereotactic Ablative Body Radiation Therapy for Primary Kidney Cancer: A 3-Dimensional Conformal Technique Associated With Low Rates of Early Toxicity

    Energy Technology Data Exchange (ETDEWEB)

    Pham, Daniel, E-mail: daniel.pham@petermac.org [Department of Radiotherapy Services, Peter MacCallum Cancer Centre, Melbourne, Victoria (Australia); Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Victoria (Australia); Thompson, Ann [Department of Radiotherapy Services, Peter MacCallum Cancer Centre, Melbourne, Victoria (Australia); Kron, Tomas [Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria (Australia); Sir Peter MacCallum Department of Oncology, Melbourne University, Melbourne, Victoria (Australia); Foroudi, Farshad [Sir Peter MacCallum Department of Oncology, Melbourne University, Melbourne, Victoria (Australia); Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria (Australia); Kolsky, Michal Schneider [Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Victoria (Australia); Devereux, Thomas; Lim, Andrew [Department of Radiotherapy Services, Peter MacCallum Cancer Centre, Melbourne, Victoria (Australia); Siva, Shankar [Sir Peter MacCallum Department of Oncology, Melbourne University, Melbourne, Victoria (Australia); Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria (Australia)

    2014-12-01

    Purpose: To describe our 3-dimensional conformal planning approaches and report early toxicities with stereotactic body radiation therapy for the management of primary renal cell carcinoma. Methods and Materials: This is an analysis of a phase 1 trial of stereotactic body radiation therapy for primary inoperable renal cell carcinoma. A dose of 42 Gy/3 fractions was prescribed to targets ≥5 cm, whereas for <5 cm 26 Gy/1 fraction was used. All patients underwent a planning 4-dimensional CT to generate a planning target volume (PTV) from a 5-mm isotropic expansion of the internal target volume. Planning required a minimum of 8 fields prescribing to the minimum isodose surrounding the PTV. Intermediate dose spillage at 50% of the prescription dose (R50%) was measured to describe the dose gradient. Early toxicity (<6 months) was scored using the Common Terminology Criteria for Adverse Events (v4.0). Results: From July 2012 to August 2013 a total of 20 patients (median age, 77 years) were recruited into a prospective clinical trial. Eleven patients underwent fractionated treatment and 9 patients a single fraction. For PTV targets <100 cm{sup 3} the median number of beams used was 8 (2 noncoplanar) to achieve an average R50% of 3.7. For PTV targets >100 cm{sup 3} the median beam number used was 10 (4 noncoplanar) for an average R50% value of 4.3. The R50% was inversely proportional to decreasing PTV volume (r=−0.62, P=.003) and increasing total beams used (r=−0.51, P=.022). Twelve of 20 patients (60%) suffered grade ≤2 early toxicity, whereas 8 of 20 patients (40%) were asymptomatic. Nausea, chest wall pain, and fatigue were the most common toxicities reported. Conclusion: A 3-dimensional conformal planning technique of 8-10 beams can be used to deliver highly tolerable stereotactic ablation to primary kidney targets with minimal early toxicities. Ongoing follow-up is currently in place to assess long-term toxicities and cancer control.

  16. Forcing lateral electron disequilibrium to spare lung tissue: a novel technique for stereotactic body radiation therapy of lung cancer

    International Nuclear Information System (INIS)

    Disher, Brandon; Hajdok, George; Gaede, Stewart; Mulligan, Matthew; Battista, Jerry J

    2013-01-01

    Stereotactic body radiation therapy (SBRT) has quickly become a preferred treatment option for early-stage lung cancer patients who are ineligible for surgery. This technique uses tightly conformed megavoltage (MV) x-ray beams to irradiate a tumour with ablative doses in only a few treatment fractions. Small high energy x-ray fields can cause lateral electron disequilibrium (LED) to occur within low density media, which can reduce tumour dose. These dose effects may be challenging to predict using analytic dose calculation algorithms, especially at higher beam energies. As a result, previous authors have suggested using low energy photons ( 5 × 5 cm 2 ) for lung cancer patients to avoid the negative dosimetric effects of LED. In this work, we propose a new form of SBRT, described as LED-optimized SBRT (LED-SBRT), which utilizes radiotherapy (RT) parameters designed to cause LED to advantage. It will be shown that LED-SBRT creates enhanced dose gradients at the tumour/lung interface, which can be used to manipulate tumour dose, and/or normal lung dose. To demonstrate the potential benefits of LED-SBRT, the DOSXYZnrc (National Research Council of Canada, Ottawa, ON) Monte Carlo (MC) software was used to calculate dose within a cylindrical phantom and a typical lung patient. 6 MV or 18 MV x-ray fields were focused onto a small tumour volume (diameter ∼1 cm). For the phantom, square fields of 1 × 1 cm 2 , 3 × 3 cm 2 , or 5 × 5 cm 2 were applied. However, in the patient, 3 × 1 cm 2 , 3 × 2 cm 2 , 3 × 2.5 cm 2 , or 3 × 3 cm 2 field sizes were used in simulations to assure target coverage in the superior–inferior direction. To mimic a 180° SBRT arc in the (symmetric) phantom, a single beam profile was calculated, rotated, and beams were summed at 1° segments to accumulate an arc dose distribution. For the patient, a 360° arc was modelled with 36 equally weighted (and spaced) fields focused on the tumour centre. A planning target volume (PTV) was generated

  17. Risk-adapted robotic stereotactic body radiation therapy for inoperable early-stage non-small-cell lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Temming, Susanne; Kocher, Martin; Baus, Wolfgang W.; Semrau, Robert; Baues, Christian; Marnitz, S. [University of Cologne, Department of Radiation Oncology, Center for Integrated Oncology, Cologne (Germany); Stoelben, Erich [Hospital of Cologne, Lung Clinic Merheim, Cologne (Germany); Hagmeyer, Lars [University of Cologne, Bethanien Hospital, Institute of Pneumology, Solingen (Germany); Chang, De-Hua [University of Cologne, Department of Diagnostic and Interventional Radiology, Center for Integrated Oncology, Cologne (Germany); Frank, Konrad [Heart Centre of the University of Cologne, Department III of Internal Medicine, Cologne (Germany); Hekmat, Khosro [University of Cologne, Department of Cardiothoracic Surgery, Center for Integrated Oncology, Cologne (Germany); Wolf, Juergen [University Hospital of Cologne, First Department of Internal Medicine, Center for Integrated Oncology, Cologne (Germany)

    2018-02-15

    To evaluate efficacy and toxicity of stereotactic body radiation therapy (SBRT) with CyberKnife {sup registered} (Accuray, Sunnyvale, CA, USA) in a selected cohort of primary, medically inoperable early-stage non-small cell lung cancer (NSCLC) patients. From 2012 to 2016, 106 patients (median age 74 years, range 50-94 years) with primary NSCLC were treated with SBRT using CyberKnife {sup registered}. Histologic confirmation was available in 87 patients (82%). For mediastinal staging, 92 patients (87%) underwent {sup 18}F-fluorodeoxyglucose positron-emission tomography (18-FDG-PET) and/or endobronchial ultrasound (EBUS)-guided lymph node biopsy or mediastinoscopy. Tumor stage (UICC8, 2017) was IA/B (T1a-c, 1-3 cm) in 86 patients (81%) and IIA (T2a/b, 3-5 cm) in 20 patients (19%). Depending on tumor localization, three different fractionation schedules were used: 3 fractions of 17Gy, 5 fractions of 11Gy, or 8 fractions of 7.5 Gy. Tracking was based on fiducial implants in 13 patients (12%) and on image guidance without markers in 88%. Median follow-up was 15 months (range 0.5-46 months). Acute side effects were mild (fatigue grade 1-2 in 20% and dyspnea grade 1-2 in 17%). Late effects were observed in 4 patients (4%): 3 patients developed pneumonitis requiring therapy (grade 2) and 1 patient suffered a rib fracture (grade 3). In total, 9/106 patients (8%) experienced a local recurrence, actuarial local control rates were 88% (95% confidence interval, CI, 80-96%) at 2 years and 77% (95%CI 56-98%) at 3 years. The median disease-free survival time was 27 months (95%CI 23-31 months). Overall survival was 77% (95%CI 65-85%) at 2 years and 56% (95%CI 39-73%) at 3 years. CyberKnife {sup registered} lung SBRT which allows for real-time tumor tracking and risk-adapted fractionation achieves satisfactory local control and low toxicity rates in inoperable early-stage primary lung cancer patients. (orig.) [German] Untersuchung von Wirkung und Toxizitaet einer stereotaktischen

  18. Stereotactic body radiation therapy planning with duodenal sparing using volumetric-modulated arc therapy vs intensity-modulated radiation therapy in locally advanced pancreatic cancer: A dosimetric analysis

    Energy Technology Data Exchange (ETDEWEB)

    Kumar, Rachit; Wild, Aaron T.; Ziegler, Mark A.; Hooker, Ted K.; Dah, Samson D.; Tran, Phuoc T.; Kang, Jun; Smith, Koren; Zeng, Jing [Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, 401N. Broadway, Weinberg Suite 1440, Baltimore, MD 21231 (United States); Pawlik, Timothy M. [Department of Surgery, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD (United States); Tryggestad, Erik [Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, 401N. Broadway, Weinberg Suite 1440, Baltimore, MD 21231 (United States); Ford, Eric [Department of Radiation Oncology, Fred Hutchinson Cancer Center, University of Washington, Seattle, WA (United States); Herman, Joseph M., E-mail: jherma15@jhmi.edu [Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, 401N. Broadway, Weinberg Suite 1440, Baltimore, MD 21231 (United States)

    2013-10-01

    Stereotactic body radiation therapy (SBRT) achieves excellent local control for locally advanced pancreatic cancer (LAPC), but may increase late duodenal toxicity. Volumetric-modulated arc therapy (VMAT) delivers intensity-modulated radiation therapy (IMRT) with a rotating gantry rather than multiple fixed beams. This study dosimetrically evaluates the feasibility of implementing duodenal constraints for SBRT using VMAT vs IMRT. Non–duodenal sparing (NS) and duodenal-sparing (DS) VMAT and IMRT plans delivering 25 Gy in 1 fraction were generated for 15 patients with LAPC. DS plans were constrained to duodenal D{sub max} of<30 Gy at any point. VMAT used 1 360° coplanar arc with 4° spacing between control points, whereas IMRT used 9 coplanar beams with fixed gantry positions at 40° angles. Dosimetric parameters for target volumes and organs at risk were compared for DS planning vs NS planning and VMAT vs IMRT using paired-sample Wilcoxon signed rank tests. Both DS VMAT and DS IMRT achieved significantly reduced duodenal D{sub mean}, D{sub max}, D{sub 1cc}, D{sub 4%}, and V{sub 20} {sub Gy} compared with NS plans (all p≤0.002). DS constraints compromised target coverage for IMRT as demonstrated by reduced V{sub 95%} (p = 0.01) and D{sub mean} (p = 0.02), but not for VMAT. DS constraints resulted in increased dose to right kidney, spinal cord, stomach, and liver for VMAT. Direct comparison of DS VMAT and DS IMRT revealed that VMAT was superior in sparing the left kidney (p<0.001) and the spinal cord (p<0.001), whereas IMRT was superior in sparing the stomach (p = 0.05) and the liver (p = 0.003). DS VMAT required 21% fewer monitor units (p<0.001) and delivered treatment 2.4 minutes faster (p<0.001) than DS IMRT. Implementing DS constraints during SBRT planning for LAPC can significantly reduce duodenal point or volumetric dose parameters for both VMAT and IMRT. The primary consequence of implementing DS constraints for VMAT is increased dose to other organs at

  19. Single-Fraction Stereotactic Body Radiation Therapy and Sequential Gemcitabine for the Treatment of Locally Advanced Pancreatic Cancer

    International Nuclear Information System (INIS)

    Schellenberg, Devin; Kim, Jeff; Christman-Skieller, Claudia; Chun, Carlene L.; Columbo, Laurie Ann; Ford, James M.; Fisher, George A.; Kunz, Pamela L.; Van Dam, Jacques; Quon, Andrew; Desser, Terry S.; Norton, Jeffrey; Hsu, Annie; Maxim, Peter G.; Xing, Lei; Goodman, Karyn A.; Chang, Daniel T.; Koong, Albert C.

    2011-01-01

    Purpose: This Phase II trial evaluated the toxicity, local control, and overall survival in patients treated with sequential gemcitabine and linear accelerator-based single-fraction stereotactic body radiotherapy (SBRT). Methods and Materials: Twenty patients with locally advanced, nonmetastatic pancreatic adenocarcinoma were enrolled on this prospective single-institution, institutional review board-approved study. Gemcitabine was administered on Days 1, 8, and 15, and SBRT on Day 29. Gemcitabine was restarted on Day 43 and continued for 3-5 cycles. SBRT of 25 Gy in a single fraction was delivered to the internal target volume with a 2- 3-mm margin using a nine-field intensity-modulated radiotherapy technique. Respiratory gating was used to account for breathing motion. Follow-up evaluations occurred at 4-6 weeks, 10-12 weeks, and every 3 months after SBRT. Results: All patients completed SBRT and a median of five cycles of chemotherapy. Follow-up for the 2 remaining alive patients was 25.1 and 36.4 months. No acute Grade 3 or greater nonhematologic toxicity was observed. Late Grade 3 or greater toxicities occurred in 1 patient (5%) and consisted of a duodenal perforation (G4). Three patients (15%) developed ulcers (G2) that were medically managed. Overall, median survival was 11.8 months, with 1-year survival of 50% and 2-year survival of 20%. Using serial computed tomography, the freedom from local progression was 94% at 1 year. Conclusion: Linear accelerator-delivered SBRT with sequential gemcitabine resulted in excellent local control of locally advanced pancreatic cancer. Future studies will address strategies for reducing long-term duodenal toxicity associated with SBRT.

  20. TH-EF-BRB-03: Significant Cord and Esophagus Dose Reduction by 4π Non-Coplanar Spine Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Yu, V; Tran, A; Nguyen, D; Woods, K; Cao, M; Kaprealian, T; Chin, R; Low, D; Sheng, K [UCLA, Los Angeles, CA (United States)

    2016-06-15

    Purpose: To demonstrate significant organ-at-risk (OAR) sparing achievable with 4π non-coplanar radiotherapy on spine SBRT and SRS patients. Methods: Twenty-five stereotactic spine cases previously treated with VMAT (n = 23) or IMRT (n = 2) were included in this study. A computer-aided-design model of a Linac with a 3D-scanned human surface was utilized to determine the feasible beam space throughout the 4π steradian and beam specific source-to-target-distances (STD) required for collision avoidance. 4π radiotherapy plans integrating beam orientation and fluence map optimization were then created using a column-generation algorithm. Twenty optimal beams were selected for each case. To evaluate the tradeoff between dosimetric benefit and treatment complexity, 4π plans including only isocentrically deliverable beams were also created. Beam angles of all standard and isocentric 4π plans were imported into Eclipse to recalculate the dose using the same calculation engine as the clinical plans for unbiased comparison. OAR and PTV dose statistics for the clinical, standard-4π, and isocentric-4π plans were compared. Results: Comparing standard-4π to clinical plans, particularly significant average percent reduction in the [mean, maximum] dose of the cord and esophagus of [41%, 21.7%], and [38.7%, 36.4%] was observed, along with global decrease in all other OAR dose statistics. The average cord volume receiving more than 50% prescription dose was substantially decreased by 76%. In addition, improved PTV coverage was demonstrated with a maximum dose reduction of 0.93% and 1.66% increase in homogeneity index (D95/D5). All isocentric-4π plans achieved dosimetric performance equivalent to that of the standard-4π plans with higher delivery complexity. Conclusion: 4π radiotherapy significantly improves stereotactic spine treatment dosimetry. With the substantial OAR dose sparing, PTV dose escalation is considerably safer. Isocentric-4π is sufficient to achieve the

  1. Hypofractionated stereotactic body radiation therapy for elderly patients with stage IIB–IV nonsmall cell lung cancer who are ineligible for or refuse other treatment modalities

    Directory of Open Access Journals (Sweden)

    Karam SD

    2014-10-01

    Full Text Available Sana D Karam,1 Zachary D Horne,2 Robert L Hong,2 Don McRae,2 David Duhamel,3 Nadim M Nasr2 1Department of Radiation Oncology, University of Colorado, Denver, CO, USA; 2Department of Radiation Oncology, 3Department of Pulmonary/Critical Care Medicine, Virginia Hospital Center, Arlington, VA, USA Objective: In elderly patients with stage IIB–IV nonsmall cell lung cancer who cannot tolerate chemotherapy, conventionally fractionated radiotherapy is the treatment of choice. We present our experience with hypofractionated stereotactic body radiation therapy (SBRT in the treatment of this patient population. Methods: Thirty-three patients with a median age of 80 years treated with fractionated SBRT were retrospectively analyzed. Most patients were smokers and had preexisting lung disease and either refused treatment or were ineligible. A median prescribed dose of 40 Gy was delivered to the prescription isodose line over a median of five treatments. The majority of patients (70% did not receive chemotherapy. Results: With a median follow-up of 9 months (range: 4–40 months, the actuarial median overall survival (OS and progression-free survival were 12 months for both. One year actuarial survival outcomes were 75%, 58%, 44%, and 48% for local control, regional control, progression-free survival, and OS, respectively. Increased volume of disease was a statistically significant predictor of worse OS. Three patients developed a grade 1 cough that peaked 3 weeks after treatment and resolved within 1 month. One patient developed grade 1 tracheal mucositis and three patients developed grade 1 pneumonitis. Both resolved 6 weeks after treatment. Three patients died within the first month of treatment, but the cause of death did not appear to be related to the treatment. Conclusion: Hypofractionated SBRT is a relatively safe and convenient treatment option for elderly patients with inoperable stage IIB–IV nonsmall cell lung cancer. However, given the small

  2. Influence of Institutional Experience and Technological Advances on Outcome of Stereotactic Body Radiation Therapy for Oligometastatic Lung Disease.

    Science.gov (United States)

    Rieber, Juliane; Abbassi-Senger, Nasrin; Adebahr, Sonja; Andratschke, Nicolaus; Blanck, Oliver; Duma, Marciana; Eble, Michael J; Ernst, Iris; Flentje, Michael; Gerum, Sabine; Hass, Peter; Henkenberens, Christoph; Hildebrandt, Guido; Imhoff, Detlef; Kahl, Henning; Klass, Nathalie Desirée; Krempien, Robert; Lohaus, Fabian; Lohr, Frank; Petersen, Cordula; Schrade, Elsge; Streblow, Jan; Uhlmann, Lorenz; Wittig, Andrea; Sterzing, Florian; Guckenberger, Matthias

    2017-07-01

    Many technological and methodical advances have made stereotactic body radiotherapy (SBRT) more accurate and more efficient during the last years. This study aims to investigate whether experience in SBRT and technological innovations also translated into improved local control (LC) and overall survival (OS). A database of 700 patients treated with SBRT for lung metastases in 20 German centers between 1997 and 2014 was used for analysis. It was the aim of this study to investigate the impact of fluorodeoxyglucose positron-emission tomography (FDG-PET) staging, biopsy confirmation, image guidance, immobilization, and dose calculation algorithm, as well as the influence of SBRT experience, on LC and OS. Median follow-up time was 14.3 months (range, 0-131.9 months), with 2-year LC and OS of 81.2% (95% confidence interval [CI] 75.8%-85.7%) and 54.4% (95% CI 50.2%-59.0%), respectively. In multivariate analysis, all treatment technologies except FDG-PET staging did not significantly influence outcome. Patients who received pre-SBRT FDG-PET staging showed superior 1- and 2-year OS of 82.7% (95% CI 77.4%-88.6%) and 64.8% (95% CI 57.5%-73.3%), compared with patients without FDG-PET staging resulting in 1- and 2-year OS rates of 72.8% (95% CI 67.4%-78.8%) and 52.6% (95% CI 46.0%-60.4%), respectively (P=.012). Experience with SBRT was identified as the main prognostic factor for LC: institutions with higher SBRT experience (patients treated with SBRT within the last 2 years of the inclusion period) showed superior LC compared with less-experienced centers (P≤.001). Experience with SBRT within the last 2 years was independent from known prognostic factors for LC. Investigated technological and methodical advancements other than FDG-PET staging before SBRT did not significantly improve outcome in SBRT for pulmonary metastases. In contrast, LC was superior with increasing SBRT experience of the individual center. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Interpreting survival data from clinical trials of surgery versus stereotactic body radiation therapy in operable Stage I non-small cell lung cancer patients.

    Science.gov (United States)

    Samson, Pamela; Keogan, Kathleen; Crabtree, Traves; Colditz, Graham; Broderick, Stephen; Puri, Varun; Meyers, Bryan

    2017-01-01

    To identify the variability of short- and long-term survival outcomes among closed Phase III randomized controlled trials with small sample sizes comparing SBRT (stereotactic body radiation therapy) and surgical resection in operable clinical Stage I non-small cell lung cancer (NSCLC) patients. Clinical Stage I NSCLC patients who underwent surgery at our institution meeting the inclusion/exclusion criteria for STARS (Randomized Study to Compare CyberKnife to Surgical Resection in Stage I Non-small Cell Lung Cancer), ROSEL (Trial of Either Surgery or Stereotactic Radiotherapy for Early Stage (IA) Lung Cancer), or both were identified. Bootstrapping analysis provided 10,000 iterations to depict 30-day mortality and three-year overall survival (OS) in cohorts of 16 patients (to simulate the STARS surgical arm), 27 patients (to simulate the pooled surgical arms of STARS and ROSEL), and 515 (to simulate the goal accrual for the surgical arm of STARS). From 2000 to 2012, 749/873 (86%) of clinical Stage I NSCLC patients who underwent resection were eligible for STARS only, ROSEL only, or both studies. When patients eligible for STARS only were repeatedly sampled with a cohort size of 16, the 3-year OS rates ranged from 27 to 100%, and 30-day mortality varied from 0 to 25%. When patients eligible for ROSEL or for both STARS and ROSEL underwent bootstrapping with n=27, the 3-year OS ranged from 46 to 100%, while 30-day mortality varied from 0 to 15%. Finally, when patients eligible for STARS were repeatedly sampled in groups of 515, 3-year OS narrowed to 70-85%, with 30-day mortality varying from 0 to 4%. Short- and long-term survival outcomes from trials with small sample sizes are extremely variable and unreliable for extrapolation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  4. The Impact of Tumor Size on Outcomes After Stereotactic Body Radiation Therapy for Medically Inoperable Early-Stage Non-Small Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Allibhai, Zishan [Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto (Canada); Taremi, Mojgan [Department of Radiation Oncology, Stronach Regional Cancer Centre, Newmarket (Canada); Bezjak, Andrea; Brade, Anthony; Hope, Andrew J.; Sun, Alexander [Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto (Canada); Cho, B.C. John, E-mail: john.cho@rmp.uhn.on.ca [Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto (Canada)

    2013-12-01

    Purpose: Stereotactic body radiation therapy for medically inoperable early-stage non-small cell lung cancer (NSCLC) offers excellent control rates. Most published series deal mainly with small (usually <4 cm), peripheral, solitary tumors. Larger tumors are associated with poorer outcomes (ie, lower control rates, higher toxicity) when treated with conventional RT. It is unclear whether SBRT is sufficiently potent to control these larger tumors. We therefore evaluated and examined the influence of tumor size on treatment outcomes after SBRT. Methods and Materials: Between October 2004 and October 2010, 185 medically inoperable patients with early (T1-T2N0M0) NSCLC were treated on a prospective research ethics board-approved single-institution protocol. Prescription doses were risk-adapted based on tumor size and location. Follow-up included prospective assessment of toxicity (as per Common Terminology Criteria for Adverse Events, version 3.0) and serial computed tomography scans. Patterns of failure, toxicity, and survival outcomes were calculated using Kaplan-Meier method, and the significance of tumor size (diameter, volume) with respect to patient, treatment, and tumor factors was tested. Results: Median follow-up was 15.2 months. Tumor size was not associated with local failure but was associated with regional failure (P=.011) and distant failure (P=.021). Poorer overall survival (P=.001), disease-free survival (P=.001), and cause-specific survival (P=.005) were also significantly associated with tumor size (with tumor volume more significant than diameter). Gross tumor volume and planning target volume were significantly associated with grade 2 or worse radiation pneumonitis. However, overall rates of grade ≥3 pneumonitis were low and not significantly affected by tumor or target size. Conclusions: Currently employed stereotactic body radiation therapy dose regimens can provide safe effective local therapy even for larger solitary NSCLC tumors (up to 5.7 cm

  5. Stereotactic body radiation therapy for patients with recurrent pancreatic adenocarcinoma at the abdominal lymph nodes or postoperative stump including pancreatic stump and other stump

    Directory of Open Access Journals (Sweden)

    Zeng XL

    2016-06-01

    Full Text Available Xian-Liang Zeng,* Huan-Huan Wang,* Mao-Bin Meng, Zhi-Qiang Wu, Yong-Chun Song, Hong-Qing Zhuang, Dong Qian, Feng-Tong Li, Lu-Jun Zhao, Zhi-Yong Yuan, Ping Wang Department of Radiation Oncology, Tianjin’s Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People’s Republic of China *These authors contributed equally to this work Background and aim: The aim of this study is to evaluate the efficacy and safety of stereotactic body radiation therapy (SBRT using CyberKnife in the treatment of patients with recurrent pancreatic adenocarcinoma at the abdominal lymph node or stump after surgery. Patients and methods: Between October 1, 2006 and May 1, 2015, patients with recurrent pancreatic adenocarcinoma at the abdominal lymph node or stump after surgery were enrolled and treated with SBRT at our hospital. The primary end point was local control rate after SBRT. Secondary end points were overall survival, time to symptom alleviation, and toxicity, assessed using the Common Terminology Criteria for Adverse Events version 4.0. Results: Twenty-four patients with 24 lesions (17 abdominal lymph nodes and seven stumps were treated with SBRT, of which five patients presented with abdominal lymph nodes and synchronous metastases in the liver and lung. The 6-, 12-, and 24-month actuarial local control rates were 95.2%, 83.8%, and 62.1%, respectively. For the entire cohort, the median overall survival from diagnosis and SBRT was 28.9 and 12.2 months, respectively. Symptom alleviation was observed in eleven of 14 patients (78.6% within a median of 8 days (range, 1–14 days after SBRT. Nine patients (37.5% experienced Common Terminology Criteria for Adverse Events version 4.0 grade 1–2 acute toxicities; one patient experienced grade 3 acute toxicity due to thrombocytopenia. Conclusion: SBRT is a safe and

  6. Noncoplanar Beam Angle Class Solutions to Replace Time-Consuming Patient-Specific Beam Angle Optimization in Robotic Prostate Stereotactic Body Radiation Therapy

    International Nuclear Information System (INIS)

    Rossi, Linda; Breedveld, Sebastiaan; Aluwini, Shafak; Heijmen, Ben

    2015-01-01

    Purpose: To investigate development of a recipe for the creation of a beam angle class solution (CS) for noncoplanar prostate stereotactic body radiation therapy to replace time-consuming individualized beam angle selection (iBAS) without significant loss in plan quality, using the in-house “Erasmus-iCycle” optimizer for fully automated beam profile optimization and iBAS. Methods and Materials: For 30 patients, Erasmus-iCycle was first used to generate 15-, 20-, and 25-beam iBAS plans for a CyberKnife equipped with a multileaf collimator. With these plans, 6 recipes for creation of beam angle CSs were investigated. Plans of 10 patients were used to create CSs based on the recipes, and the other 20 to independently test them. For these tests, Erasmus-iCycle was also used to generate intensity modulated radiation therapy plans for the fixed CS beam setups. Results: Of the tested recipes for CS creation, only 1 resulted in 15-, 20-, and 25-beam noncoplanar CSs without plan deterioration compared with iBAS. For the patient group, mean differences in rectum D 1cc , V 60GyEq , V 40GyEq , and D mean between 25-beam CS plans and 25-beam plans generated with iBAS were 0.2 ± 0.4 Gy, 0.1% ± 0.2%, 0.2% ± 0.3%, and 0.1 ± 0.2 Gy, respectively. Differences between 15- and 20-beam CS and iBAS plans were also negligible. Plan quality for CS plans relative to iBAS plans was also preserved when narrower planning target volume margins were arranged and when planning target volume dose inhomogeneity was decreased. Using a CS instead of iBAS reduced the computation time by a factor of 14 to 25, mainly depending on beam number, without loss in plan quality. Conclusions: A recipe for creation of robust beam angle CSs for robotic prostate stereotactic body radiation therapy has been developed. Compared with iBAS, computation times decreased by a factor 14 to 25. The use of a CS may avoid long planning times without losses in plan quality

  7. Proton Arc Reduces Range Uncertainty Effects and Improves Conformality Compared With Photon Volumetric Modulated Arc Therapy in Stereotactic Body Radiation Therapy for Non-Small Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Seco, Joao, E-mail: jseco@partners.org [Francis H. Burr Proton Therapy Center, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Gu, Guan; Marcelos, Tiago; Kooy, Hanne; Willers, Henning [Francis H. Burr Proton Therapy Center, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States)

    2013-09-01

    Purpose: To describe, in a setting of non-small cell lung cancer (NSCLC), the theoretical dosimetric advantages of proton arc stereotactic body radiation therapy (SBRT) in which the beam penumbra of a rotating beam is used to reduce the impact of range uncertainties. Methods and Materials: Thirteen patients with early-stage NSCLC treated with proton SBRT underwent repeat planning with photon volumetric modulated arc therapy (Photon-VMAT) and an in-house-developed arc planning approach for both proton passive scattering (Passive-Arc) and intensity modulated proton therapy (IMPT-Arc). An arc was mimicked with a series of beams placed at 10° increments. Tumor and organ at risk doses were compared in the context of high- and low-dose regions, represented by volumes receiving >50% and <50% of the prescription dose, respectively. Results: In the high-dose region, conformality index values are 2.56, 1.91, 1.31, and 1.74, and homogeneity index values are 1.29, 1.22, 1.52, and 1.18, respectively, for 3 proton passive scattered beams, Passive-Arc, IMPT-Arc, and Photon-VMAT. Therefore, proton arc leads to a 30% reduction in the 95% isodose line volume to 3-beam proton plan, sparing surrounding organs, such as lung and chest wall. For chest wall, V30 is reduced from 21 cm{sup 3} (3 proton beams) to 11.5 cm{sup 3}, 12.9 cm{sup 3}, and 8.63 cm{sup 3} (P=.005) for Passive-Arc, IMPT-Arc, and Photon-VMAT, respectively. In the low-dose region, the mean lung dose and V20 of the ipsilateral lung are 5.01 Gy(relative biological effectiveness [RBE]), 4.38 Gy(RBE), 4.91 Gy(RBE), and 5.99 Gy(RBE) and 9.5%, 7.5%, 9.0%, and 10.0%, respectively, for 3-beam, Passive-Arc, IMPT-Arc, and Photon-VMAT, respectively. Conclusions: Stereotactic body radiation therapy with proton arc and Photon-VMAT generate significantly more conformal high-dose volumes than standard proton SBRT, without loss of coverage of the tumor and with significant sparing of nearby organs, such as chest wall. In addition

  8. Noncoplanar Beam Angle Class Solutions to Replace Time-Consuming Patient-Specific Beam Angle Optimization in Robotic Prostate Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Rossi, Linda, E-mail: l.rossi@erasmusmc.nl; Breedveld, Sebastiaan; Aluwini, Shafak; Heijmen, Ben

    2015-07-15

    Purpose: To investigate development of a recipe for the creation of a beam angle class solution (CS) for noncoplanar prostate stereotactic body radiation therapy to replace time-consuming individualized beam angle selection (iBAS) without significant loss in plan quality, using the in-house “Erasmus-iCycle” optimizer for fully automated beam profile optimization and iBAS. Methods and Materials: For 30 patients, Erasmus-iCycle was first used to generate 15-, 20-, and 25-beam iBAS plans for a CyberKnife equipped with a multileaf collimator. With these plans, 6 recipes for creation of beam angle CSs were investigated. Plans of 10 patients were used to create CSs based on the recipes, and the other 20 to independently test them. For these tests, Erasmus-iCycle was also used to generate intensity modulated radiation therapy plans for the fixed CS beam setups. Results: Of the tested recipes for CS creation, only 1 resulted in 15-, 20-, and 25-beam noncoplanar CSs without plan deterioration compared with iBAS. For the patient group, mean differences in rectum D{sub 1cc}, V{sub 60GyEq}, V{sub 40GyEq}, and D{sub mean} between 25-beam CS plans and 25-beam plans generated with iBAS were 0.2 ± 0.4 Gy, 0.1% ± 0.2%, 0.2% ± 0.3%, and 0.1 ± 0.2 Gy, respectively. Differences between 15- and 20-beam CS and iBAS plans were also negligible. Plan quality for CS plans relative to iBAS plans was also preserved when narrower planning target volume margins were arranged and when planning target volume dose inhomogeneity was decreased. Using a CS instead of iBAS reduced the computation time by a factor of 14 to 25, mainly depending on beam number, without loss in plan quality. Conclusions: A recipe for creation of robust beam angle CSs for robotic prostate stereotactic body radiation therapy has been developed. Compared with iBAS, computation times decreased by a factor 14 to 25. The use of a CS may avoid long planning times without losses in plan quality.

  9. Stereotactic body radiotherapy for liver tumors. Principles and practical guidelines of the DEGRO Working Group on Stereotactic Radiotherapy

    International Nuclear Information System (INIS)

    Sterzing, Florian; Brunner, Thomas B.; Ernst, Iris; Greve, Burkhard; Baus, Wolfgang W.; Herfarth, Klaus; Guckenberger, Matthias

    2014-01-01

    This report of the Working Group on Stereotactic Radiotherapy of the German Society of Radiation Oncology (DEGRO) aims to provide a practical guideline for safe and effective stereotactic body radiotherapy (SBRT) of liver tumors. The literature on the clinical evidence of SBRT for both primary liver tumors and liver metastases was reviewed and analyzed focusing on both physical requirements and special biological characteristics. Recommendations were developed for patient selection, imaging, planning, treatment delivery, motion management, dose reporting, and follow-up. Radiation dose constraints to critical organs at risk are provided. SBRT is a well-established treatment option for primary and secondary liver tumors associated with low morbidity. (orig.) [de

  10. SU-F-T-587: Quality Assurance of Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiation Therapy (SBRT) for Patient Specific Plans: A Comparison Between MATRIXX and Delta4 QA Devices

    Energy Technology Data Exchange (ETDEWEB)

    Tsai, YC; Lu, SH; Chen, LH; Kuo, SH; Wang, CW [National Taiwan University Hospital, Taipei City, Taiwan (China)

    2016-06-15

    Purpose: Patient-specific quality assurance (QA) is necessary to accurately deliver high dose radiation to the target, especially for stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT). Unlike previous 2 dimensional (D) array QA devices, Delta{sup 4} can verify the dose delivery in 3D. In this study, the difference between calculated and measured dose distribution was compared with two QA devices (MATRIXX and Delta{sup 4}) to evaluate the delivery accuracy. Methods: Twenty-seven SRS/SBRT plans with VMAT were verified with point-dose and dose-map analysis. We use an ion chamber (A1SL, 0.053cc) for point-dose measurement. For verification of the dose map, the differences between the calculated and measured doses were analyzed with a gamma index using MATRIXX and Delta{sup 4} devices. The passing criteria for gamma evaluation were set at 3 mm for distance-to-agreement (DTA) and 3% for dose-difference. A gamma index less than 1 was defined as the verification passing the criteria and satisfying at least 95% of the points. Results: The mean prescribed dose and fraction was 40 ± 14.41 Gy (range: 16–60) and 10 ± 2.35 fractions (range: 1–8), respectively. In point dose analysis, the differences between the calculated and measured doses were all less than 5% (mean: 2.12 ± 1.13%; range: −0.55% to 4.45%). In dose-map analysis, the average passing rates were 99.38 ± 0.96% (range: 95.31–100%) and 100 ± 0.12% (range: 99.5%–100%) for MATRIXX and Delta{sup 4}, respectively. Even using criteria of 2%/2 mm, the passing rate of Delta{sup 4} was still more than 95% (mean: 99 ± 1.08%; range: 95.6%–100%). Conclusion: Both MATRIXX and Delta{sup 4} offer accurate and efficient verification for SRS/SBRT plans. The results measured by MATRIXX and Delta{sup 4} dosimetry systems are similar for SRS/SBRT performed with the VMAT technique.

  11. WE-G-BRD-07: Investigation of Distal Lung Atelectasis Following Stereotactic Body Radiation Therapy Using Regional Lung Volume Changes Between Pre- and Post- Treatment CT Scans

    Energy Technology Data Exchange (ETDEWEB)

    Diot, Q; Kavanagh, B; Miften, M [University of Colorado School of Medicine, Aurora, CO (United States)

    2014-06-15

    Purpose: To propose a quantitative method using lung deformations to differentiate between radiation-induced fibrosis and potential airway stenosis with distal atelectasis in patients treated with stereotactic body radiation therapy (SBRT) for lung tumors. Methods: Twenty-four lung patients with large radiation-induced density increases outside the high dose region had their pre- and post-treatment CT scans manually registered. They received SBRT treatments at our institution between 2002 and 2009 in 3 or 5 fractions, to a median total dose of 54Gy (range, 30–60). At least 50 anatomical landmarks inside the lung (airway branches) were paired for the pre- and post-treatment scans to guide the deformable registration of the lung structure, which was then interpolated to the whole lung using splines. Local volume changes between the planning and follow-up scans were calculated using the deformation field Jacobian. Hyperdense regions were classified as atelectatic or fibrotic based on correlations between regional density increases and significant volume contractions compared to the surrounding tissues. Results: Out of 24 patients, only 7 demonstrated a volume contraction that was at least one σ larger than the remaining lung average. Because they did not receive high doses, these shrunk hyperdense regions were likely showing distal atelectasis resulting from radiation-induced airway stenosis rather than conventional fibrosis. On average, the hyperdense regions extended 9.2 cm farther than the GTV contours but not significantly more than 8.6 cm for the other patients (p>0.05), indicating that a large offset between the radiation and hyperdense region centers is not a good surrogate for atelectasis. Conclusion: A method based on the relative comparison of volume changes between different dates was developed to identify potential lung regions experiencing distal atelectasis. Such a tool is essential to study which lung structures need to be avoided to prevent

  12. The influence of target and patient characteristics on the volume obtained from cone beam CT in lung stereotactic body radiation therapy

    International Nuclear Information System (INIS)

    Liu, Hong-Wei; Khan, Rao; D’Ambrosi, Rafael; Krobutschek, Krista; Nugent, Zoann; Lau, Harold

    2013-01-01

    Purpose: To investigate the influence of tumor and patient characteristics on the target volume obtained from cone beam CT (CBCT) in lung stereotactic body radiation therapy (SBRT). Materials and methods: For a given cohort of 71 patients, the internal target volume (ITV) in CBCT obtained from four different datasets was compared with a reference ITV drawn on a four-dimensional CT (4DCT). The significance of the tumor size, location, relative target motion (RM) and patient’s body mass index (BMI) and gender on the adequacy of ITV obtained from CBCT was determined. Results: The median ITV-CBCT was found to be smaller than the ITV-4DCT by 11.8% (range: −49.8 to +24.3%, P < 0.001). Small tumors located in the lower lung were found to have a larger RM than large tumors in the upper lung. Tumors located near the central lung had high CT background which reduced the target contrast near the edges. Tumor location close to center vs. periphery was the only significant factor (P = 0.046) causing underestimation of ITV in CBCT, rather than RM (P = 0.323) and other factors. Conclusions: The current clinical study has identified that the location of tumor is a major source of discrepancy between ITV-CBCT and ITV-4DCT for lung SBRT

  13. Clinical Analysis of stereotactic body radiation therapy using extracranial gamma knife for patients with mainly bulky inoperable early stage non-small cell lung carcinoma

    Directory of Open Access Journals (Sweden)

    Tang Hanjun

    2011-07-01

    Full Text Available Abstract Purpose To evaluate the clinical efficacy and toxicity of stereotactic body radiation therapy (SBRT using extracranial gamma knife in patients with mainly bulky inoperable early stage non-small cell lung carcinoma (NSCLC. Materials and methods A total of 43 medically inoperable patients with mainly bulky Stage I/II NSCLC received SBRT using gamma knife were reviewed. The fraction dose and the total dose were determined by the radiation oncologist according to patients' general status, tumor location, tumor size and the relationship between tumor and nearby organ at risk (OAR. The total dose of 34~47.5 Gy was prescribed in 4~12 fractions, 3.5~10 Gy per fraction, one fraction per day or every other day. The therapeutic efficacy and toxicity were evaluated. Results The median follow-up was 22 months (range, 3-102 months. The local tumor response rate was 95.35%, with CR 18.60% (8/43 and PR 76.74% (33/43, respectively. The local control rates at 1, 2, 3, 5 years were 77.54%, 53.02%, 39.77%, and 15.46%, respectively, while the 1- and 2-year local control rates were 75% and 60% for tumor ≤3 cm; 84% and 71% for tumor sized 3~5 cm; 55% and 14.6% for tumor sized 5~7 cm; and 45%, 21% in those with tumor size of >7 cm. The overall survival rate at 1, 2, 3, 5 years were 92.04%, 78.04%, 62.76%, 42.61%, respectively. The toxicity of stereotactic radiation therapy was grade 1-2. Clinical stages were significantly important factor in local control of lung tumors (P = 0.000. Both clinical stages (P = 0.015 and chemotherapy (P = 0.042 were significantly important factors in overall survival of lung tumors. Conclusion SBRT is an effective and safe therapy for medically inoperable patients with early stage NSCLC. Clinical stage was the significant prognostic factors for both local tumor control and overall survival. The toxicity is mild. The overall local control for bulky tumors is poor. Tumor size is a poor prognostic factor, and the patients for

  14. Stereotactic body radiation therapy (SBRT) in the treatment of liver metastases: State of the art; Radiotherapie en conditions stereotaxiques des metastases hepatiques

    Energy Technology Data Exchange (ETDEWEB)

    De Bari, B.; Guillet, M.; Mornex, F. [Departement de radiotherapie oncologie, centre hospitalier Lyon-Sud, chemin du Grand-Revoyet, 69310 Pierre-Benite (France); EA3738, domaine Rockefeller, universite Claude-Bernard, 8, avenue Rockefeller, 69373 Lyon cedex 08 (France)

    2011-02-15

    Liver metastases are frequently found in oncologic patients. Chemotherapy is the standard treatment in pluri-metastatic patients, with the possibility to obtain a clear improvement of their prognosis. Local treatment (surgery, radiofrequency, cryo-therapy, radiotherapy, etc.) could be proposed for oligo-metastatic patients, particularly for those with a good prognosis. Historically, radiation therapy has had a limited role in the treatment of liver metastases because of its toxicity when whole liver irradiation was delivered. Improvements in the knowledge of liver radiobiology and radio-pathology as well as technical innovations in delivering radiation therapy are the basis of the modern partial liver irradiation concept. In this historical and therapeutic landscape, extracranial stereotactic radiation therapy is particularly interesting for the treatment of liver metastases. This review summarises published data on stereotactic radiotherapy for the treatment of liver metastases. (authors)

  15. Dosimetric evaluation of 4 different treatment modalities for curative-intent stereotactic body radiation therapy for isolated thoracic spinal metastases

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Jun [Department of Radiation Oncology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 (China); Department of Oncology, First Affiliated Hospital of Xinxiang Medical University, 88 Jiankang Road, Weihui, Henan, 453100 (China); Ma, Lin [Department of Radiation Oncology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 (China); Department of Radiation Oncology, Hainan Branch of Chinese PLA General Hospital, Haitang Bay, Sanya, 572000 (China); Wang, Xiao-Shen; Xu, Wei Xu; Cong, Xiao-Hu; Xu, Shou-Ping; Ju, Zhong-Jian [Department of Radiation Oncology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 (China); Du, Lei [Department of Radiation Oncology, Hainan Branch of Chinese PLA General Hospital, Haitang Bay, Sanya, 572000 (China); Cai, Bo-Ning [Department of Radiation Oncology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853 (China); Yang, Jack [Department of Radiation Oncology, Monmouth Medical Center, 300 2nd Avenue, Long Branch, NJ 07740 (United States)

    2016-07-01

    To investigate the dosimetric characteristics of 4 SBRT-capable dose delivery systems, CyberKnife (CK), Helical TomoTherapy (HT), Volumetric Modulated Arc Therapy (VMAT) by Varian RapidArc (RA), and segmental step-and-shoot intensity-modulated radiation therapy (IMRT) by Elekta, on isolated thoracic spinal lesions. CK, HT, RA, and IMRT planning were performed simultaneously for 10 randomly selected patients with 6 body types and 6 body + pedicle types with isolated thoracic lesions. The prescription was set with curative intent and dose of either 33 Gy in 3 fractions (3F) or 40 Gy in 5F to cover at least 90% of the planning target volume (PTV), correspondingly. Different dosimetric indices, beam-on time, and monitor units (MUs) were evaluated to compare the advantages/disadvantages of each delivery modality. In ensuring the dose-volume constraints for cord and esophagus of the premise, CK, HT, and RA all achieved a sharp conformity index (CI) and a small penumbra volume compared to IMRT. RA achieved a CI comparable to those from CK, HT, and IMRT. CK had a heterogeneous dose distribution in the target as its radiosurgical nature with less dose uniformity inside the target. CK had the longest beam-on time and the largest MUs, followed by HT and RA. IMRT presented the shortest beam-on time and the least MUs delivery. For the body-type lesions, CK, HT, and RA satisfied the target coverage criterion in 6 cases, but the criterion was satisfied in only 3 (50%) cases with the IMRT technique. For the body + pedicle-type lesions, HT satisfied the criterion of the target coverage of ≥90% in 4 of the 6 cases, and reached a target coverage of 89.0% in another case. However, the criterion of the target coverage of ≥90% was reached in 2 cases by CK and RA, and only in 1 case by IMRT. For curative-intent SBRT of isolated thoracic spinal lesions, RA is the first choice for the body-type lesions owing to its delivery efficiency (time); the second choice is CK or HT; HT is the

  16. Dosimetric evaluation of 4 different treatment modalities for curative-intent stereotactic body radiation therapy for isolated thoracic spinal metastases

    International Nuclear Information System (INIS)

    Yang, Jun; Ma, Lin; Wang, Xiao-Shen; Xu, Wei Xu; Cong, Xiao-Hu; Xu, Shou-Ping; Ju, Zhong-Jian; Du, Lei; Cai, Bo-Ning; Yang, Jack

    2016-01-01

    To investigate the dosimetric characteristics of 4 SBRT-capable dose delivery systems, CyberKnife (CK), Helical TomoTherapy (HT), Volumetric Modulated Arc Therapy (VMAT) by Varian RapidArc (RA), and segmental step-and-shoot intensity-modulated radiation therapy (IMRT) by Elekta, on isolated thoracic spinal lesions. CK, HT, RA, and IMRT planning were performed simultaneously for 10 randomly selected patients with 6 body types and 6 body + pedicle types with isolated thoracic lesions. The prescription was set with curative intent and dose of either 33 Gy in 3 fractions (3F) or 40 Gy in 5F to cover at least 90% of the planning target volume (PTV), correspondingly. Different dosimetric indices, beam-on time, and monitor units (MUs) were evaluated to compare the advantages/disadvantages of each delivery modality. In ensuring the dose-volume constraints for cord and esophagus of the premise, CK, HT, and RA all achieved a sharp conformity index (CI) and a small penumbra volume compared to IMRT. RA achieved a CI comparable to those from CK, HT, and IMRT. CK had a heterogeneous dose distribution in the target as its radiosurgical nature with less dose uniformity inside the target. CK had the longest beam-on time and the largest MUs, followed by HT and RA. IMRT presented the shortest beam-on time and the least MUs delivery. For the body-type lesions, CK, HT, and RA satisfied the target coverage criterion in 6 cases, but the criterion was satisfied in only 3 (50%) cases with the IMRT technique. For the body + pedicle-type lesions, HT satisfied the criterion of the target coverage of ≥90% in 4 of the 6 cases, and reached a target coverage of 89.0% in another case. However, the criterion of the target coverage of ≥90% was reached in 2 cases by CK and RA, and only in 1 case by IMRT. For curative-intent SBRT of isolated thoracic spinal lesions, RA is the first choice for the body-type lesions owing to its delivery efficiency (time); the second choice is CK or HT; HT is the

  17. Radiological differential diagnosis between fibrosis and recurrence after stereotactic body radiation therapy (SBRT) in early stage non-small cell lung cancer (NSCLC).

    Science.gov (United States)

    Frakulli, Rezarta; Salvi, Fabrizio; Balestrini, Damiano; Palombarini, Marcella; Akshija, Ilir; Cammelli, Silvia; Morganti, Alessio Giuseppe; Zompatori, Maurizio; Frezza, Giovanni

    2017-12-01

    Parenchymal changes after stereotactic body radiation therapy (SBRT) make differential diagnosis between treatment outcomes and disease recurrence often difficult. The purpose of our study was to identify the radiographic features detectable at computed tomography (CT) scan [high-risk features (HRFs)] that allow enough specificity and sensitivity for early detection of recurrence. We retrospectively evaluated patients who underwent SBRT for inoperable early stage non-small cell lung cancer (NSCLC). The median delivered dose performed was 50 Gy in 5 fractions prescribed to 80% isodose. All patients underwent chest CT scan before SBRT and at 3, 6, 12, 18, 24 months after, and then annually. Each CT scan was evaluated and benign and HRFs were recorded. 18 F-fluorodeoxyglucose-CT was not used routinely. Forty-five patients were included (34 males, 11 females; median age: 77 years; stage IA: 77.8%, stage IB: 22.2%; median follow-up: 21.7 months). Two year and actuarial local control was 77%. HRFs were identified in 20 patients. The most significant predictor of relapse was an enlarging opacity at 12 months (P2 HRFs.

  18. Predictors of Rectal Tolerance Observed in a Dose-Escalated Phase 1-2 Trial of Stereotactic Body Radiation Therapy for Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, D.W. Nathan [Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Cho, L. Chinsoo [Department of Radiation Oncology, University of Minnesota, Minneapolis, Minnesota (United States); Straka, Christopher [Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Christie, Alana [Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Lotan, Yair [Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Pistenmaa, David [Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Kavanagh, Brian D. [Department of Radiation Oncology, University of Colorado, Denver, Colorado (United States); Nanda, Akash [Department of Radiation Oncology, University of Florida Health Cancer Center at Orlando Health, Orlando, Florida (United States); Kueplian, Patrick [Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California (United States); Brindle, Jeffrey [Prairie Lakes Hospital, Watertown, South Dakota (United States); Cooley, Susan; Perkins, Alida [Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Raben, David [Department of Radiation Oncology, University of Colorado, Denver, Colorado (United States); Xie, Xian-Jin [Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas (United States); Timmerman, Robert D., E-mail: robert.timmerman@utsouthwestern.edu [Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas (United States)

    2014-07-01

    Purpose: To convey the occurrence of isolated cases of severe rectal toxicity at the highest dose level tested in 5-fraction stereotactic body radiation therapy (SBRT) for localized prostate cancer; and to rationally test potential causal mechanisms to guide future studies and experiments to aid in mitigating or altogether avoiding such severe bowel injury. Methods and Materials: Clinical and treatment planning data were analyzed from 91 patients enrolled from 2006 to 2011 on a dose-escalation (45, 47.5, and 50 Gy in 5 fractions) phase 1/2 clinical study of SBRT for localized prostate cancer. Results: At the highest dose level, 6.6% of patients treated (6 of 91) developed high-grade rectal toxicity, 5 of whom required colostomy. Grade 3+ delayed rectal toxicity was strongly correlated with volume of rectal wall receiving 50 Gy >3 cm{sup 3} (P<.0001), and treatment of >35% circumference of rectal wall to 39 Gy (P=.003). Grade 2+ acute rectal toxicity was significantly correlated with treatment of >50% circumference of rectal wall to 24 Gy (P=.010). Conclusion: Caution is advised when considering high-dose SBRT for treatment of tumors near bowel structures, including prostate cancer. Threshold dose constraints developed from physiologic principles are defined, and if respected can minimize risk of severe rectal toxicity.

  19. Stereotactic body radiotherapy for Stage I lung cancer with chronic obstructive pulmonary disease. Special reference to survival and radiation-induced pneumonitis

    International Nuclear Information System (INIS)

    Inoue, Toshihiko; Shiomi, Hiroya; Oh, Ryoong-Jin

    2015-01-01

    This retrospective study aimed to evaluate radiation-induced pneumonitis (RIP) and a related condition that we define in this report — prolonged minimal RIP (pmRIP) — after stereotactic body radiotherapy (SBRT) for Stage I primary lung cancer in patients with chronic obstructive pulmonary disease (COPD). We assessed 136 Stage I lung cancer patients with COPD who underwent SBRT. Airflow limitation on spirometry was classified into four Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades, with minor modifications: GOLD 1 (mild), GOLD 2 (moderate), GOLD 3 (severe) and GOLD 4 (very severe). On this basis, we defined two subgroups: COPD-free (COPD -) and COPD-positive (COPD +). There was no significant difference in overall survival or cause-specific–survival between these groups. Of the 136 patients, 44 (32%) had pmRIP. Multivariate analysis showed that COPD and the Brinkman index were statistically significant risk factors for the development of pmRIP. COPD and the Brinkman index were predictive factors for pmRIP, although our findings also indicate that SBRT can be tolerated in early lung cancer patients with COPD. (author)

  20. Pretreatment Modified Glasgow Prognostic Score Predicts Clinical Outcomes After Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kishi, Takahiro; Matsuo, Yukinori, E-mail: ymatsuo@kuhp.kyoto-u.ac.jp; Ueki, Nami; Iizuka, Yusuke; Nakamura, Akira; Sakanaka, Katsuyuki; Mizowaki, Takashi; Hiraoka, Masahiro

    2015-07-01

    Purpose: This study aimed to evaluate the prognostic significance of the modified Glasgow Prognostic Score (mGPS) in patients with non-small cell lung cancer (NSCLC) who received stereotactic body radiation therapy (SBRT). Methods and Materials: Data from 165 patients who underwent SBRT for stage I NSCLC with histologic confirmation from January 1999 to September 2010 were collected retrospectively. Factors, including age, performance status, histology, Charlson comorbidity index, mGPS, and recursive partitioning analysis (RPA) class based on sex and T stage, were evaluated with regard to overall survival (OS) using the Cox proportional hazards model. The impact of the mGPS on cause of death and failure patterns was also analyzed. Results: The 3-year OS was 57.9%, with a median follow-up time of 3.5 years. A higher mGPS correlated significantly with poor OS (P<.001). The 3-year OS of lower mGPS patients was 66.4%, whereas that of higher mGPS patients was 44.5%. On multivariate analysis, mGPS and RPA class were significant factors for OS. A higher mGPS correlated significantly with lung cancer death (P=.019) and distant metastasis (P=.013). Conclusions: The mGPS was a significant predictor of clinical outcomes for SBRT in NSCLC patients.

  1. Response assessment of stereotactic body radiation therapy using dynamic contrast-enhanced integrated MR-PET in non-small cell lung cancer patients.

    Science.gov (United States)

    Huang, Yu-Sen; Chen, Jenny Ling-Yu; Hsu, Feng-Ming; Huang, Jei-Yie; Ko, Wei-Chun; Chen, Yi-Chang; Jaw, Fu-Shan; Yen, Ruoh-Fang; Chang, Yeun-Chung

    2018-01-01

    To evaluate the response in patients undergoing SBRT using dynamic contrast-enhanced (DCE) integrated magnetic resonance positron emission tomography (MR-PET). Stereotactic body radiation therapy (SBRT) is efficacious as a front-line local treatment for non-small cell lung cancer (NSCLC). We prospectively enrolled 19 lung tumors in 17 nonmetastatic NSCLC patients who were receiving SBRT as a primary treatment. They underwent DCE-integrated 3T MR-PET before and 6 weeks after SBRT. The following image parameters were analyzed: tumor size, standardized uptake value (SUV), apparent diffusion coefficient, K trans , k ep , v e , v p , and iAUC 60 . Chest computed tomography (CT) was performed at 3 months after SBRT. SBRT treatment led to tumor changes including significant decreases in the SUV max (-61%, P PET SUV max was correlated with the MR k ep mean (P = 0.002) and k ep SD (P 10 (P = 0.083). In patients with NSCLC who are receiving SBRT, DCE-integrated MR-PET can be used to evaluate the response after SBRT and to predict the local treatment outcome. 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:191-199. © 2017 International Society for Magnetic Resonance in Medicine.

  2. Incidence and Predictive Factors of Pain Flare After Spine Stereotactic Body Radiation Therapy: Secondary Analysis of Phase 1/2 Trials

    International Nuclear Information System (INIS)

    Pan, Hubert Y.; Allen, Pamela K.; Wang, Xin S.; Chang, Eric L.; Rhines, Laurence D.; Tatsui, Claudio E.; Amini, Behrang; Wang, Xin A.; Tannir, Nizar M.; Brown, Paul D.; Ghia, Amol J.

    2014-01-01

    Purpose/Objective(s): To perform a secondary analysis of institutional prospective spine stereotactic body radiation therapy (SBRT) trials to investigate posttreatment acute pain flare. Methods and Materials: Medical records for enrolled patients were reviewed. Study protocol included baseline and follow-up surveys with pain assessment by Brief Pain Inventory and documentation of pain medications. Patients were considered evaluable for pain flare if clinical note or follow-up survey was completed within 2 weeks of SBRT. Pain flare was defined as a clinical note indicating increased pain at the treated site or survey showing a 2-point increase in worst pain score, a 25% increase in analgesic intake, or the initiation of steroids. Binary logistic regression was used to determine predictive factors for pain flare occurrence. Results: Of the 210 enrolled patients, 195 (93%) were evaluable for pain flare, including 172 (88%) clinically, 135 (69%) by survey, and 112 (57%) by both methods. Of evaluable patients, 61 (31%) had undergone prior surgery, 57 (29%) had received prior radiation, and 34 (17%) took steroids during treatment, mostly for prior conditions. Pain flare was observed in 44 patients (23%). Median time to pain flare was 5 days (range, 0-20 days) after the start of treatment. On multivariate analysis, the only independent factor associated with pain flare was the number of treatment fractions (odds ratio = 0.66, P=.004). Age, sex, performance status, spine location, number of treated vertebrae, prior radiation, prior surgery, primary tumor histology, baseline pain score, and steroid use were not significant. Conclusions: Acute pain flare after spine SBRT is a relatively common event, for which patients should be counseled. Additional study is needed to determine whether prophylactic or symptomatic intervention is preferred

  3. Incidence and Predictive Factors of Pain Flare After Spine Stereotactic Body Radiation Therapy: Secondary Analysis of Phase 1/2 Trials

    Energy Technology Data Exchange (ETDEWEB)

    Pan, Hubert Y.; Allen, Pamela K. [Department of Radiation Oncology, University of Texas MD Anderson Cancer, Houston, Texas (United States); Wang, Xin S. [Department of Symptom Research, University of Texas MD Anderson Cancer, Houston, Texas (United States); Chang, Eric L. [Department of Radiation Oncology, University of Texas MD Anderson Cancer, Houston, Texas (United States); Department of Radiation Oncology, USC Norris Cancer Center, Los Angeles, California (United States); Rhines, Laurence D.; Tatsui, Claudio E. [Department of Neurosurgery, University of Texas MD Anderson Cancer, Houston, Texas (United States); Amini, Behrang [Department of Diagnostic Radiology, University of Texas MD Anderson Cancer, Houston, Texas (United States); Wang, Xin A. [Department of Radiation Physics, University of Texas MD Anderson Cancer, Houston, Texas (United States); Tannir, Nizar M. [Department of Genitourinary Medical Oncology, University of Texas MD Anderson Cancer, Houston, Texas (United States); Brown, Paul D. [Department of Radiation Oncology, University of Texas MD Anderson Cancer, Houston, Texas (United States); Ghia, Amol J., E-mail: AJGhia@mdanderson.org [Department of Radiation Oncology, University of Texas MD Anderson Cancer, Houston, Texas (United States)

    2014-11-15

    Purpose/Objective(s): To perform a secondary analysis of institutional prospective spine stereotactic body radiation therapy (SBRT) trials to investigate posttreatment acute pain flare. Methods and Materials: Medical records for enrolled patients were reviewed. Study protocol included baseline and follow-up surveys with pain assessment by Brief Pain Inventory and documentation of pain medications. Patients were considered evaluable for pain flare if clinical note or follow-up survey was completed within 2 weeks of SBRT. Pain flare was defined as a clinical note indicating increased pain at the treated site or survey showing a 2-point increase in worst pain score, a 25% increase in analgesic intake, or the initiation of steroids. Binary logistic regression was used to determine predictive factors for pain flare occurrence. Results: Of the 210 enrolled patients, 195 (93%) were evaluable for pain flare, including 172 (88%) clinically, 135 (69%) by survey, and 112 (57%) by both methods. Of evaluable patients, 61 (31%) had undergone prior surgery, 57 (29%) had received prior radiation, and 34 (17%) took steroids during treatment, mostly for prior conditions. Pain flare was observed in 44 patients (23%). Median time to pain flare was 5 days (range, 0-20 days) after the start of treatment. On multivariate analysis, the only independent factor associated with pain flare was the number of treatment fractions (odds ratio = 0.66, P=.004). Age, sex, performance status, spine location, number of treated vertebrae, prior radiation, prior surgery, primary tumor histology, baseline pain score, and steroid use were not significant. Conclusions: Acute pain flare after spine SBRT is a relatively common event, for which patients should be counseled. Additional study is needed to determine whether prophylactic or symptomatic intervention is preferred.

  4. Urethrogram-directed Stereotactic Body Radiation Therapy (SBRT for Clinically Localized Prostate Cancer in Patients with Contraindications to Magnetic Resonance Imaging

    Directory of Open Access Journals (Sweden)

    Ima ePaydar

    2015-09-01

    Full Text Available Purpose: Magnetic resonance imaging (MRI-directed stereotactic body radiation therapy (SBRT has been established as a safe and effective treatment for prostate cancer. For patients with contraindications to MRI, CT-urethrogram is an alternative imaging approach to identify the location of the prostatic apex to guide treatment. This study sought to evaluate the safety of urethrogram-directed SBRT for prostate cancer.Methods: Between February 2009 and January 2014, 31 men with clinically localized prostate cancer were treated definitively with urethrogram-directed SBRT with or without supplemental intensity modulated radiation therapy (IMRT at Georgetown University Hospital. SBRT was delivered either as a primary treatment of 35-36.25 Gray (Gy in 5 fractions or as a boost of 19.5 Gy in 3 fractions followed by supplemental conventionally fractionated intensity modulated radiation therapy (45-50.4 Gy. Toxicities were recorded and scored using the Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v.4.0.Results: The median patient age was 70 years with a median prostate volume of 38 cc. The median follow-up was 3.7 years. The patients were elderly (Median age = 70, and comorbidities were common (Carlson Comorbidity Index > 2 in 36%. 71% of patients utilized alpha agonists prior to treatment, and 9.7% had prior procedures for benign prostatic hyperplasia (BPH. The 3-year actuarial incidence rates of > Grade 3 GU toxicity and > Grade 2 GI toxicity were 3.2% and 9.7%, respectively. There were no Grade 4 or 5 toxicities.Conclusions: MRI is the preferred imaging modality to guide prostate SBRT treatment. However, urethrogram-directed SBRT is a safe alternative for the treatment of patients with prostate cancer who are unable to undergo MRI.

  5. Comparison of the Effectiveness of Radiofrequency Ablation With Stereotactic Body Radiation Therapy in Inoperable Stage I Non-Small Cell Lung Cancer: A Systemic Review and Pooled Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Bi, Nan [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Shedden, Kerby [Department of Biostatistics, University of Michigan, Ann Arbor, Michigan (United States); Zheng, Xiangpeng [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Kong, Feng-Ming, E-mail: fskong@iupui.edu [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Department of Radiation Oncology, Indiana University, Indianapolis (United States)

    2016-08-01

    Purpose: To performed a systematic review and pooled analysis to compare clinical outcomes of stereotactic body radiation therapy (SBRT) and radiofrequency ablation (RFA) for the treatment of medically inoperable stage I non-small cell lung cancer. Methods and Materials: A comprehensive literature search for published trials from 2001 to 2012 was undertaken. Pooled analyses were performed to obtain overall survival (OS) and local tumor control rates (LCRs) and adverse events. Regression analysis was conducted considering each study's proportions of stage IA and age. Results: Thirty-one studies on SBRT (2767 patients) and 13 studies on RFA (328 patients) were eligible. The LCR (95% confidence interval) at 1, 2, 3, and 5 years for RFA was 77% (70%-85%), 48% (37%-58%), 55% (47%-62%), and 42% (30%-54%) respectively, which was significantly lower than that for SBRT: 97% (96%-98%), 92% (91%-94%), 88% (86%-90%), and 86% (85%-88%) (P<.001). These differences remained significant after correcting for stage IA and age (P<.001 at 1 year, 2 years, and 3 years; P=.04 at 5 years). The effect of RFA was not different from that of SBRT on OS (P>.05). The most frequent complication of RFA was pneumothorax, occurring in 31% of patients, whereas that for SBRT (grade ≥3) was radiation pneumonitis, occurring in 2% of patients. Conclusions: Compared with RFA, SBRT seems to have a higher LCR but similar OS. More studies with larger sample sizes are warranted to validate such findings.

  6. Quantification of incidental mediastinal and hilar irradiation delivered during definitive stereotactic body radiation therapy for peripheral non-small cell lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Martin, Kate L.; Gomez, Jorge; Nazareth, Daryl P.; Warren, Graham W. [Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY (United States); Singh, Anurag K., E-mail: anurag.singh@roswellpark.org [Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY (United States)

    2012-07-01

    To determine the amount of incidental radiation dose received by the mediastinal and hilar nodes for patients with non-small cell lung cancer (NSCLC) treated with stereotactic body radiation therapy (SBRT). Fifty consecutive patients with NSCLC, treated using an SBRT technique, were identified. Of these patients, 38 had a prescription dose of 60 Gy in 20-Gy fractions and were eligible for analysis. For each patient, ipsilateral upper (level 2) and lower (level 4) paratracheal, and hilar (level 10) nodal regions were contoured on the planning computed tomography (CT) images. Using the clinical treatment plan, dose and volume calculations were performed retrospectively for each nodal region. SBRT to upper lobe tumors resulted in an average total ipsilateral mean dose of between 5.2 and 7.8 Gy for the most proximal paratracheal nodal stations (2R and 4R for right upper lobe lesions, 2L and 4L for left upper lobe lesions). SBRT to lower lobe tumors resulted in an average total ipsilateral mean dose of between 15.6 and 21.5 Gy for the most proximal hilar nodal stations (10R for right lower lobe lesions, 10 l for left lower lobe lesions). Doses to more distal nodes were substantially lower than 5 Gy. The often substantial incidental irradiation, delivered during SBRT for peripheral NSCLC of the lower lobes to the most proximal hilar lymph nodes may be therapeutic for low-volume, subclinical nodal disease. Treatment of peripheral upper lobe lung tumors delivers less incidental irradiation to the paratracheal lymph nodes with lower likelihood of therapeutic benefit.

  7. Quantification of incidental mediastinal and hilar irradiation delivered during definitive stereotactic body radiation therapy for peripheral non–small cell lung cancer

    International Nuclear Information System (INIS)

    Martin, Kate L.; Gomez, Jorge; Nazareth, Daryl P.; Warren, Graham W.; Singh, Anurag K.

    2012-01-01

    To determine the amount of incidental radiation dose received by the mediastinal and hilar nodes for patients with non–small cell lung cancer (NSCLC) treated with stereotactic body radiation therapy (SBRT). Fifty consecutive patients with NSCLC, treated using an SBRT technique, were identified. Of these patients, 38 had a prescription dose of 60 Gy in 20-Gy fractions and were eligible for analysis. For each patient, ipsilateral upper (level 2) and lower (level 4) paratracheal, and hilar (level 10) nodal regions were contoured on the planning computed tomography (CT) images. Using the clinical treatment plan, dose and volume calculations were performed retrospectively for each nodal region. SBRT to upper lobe tumors resulted in an average total ipsilateral mean dose of between 5.2 and 7.8 Gy for the most proximal paratracheal nodal stations (2R and 4R for right upper lobe lesions, 2L and 4L for left upper lobe lesions). SBRT to lower lobe tumors resulted in an average total ipsilateral mean dose of between 15.6 and 21.5 Gy for the most proximal hilar nodal stations (10R for right lower lobe lesions, 10 l for left lower lobe lesions). Doses to more distal nodes were substantially lower than 5 Gy. The often substantial incidental irradiation, delivered during SBRT for peripheral NSCLC of the lower lobes to the most proximal hilar lymph nodes may be therapeutic for low-volume, subclinical nodal disease. Treatment of peripheral upper lobe lung tumors delivers less incidental irradiation to the paratracheal lymph nodes with lower likelihood of therapeutic benefit.

  8. Efficacy of flattening-filter-free beam in stereotactic body radiation therapy planning and treatment: A systematic review with meta-analysis

    International Nuclear Information System (INIS)

    Dang, Thu M.; Peters, Mitchell J.; Hickey, Brigid; Semciw, Adam

    2017-01-01

    A linear accelerator with the flattening-filter removed generates a non-uniform dose profile beam. We aimed to analyse and compare plan quality and treatment time between flattened beam (FB) and flattening-filter-free (FFF) beam to assess the efficacy of FFF beam for stereotactic body radiation therapy (SBRT). The search strategy was based around 3 concepts; radiation therapy, flattening-filter-free and treatment delivery. The years searched were restricted from 2010 to date of review (October 2015). All plan quality comparisons were between FFF and FB plans from the same data sets. We identified 210 potential studies based on the three searched concepts. All articles were screened by two authors for title and abstract and by three authors for full text. Ten studies met the eligibility criteria. Plan quality was evaluated using conformity index (CI), heterogeneity index (HI) and gradient index (GI). Dose to organs-at-risk (OAR) and healthy tissues were compared. Differences between beam-on-time (BOT) and treatment time (T × T) were also analysed. Normalized percentage ratios of CI and HI demonstrated no clinical differences among the studied articles. GI displayed small variations between the articles favouring FFF beam. The BOT with FFF is substantially reduced, and appears to impact the frequency of intra-fraction imaging which, in turn, affects total treatment time. Based on planning tumour volume (PTV) coverage, dose to OAR and healthy tissue sparing, FFF beam is clinically effective for the treatment of cancer patients using SBRT. We recommend the use of FFF beam for SBRT based on these factors and the reported overall treatment time reduction.

  9. Use of Image-Guided Stereotactic Body Radiation Therapy in Lieu of Intracavitary Brachytherapy for the Treatment of Inoperable Endometrial Neoplasia

    Energy Technology Data Exchange (ETDEWEB)

    Kemmerer, Eric [Department of Radiation Oncology, Temple University Hospital, Philadelphia, Pennsylvania (United States); Hernandez, Enrique; Ferriss, James S. [Department of Obstetrics and Gynecology, Temple University Hospital, Philadelphia, Pennsylvania (United States); Valakh, Vladimir; Miyamoto, Curtis; Li, Shidong [Department of Radiation Oncology, Temple University Hospital, Philadelphia, Pennsylvania (United States); Micaily, Bizhan, E-mail: bizhan.micaily@tuhs.temple.edu [Department of Radiation Oncology, Temple University Hospital, Philadelphia, Pennsylvania (United States)

    2013-01-01

    Purpose: Retrospective analysis of patients with invasive endometrial neoplasia who were treated with external beam radiation therapy followed by stereotactic body radiation therapy (SBRT) boost because of the inability to undergo surgery or brachytherapy. Methods and Materials: We identified 11 women with stage I-III endometrial cancer with a median age of 78 years that were not candidates for hysterectomy or intracavitary brachytherapy secondary to comorbidities (91%) or refusal (9%). Eight patients were American Joint Committee on Cancer (AJCC) stage I (3 stage IA, 5 stage IB), and 3 patients were AJCC stage III. Patients were treated to a median of 4500 cGy at 180 cGy per fraction followed by SBRT boost (600 cGy per fraction Multiplication-Sign 5). Results: The most common side effect was acute grade 1 gastrointestinal toxicity in 73% of patients, with no late toxicities observed. With a median follow-up of 10 months since SBRT, 5 patients (45%) experienced locoregional disease progression, with 3 patients (27%) succumbing to their malignancy. At 12 and 18 months from SBRT, the overall freedom from progression was 68% and 41%, respectively. Overall freedom from progression (FFP) was 100% for all patients with AJCC stage IA endometrial carcinoma, whereas it was 33% for stage IB at 18 months. The overall FFP was 100% for International Federation of Obstetrics and Gynecology grade 1 disease. The estimated overall survival was 57% at 18 months from diagnosis. Conclusion: In this study, SBRT boost to the intact uterus was feasible, with encouragingly low rates of acute and late toxicity, and favorable disease control in patients with early-stage disease. Additional studies are needed to provide better insight into the best management of these clinically challenging cases.

  10. No Clinically Significant Changes in Pulmonary Function Following Stereotactic Body Radiation Therapy for Early- Stage Peripheral Non-Small Cell Lung Cancer: An Analysis of RTOG 0236

    Energy Technology Data Exchange (ETDEWEB)

    Stanic, Sinisa, E-mail: sinisa.stanic@carle.com [Carle Cancer Center and University of Illinois College of Medicine, Urbana, Illinois (United States); Paulus, Rebecca [Radiation Therapy Oncology Group Statistical Center, Philadelphia, Pennsylvania (United States); Timmerman, Robert D. [University of Texas Southwestern, Dallas, Texas (United States); Michalski, Jeff M. [Washington University, St. Louis, Missouri (United States); Barriger, Robert B. [Indiana University, Indianapolis, Indiana (United States); Bezjak, Andrea [Princess Margaret Cancer Center, Toronto, Ontario (Canada); Videtic, Gregory M.M. [Cleveland Clinic Foundation, Cleveland, Ohio (United States); Bradley, Jeffrey [Washington University, St. Louis, Missouri (United States)

    2014-04-01

    Purpose: To investigate pulmonary function test (PFT) results and arterial blood gas changes (complete PFT) following stereotactic body radiation therapy (SBRT) and to see whether baseline PFT correlates with lung toxicity and overall survival in medically inoperable patients receiving SBRT for early stage, peripheral, non-small cell lung cancer (NSCLC). Methods and Materials: During the 2-year follow-up, PFT data were collected for patients with T1-T2N0M0 peripheral NSCLC who received effectively 18 Gy × 3 in a phase 2 North American multicenter study (Radiation Therapy Oncology Group [RTOG] protocol 0236). Pulmonary toxicity was graded by using the RTOG SBRT pulmonary toxicity scale. Paired Wilcoxon signed rank test, logistic regression model, and Kaplan-Meier method were used for statistical analysis. Results: At 2 years, mean percentage predicted forced expiratory volume in the first second and diffusing capacity for carbon monoxide declines were 5.8% and 6.3%, respectively, with minimal changes in arterial blood gases and no significant decline in oxygen saturation. Baseline PFT was not predictive of any pulmonary toxicity following SBRT. Whole-lung V5 (the percentage of normal lung tissue receiving 5 Gy), V10, V20, and mean dose to the whole lung were almost identical between patients who developed pneumonitis and patients who were pneumonitis-free. Poor baseline PFT did not predict decreased overall survival. Patients with poor baseline PFT as the reason for medical inoperability had higher median and overall survival rates than patients with normal baseline PFT values but with cardiac morbidity. Conclusions: Poor baseline PFT did not appear to predict pulmonary toxicity or decreased overall survival after SBRT in this medically inoperable population. Poor baseline PFT alone should not be used to exclude patients with early stage lung cancer from treatment with SBRT.

  11. No Clinically Significant Changes in Pulmonary Function Following Stereotactic Body Radiation Therapy for Early- Stage Peripheral Non-Small Cell Lung Cancer: An Analysis of RTOG 0236

    International Nuclear Information System (INIS)

    Stanic, Sinisa; Paulus, Rebecca; Timmerman, Robert D.; Michalski, Jeff M.; Barriger, Robert B.; Bezjak, Andrea; Videtic, Gregory M.M.; Bradley, Jeffrey

    2014-01-01

    Purpose: To investigate pulmonary function test (PFT) results and arterial blood gas changes (complete PFT) following stereotactic body radiation therapy (SBRT) and to see whether baseline PFT correlates with lung toxicity and overall survival in medically inoperable patients receiving SBRT for early stage, peripheral, non-small cell lung cancer (NSCLC). Methods and Materials: During the 2-year follow-up, PFT data were collected for patients with T1-T2N0M0 peripheral NSCLC who received effectively 18 Gy × 3 in a phase 2 North American multicenter study (Radiation Therapy Oncology Group [RTOG] protocol 0236). Pulmonary toxicity was graded by using the RTOG SBRT pulmonary toxicity scale. Paired Wilcoxon signed rank test, logistic regression model, and Kaplan-Meier method were used for statistical analysis. Results: At 2 years, mean percentage predicted forced expiratory volume in the first second and diffusing capacity for carbon monoxide declines were 5.8% and 6.3%, respectively, with minimal changes in arterial blood gases and no significant decline in oxygen saturation. Baseline PFT was not predictive of any pulmonary toxicity following SBRT. Whole-lung V5 (the percentage of normal lung tissue receiving 5 Gy), V10, V20, and mean dose to the whole lung were almost identical between patients who developed pneumonitis and patients who were pneumonitis-free. Poor baseline PFT did not predict decreased overall survival. Patients with poor baseline PFT as the reason for medical inoperability had higher median and overall survival rates than patients with normal baseline PFT values but with cardiac morbidity. Conclusions: Poor baseline PFT did not appear to predict pulmonary toxicity or decreased overall survival after SBRT in this medically inoperable population. Poor baseline PFT alone should not be used to exclude patients with early stage lung cancer from treatment with SBRT

  12. Hepatic arterial phase and portal venous phase computed tomography for dose calculation of stereotactic body radiation therapy plans in liver cancer: a dosimetric comparison study

    International Nuclear Information System (INIS)

    Xiao, Jianghong; Li, Yan; Jiang, Qingfeng; Sun, Lan; Henderson Jr, Fraser; Wang, Yongsheng; Jiang, Xiaoqin; Li, Guangjun; Chen, Nianyong

    2013-01-01

    To investigate the effect of computed tomography (CT) using hepatic arterial phase (HAP) and portal venous phase (PVP) contrast on dose calculation of stereotactic body radiation therapy (SBRT) for liver cancer. Twenty-one patients with liver cancer were studied. HAP, PVP and non-enhanced CTs were performed on subjects scanned in identical positions under active breathing control (ABC). SBRT plans were generated using seven-field three-dimensional conformal radiotherapy (7 F-3D-CRT), seven-field intensity-modulated radiotherapy (7 F-IMRT) and single-arc volumetric modulated arc therapy (VMAT) based on the PVP CT. Plans were copied to the HAP and non-enhanced CTs. Radiation doses calculated from the three phases of CTs were compared with respect to the planning target volume (PTV) and the organs at risk (OAR) using the Friedman test and the Wilcoxon signed ranks test. SBRT plans calculated from either PVP or HAP CT, including 3D-CRT, IMRT and VMAT plans, demonstrated significantly lower (p <0.05) minimum absorbed doses covering 98%, 95%, 50% and 2% of PTV (D98%, D95%, D50% and D2%) than those calculated from non-enhanced CT. The mean differences between PVP or HAP CT and non-enhanced CT were less than 2% and 1% respectively. All mean dose differences between the three phases of CTs for OARs were less than 2%. Our data indicate that though the differences in dose calculation between contrast phases are not clinically relevant, dose underestimation (IE, delivery of higher-than-intended doses) resulting from CT using PVP contrast is larger than that resulting from CT using HAP contrast when compared against doses based upon non-contrast CT in SBRT treatment of liver cancer using VMAT, IMRT or 3D-CRT

  13. Stereotactic body radiation therapy via helical tomotherapy to replace brachytherapy for brachytherapy-unsuitable cervical cancer patients – a preliminary result

    Directory of Open Access Journals (Sweden)

    Hsieh CH

    2013-02-01

    Full Text Available Chen-Hsi Hsieh,1–3 Hui-Ju Tien,1 Sheng-Mou Hsiao,4 Ming-Chow Wei,4 Wen-Yih Wu,4 Hsu-Dong Sun,4 Li-Ying Wang,5 Yen-Ping Hsieh,6 Yu-Jen Chen,3,7–9 Pei-Wei Shueng1,101Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei, Taiwan; 2Department of Medicine, 3Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 4Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Taipei, Taiwan; 5School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; 6Department of Senior Citizen Service Management, National Taichung University of Science and Technology, Taichung, Taiwan; 7Department of Radiation Oncology, 8Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; 9Graduate Institute of Sport Coaching Science, Chinese Culture University, Taipei, Taiwan; 10Department of Radiation Oncology, National Defense Medical Center, Taipei, TaiwanAim: To review the experience and to evaluate the results of stereotactic body radiation therapy (SBRT via helical tomotherapy (HT, for the treatment of brachytherapy-unsuitable cervical cancer.Methods: Between September 1, 2008 to January 31, 2012, nine cervical cancer patients unsuitable for brachytherapy were enrolled. All of the patients received definitive whole pelvic radiotherapy with or without chemotherapy, followed by SBRT via HT.Results: The actuarial locoregional control rate at 3 years was 78%. The mean biological equivalent dose in 2-Gy fractions of the tumor, rectum, bladder, and intestines was 76.0 ± 7.3, 73.8 ± 13.2, 70.5 ± 10.0, and 43.1 ± 7.1, respectively. Only two had residual tumors after treatment, and the others were tumor-free. Two patients experienced grade 3 acute toxicity: one had diarrhea; and another experienced thrombocytopenia. There were no grade 3 or 4 subacute toxicities. Three patients suffered from manageable rectal bleeding in

  14. Benchmark Credentialing Results for NRG-BR001: The First National Cancer Institute-Sponsored Trial of Stereotactic Body Radiation Therapy for Multiple Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Al-Hallaq, Hania A., E-mail: halhallaq@radonc.uchicago.edu [Department of Radiation and Cellular Oncology, Chicago, Illinois (United States); Chmura, Steven J. [Department of Radiation and Cellular Oncology, Chicago, Illinois (United States); Salama, Joseph K. [Department of Radiation Oncology, Durham, North Carolina (United States); Lowenstein, Jessica R. [Imaging and Radiation Oncology Core Group (IROC) Houston, MD Anderson Cancer Center, Houston, Texas (United States); McNulty, Susan; Galvin, James M. [Imaging and Radiation Oncology Core Group (IROC) PHILADELPHIA RT, Philadelphia, Pennsylvania (United States); Followill, David S. [Imaging and Radiation Oncology Core Group (IROC) Houston, MD Anderson Cancer Center, Houston, Texas (United States); Robinson, Clifford G. [Department of Radiation Oncology, St Louis, Missouri (United States); Pisansky, Thomas M. [Department of Radiation Oncology, Rochester, Minnesota (United States); Winter, Kathryn A. [NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania (United States); White, Julia R. [Department of Radiation Oncology, Columbus, Ohio (United States); Xiao, Ying [Imaging and Radiation Oncology Core Group (IROC) PHILADELPHIA RT, Philadelphia, Pennsylvania (United States); Department of Radiation Oncology, Philadelphia, Pennsylvania (United States); Matuszak, Martha M. [Department of Radiation Oncology, Ann Arbor, Michigan (United States)

    2017-01-01

    Purpose: The NRG-BR001 trial is the first National Cancer Institute–sponsored trial to treat multiple (range 2-4) extracranial metastases with stereotactic body radiation therapy. Benchmark credentialing is required to ensure adherence to this complex protocol, in particular, for metastases in close proximity. The present report summarizes the dosimetric results and approval rates. Methods and Materials: The benchmark used anonymized data from a patient with bilateral adrenal metastases, separated by <5 cm of normal tissue. Because the planning target volume (PTV) overlaps with organs at risk (OARs), institutions must use the planning priority guidelines to balance PTV coverage (45 Gy in 3 fractions) against OAR sparing. Submitted plans were processed by the Imaging and Radiation Oncology Core and assessed by the protocol co-chairs by comparing the doses to targets, OARs, and conformity metrics using nonparametric tests. Results: Of 63 benchmarks submitted through October 2015, 94% were approved, with 51% approved at the first attempt. Most used volumetric arc therapy (VMAT) (78%), a single plan for both PTVs (90%), and prioritized the PTV over the stomach (75%). The median dose to 95% of the volume was 44.8 ± 1.0 Gy and 44.9 ± 1.0 Gy for the right and left PTV, respectively. The median dose to 0.03 cm{sup 3} was 14.2 ± 2.2 Gy to the spinal cord and 46.5 ± 3.1 Gy to the stomach. Plans that spared the stomach significantly reduced the dose to the left PTV and stomach. Conformity metrics were significantly better for single plans that simultaneously treated both PTVs with VMAT, intensity modulated radiation therapy, or 3-dimensional conformal radiation therapy compared with separate plans. No significant differences existed in the dose at 2 cm from the PTVs. Conclusions: Although most plans used VMAT, the range of conformity and dose falloff was large. The decision to prioritize either OARs or PTV coverage varied considerably, suggesting that

  15. Survival Outcome After Stereotactic Body Radiation Therapy and Surgery for Stage I Non-Small Cell Lung Cancer: A Meta-Analysis

    International Nuclear Information System (INIS)

    Zheng, Xiangpeng; Schipper, Matthew; Kidwell, Kelley; Lin, Jules; Reddy, Rishindra; Ren, Yanping; Chang, Andrew; Lv, Fanzhen; Orringer, Mark; Spring Kong, Feng-Ming

    2014-01-01

    Purpose: This study compared treatment outcomes of stereotactic body radiation therapy (SBRT) with those of surgery in stage I non-small cell lung cancer (NSCLC). Methods and Materials: Eligible studies of SBRT and surgery were retrieved through extensive searches of the PubMed, Medline, Embase, and Cochrane library databases from 2000 to 2012. Original English publications of stage I NSCLC with adequate sample sizes and adequate SBRT doses were included. A multivariate random effects model was used to perform a meta-analysis to compare survival between treatments while adjusting for differences in patient characteristics. Results: Forty SBRT studies (4850 patients) and 23 surgery studies (7071 patients) published in the same period were eligible. The median age and follow-up duration were 74 years and 28.0 months for SBRT patients and 66 years and 37 months for surgery patients, respectively. The mean unadjusted overall survival rates at 1, 3, and 5 years with SBRT were 83.4%, 56.6%, and 41.2% compared to 92.5%, 77.9%, and 66.1% with lobectomy and 93.2%, 80.7%, and 71.7% with limited lung resections. In SBRT studies, overall survival improved with increasing proportion of operable patients. After we adjusted for proportion of operable patients and age, SBRT and surgery had similar estimated overall and disease-free survival. Conclusions: Patients treated with SBRT differ substantially from patients treated with surgery in age and operability. After adjustment for these differences, OS and DFS do not differ significantly between SBRT and surgery in patients with operable stage I NSCLC. A randomized prospective trial is warranted to compare the efficacy of SBRT and surgery

  16. SU-F-R-53: CT-Based Radiomics Analysis of Non-Small Cell Lung Cancer Patients Treated with Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Huynh, E; Coroller, T; Narayan, V; Agrawal, V; Hou, Y; Romano, J; Franco, I; Mak, R; Aerts, H [Brigham Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA (United States)

    2016-06-15

    Purpose: Stereotactic body radiation therapy (SBRT) is the standard of care for medically inoperable non-small cell lung cancer (NSCLC) patients and has demonstrated excellent local control and survival. However, some patients still develop distant metastases and local recurrence, and therefore, there is a clinical need to identify patients at high-risk of disease recurrence. The aim of the current study is to use a radiomics approach to identify imaging biomarkers, based on tumor phenotype, for clinical outcomes in SBRT patients. Methods: Radiomic features were extracted from free breathing computed tomography (CT) images of 113 Stage I-II NSCLC patients treated with SBRT. Their association to and prognostic performance for distant metastasis (DM), locoregional recurrence (LRR) and survival was assessed and compared with conventional features (tumor volume and diameter) and clinical parameters (e.g. performance status, overall stage). The prognostic performance was evaluated using the concordance index (CI). Multivariate model performance was evaluated using cross validation. All p-values were corrected for multiple testing using the false discovery rate. Results: Radiomic features were associated with DM (one feature), LRR (one feature) and survival (four features). Conventional features were only associated with survival and one clinical parameter was associated with LRR and survival. One radiomic feature was significantly prognostic for DM (CI=0.670, p<0.1 from random), while none of the conventional and clinical parameters were significant for DM. The multivariate radiomic model had a higher median CI (0.671) for DM than the conventional (0.618) and clinical models (0.617). Conclusion: Radiomic features have potential to be imaging biomarkers for clinical outcomes that conventional imaging metrics and clinical parameters cannot predict in SBRT patients, such as distant metastasis. Development of a radiomics biomarker that can identify patients at high-risk of

  17. Comparison of helical, maximum intensity projection (MIP), and averaged intensity (AI) 4D CT imaging for stereotactic body radiation therapy (SBRT) planning in lung cancer

    International Nuclear Information System (INIS)

    Bradley, Jeffrey D.; Nofal, Ahmed N.; El Naqa, Issam M.; Lu, Wei; Liu, Jubei; Hubenschmidt, James; Low, Daniel A.; Drzymala, Robert E.; Khullar, Divya

    2006-01-01

    Background and Purpose: To compare helical, MIP and AI 4D CT imaging, for the purpose of determining the best CT-based volume definition method for encompassing the mobile gross tumor volume (mGTV) within the planning target volume (PTV) for stereotactic body radiation therapy (SBRT) in stage I lung cancer. Materials and methods: Twenty patients with medically inoperable peripheral stage I lung cancer were planned for SBRT. Free-breathing helical and 4D image datasets were obtained for each patient. Two composite images, the MIP and AI, were automatically generated from the 4D image datasets. The mGTV contours were delineated for the MIP, AI and helical image datasets for each patient. The volume for each was calculated and compared using analysis of variance and the Wilcoxon rank test. A spatial analysis for comparing center of mass (COM) (i.e. isocenter) coordinates for each imaging method was also performed using multivariate analysis of variance. Results: The MIP-defined mGTVs were significantly larger than both the helical- (p 0.001) and AI-defined mGTVs (p = 0.012). A comparison of COM coordinates demonstrated no significant spatial difference in the x-, y-, and z-coordinates for each tumor as determined by helical, MIP, or AI imaging methods. Conclusions: In order to incorporate the extent of tumor motion from breathing during SBRT, MIP is superior to either helical or AI images for defining the mGTV. The spatial isocenter coordinates for each tumor were not altered significantly by the imaging methods

  18. Differences in the dose-volume metrics with heterogeneity correction status and its influence on local control in stereotactic body radiation therapy for lung cancer

    International Nuclear Information System (INIS)

    Ueki, Nami; Matsuo, Yukinori; Nakamura, Mitsuhiro; Narabayashi, Masaru; Sakanaka, Katsuyuki; Norihisa, Yoshiki; Mizowaki, Takashi; Hiraoka, Masahiro; Shibuya, Keiko

    2013-01-01

    The purpose of this study is to evaluate the dose-volume metrics under different heterogeneity corrections and the factors associated with local recurrence (LR) after stereotactic body radiation therapy (SBRT) for non-small-cell lung cancer (NSCLC). Eighty-three patients who underwent SBRT for pathologically proven stage I NSCLC were reviewed retrospectively. The prescribed dose was 48 Gy in four fractions at the isocenter (IC) under heterogeneity correction with the Batho power law (BPL). The clinical plans were recalculated with Eclipse (Varian) for the same monitor units under the BPL and anisotropic analytical algorithm (AAA) and with no heterogeneity correction (NC). The dose at the IC, dose that covers 95% of the volume (D95), minimum dose (Min), and mean dose (Mean) of the planning target volume (PTV) were compared under each algorithm and between patients with local lesion control (LC) and LR. The IC doses under NC were significantly lower than those under the BPL and AAA. Under the BPL, the mean PTV D95, Min and Mean were 8.0, 9.4 and 7.4% higher than those under the AAA, and 9.6, 9.2 and 4.6% higher than those under NC, respectively. Under the AAA, all dose-volumetric parameters were significantly lower in T1a patients than in those with T1b and T2a. With a median follow-up of 35.9 months, LR occurred in 18 patients. Between the LC and LR groups, no significant differences were observed for any of the metrics. Even after stratification according to T-stage, no significant difference was observed between LC and LR. (author)

  19. SU-F-T-250: What Does It Take to Correctly Assess the High Failure Modes of an Advanced Radiotherapy Procedure Such as Stereotactic Body Radiation Therapy?

    International Nuclear Information System (INIS)

    Han, D; Vile, D; Rosu, M; Palta, J

    2016-01-01

    Purpose: Assess the correct implementation of risk-based methodology of TG 100 to optimize quality management and patient safety procedures for Stereotactic Body Radiation Therapy. Methods: A detailed process map of SBRT treatment procedure was generated by a team of three physicists with varying clinical experience at our institution to assess the potential high-risk failure modes. The probabilities of occurrence (O), severity (S) and detectability (D) for potential failure mode in each step of the process map were assigned by these individuals independently on the scale from1 to 10. The risk priority numbers (RPN) were computed and analyzed. The highest 30 potential modes from each physicist’s analysis were then compared. Results: The RPN values assessed by the three physicists ranged from 30 to 300. The magnitudes of the RPN values from each physicist were different, and there was no concordance in the highest RPN values recorded by three physicists independently. The 10 highest RPN values belonged to sub steps of CT simulation, contouring and delivery in the SBRT process map. For these 10 highest RPN values, at least two physicists, irrespective of their length of experience had concordance but no general conclusions emerged. Conclusion: This study clearly shows that the risk-based assessment of a clinical process map requires great deal of preparation, group discussions, and participation by all stakeholders. One group albeit physicists cannot effectively implement risk-based methodology proposed by TG100. It should be a team effort in which the physicists can certainly play the leading role. This also corroborates TG100 recommendation that risk-based assessment of clinical processes is a multidisciplinary team effort.

  20. Effect of intra-fraction motion on the accumulated dose for free-breathing MR-guided stereotactic body radiation therapy of renal-cell carcinoma

    Science.gov (United States)

    Stemkens, Bjorn; Glitzner, Markus; Kontaxis, Charis; de Senneville, Baudouin Denis; Prins, Fieke M.; Crijns, Sjoerd P. M.; Kerkmeijer, Linda G. W.; Lagendijk, Jan J. W.; van den Berg, Cornelis A. T.; Tijssen, Rob H. N.

    2017-09-01

    Stereotactic body radiation therapy (SBRT) has shown great promise in increasing local control rates for renal-cell carcinoma (RCC). Characterized by steep dose gradients and high fraction doses, these hypo-fractionated treatments are, however, prone to dosimetric errors as a result of variations in intra-fraction respiratory-induced motion, such as drifts and amplitude alterations. This may lead to significant variations in the deposited dose. This study aims to develop a method for calculating the accumulated dose for MRI-guided SBRT of RCC in the presence of intra-fraction respiratory variations and determine the effect of such variations on the deposited dose. For this, RCC SBRT treatments were simulated while the underlying anatomy was moving, based on motion information from three motion models with increasing complexity: (1) STATIC, in which static anatomy was assumed, (2) AVG-RESP, in which 4D-MRI phase-volumes were time-weighted, and (3) PCA, a method that generates 3D volumes with sufficient spatio-temporal resolution to capture respiration and intra-fraction variations. Five RCC patients and two volunteers were included and treatments delivery was simulated, using motion derived from subject-specific MR imaging. Motion was most accurately estimated using the PCA method with root-mean-squared errors of 2.7, 2.4, 1.0 mm for STATIC, AVG-RESP and PCA, respectively. The heterogeneous patient group demonstrated relatively large dosimetric differences between the STATIC and AVG-RESP, and the PCA reconstructed dose maps, with hotspots up to 40% of the D99 and an underdosed GTV in three out of the five patients. This shows the potential importance of including intra-fraction motion variations in dose calculations.

  1. Survival Outcome After Stereotactic Body Radiation Therapy and Surgery for Stage I Non-Small Cell Lung Cancer: A Meta-Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Zheng, Xiangpeng [Department of Radiation Oncology, Huadong Hospital, Fudan University, Shanghai (China); Schipper, Matthew [Department of Radiation Oncology, the University of Michigan, Ann Arbor, Michigan (United States); Department of Biostatistics, the University of Michigan, Ann Arbor, Michigan (United States); Kidwell, Kelley [Department of Biostatistics, the University of Michigan, Ann Arbor, Michigan (United States); Lin, Jules; Reddy, Rishindra [Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan (United States); Ren, Yanping [Department of Radiation Oncology, Huadong Hospital, Fudan University, Shanghai (China); Chang, Andrew [Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan (United States); Lv, Fanzhen [Department of Thoracic Surgery, Huadong Hospital, Fudan University, Shanghai (China); Orringer, Mark [Department of Surgery, Section of Thoracic Surgery, University of Michigan, Ann Arbor, Michigan (United States); Spring Kong, Feng-Ming, E-mail: Fkong@gru.edu [Department of Radiation Oncology, the University of Michigan, Ann Arbor, Michigan (United States)

    2014-11-01

    Purpose: This study compared treatment outcomes of stereotactic body radiation therapy (SBRT) with those of surgery in stage I non-small cell lung cancer (NSCLC). Methods and Materials: Eligible studies of SBRT and surgery were retrieved through extensive searches of the PubMed, Medline, Embase, and Cochrane library databases from 2000 to 2012. Original English publications of stage I NSCLC with adequate sample sizes and adequate SBRT doses were included. A multivariate random effects model was used to perform a meta-analysis to compare survival between treatments while adjusting for differences in patient characteristics. Results: Forty SBRT studies (4850 patients) and 23 surgery studies (7071 patients) published in the same period were eligible. The median age and follow-up duration were 74 years and 28.0 months for SBRT patients and 66 years and 37 months for surgery patients, respectively. The mean unadjusted overall survival rates at 1, 3, and 5 years with SBRT were 83.4%, 56.6%, and 41.2% compared to 92.5%, 77.9%, and 66.1% with lobectomy and 93.2%, 80.7%, and 71.7% with limited lung resections. In SBRT studies, overall survival improved with increasing proportion of operable patients. After we adjusted for proportion of operable patients and age, SBRT and surgery had similar estimated overall and disease-free survival. Conclusions: Patients treated with SBRT differ substantially from patients treated with surgery in age and operability. After adjustment for these differences, OS and DFS do not differ significantly between SBRT and surgery in patients with operable stage I NSCLC. A randomized prospective trial is warranted to compare the efficacy of SBRT and surgery.

  2. SU-F-T-250: What Does It Take to Correctly Assess the High Failure Modes of an Advanced Radiotherapy Procedure Such as Stereotactic Body Radiation Therapy?

    Energy Technology Data Exchange (ETDEWEB)

    Han, D; Vile, D; Rosu, M; Palta, J [Virginia Commonwealth University, Richmond, VA (United States)

    2016-06-15

    Purpose: Assess the correct implementation of risk-based methodology of TG 100 to optimize quality management and patient safety procedures for Stereotactic Body Radiation Therapy. Methods: A detailed process map of SBRT treatment procedure was generated by a team of three physicists with varying clinical experience at our institution to assess the potential high-risk failure modes. The probabilities of occurrence (O), severity (S) and detectability (D) for potential failure mode in each step of the process map were assigned by these individuals independently on the scale from1 to 10. The risk priority numbers (RPN) were computed and analyzed. The highest 30 potential modes from each physicist’s analysis were then compared. Results: The RPN values assessed by the three physicists ranged from 30 to 300. The magnitudes of the RPN values from each physicist were different, and there was no concordance in the highest RPN values recorded by three physicists independently. The 10 highest RPN values belonged to sub steps of CT simulation, contouring and delivery in the SBRT process map. For these 10 highest RPN values, at least two physicists, irrespective of their length of experience had concordance but no general conclusions emerged. Conclusion: This study clearly shows that the risk-based assessment of a clinical process map requires great deal of preparation, group discussions, and participation by all stakeholders. One group albeit physicists cannot effectively implement risk-based methodology proposed by TG100. It should be a team effort in which the physicists can certainly play the leading role. This also corroborates TG100 recommendation that risk-based assessment of clinical processes is a multidisciplinary team effort.

  3. Risk of Severe Toxicity According to Site of Recurrence in Patients Treated With Stereotactic Body Radiation Therapy for Recurrent Head and Neck Cancer

    International Nuclear Information System (INIS)

    Ling, Diane C.; Vargo, John A.; Ferris, Robert L.; Ohr, James; Clump, David A.; Yau, Wai-Ying Wendy; Duvvuri, Umamaheswar; Kim, Seungwon; Johnson, Jonas T.; Bauman, Julie E.; Branstetter, Barton F.; Heron, Dwight E.

    2016-01-01

    Purpose: To report a 10-year update of our institutional experience with stereotactic body radiation therapy (SBRT) for reirradiation of locally recurrent head and neck cancer, focusing on predictors of toxicity. Methods and Materials: A retrospective review was performed on 291 patients treated with SBRT for recurrent, previously irradiated head and neck cancer between April 2002 and March 2013. Logistic regression analysis was performed to identify predictors of severe acute and late toxicity. Patients with <3 months of follow-up (n=43) or who died within 3 months of treatment (n=21) were excluded from late toxicity analysis. Results: Median time to death or last clinical follow-up was 9.8 months among the entire cohort and 53.1 months among surviving patients. Overall, 33 patients (11.3%) experienced grade ≥3 acute toxicity and 43 (18.9%) experienced grade ≥3 late toxicity. Compared with larynx/hypopharynx, treatment of nodal recurrence was associated with a lower risk of severe acute toxicity (P=.03), with no significant differences in severe acute toxicity among other sites. Patients treated for a recurrence in the larynx/hypopharynx experienced significantly more severe late toxicity compared with those with oropharyngeal, oral cavity, base of skull/paranasal sinus, salivary gland, or nodal site of recurrence (P<.05 for all). Sixteen patients (50%) with laryngeal/hypopharyngeal recurrence experienced severe late toxicity, compared with 6-20% for other sites. Conclusions: Salvage SBRT is a safe and effective option for most patients with previously irradiated head and neck cancer. However, patients treated to the larynx or hypopharynx experience significantly more late toxicity compared with others and should be carefully selected for treatment, with consideration given to patient performance status, pre-existing organ dysfunction, and goals of care. Treatment toxicity in these patients may be mitigated with more conformal plans to allow for increased

  4. Pain Flare Is a Common Adverse Event in Steroid-Naïve Patients After Spine Stereotactic Body Radiation Therapy: A Prospective Clinical Trial

    Energy Technology Data Exchange (ETDEWEB)

    Chiang, Andrew [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada); Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON (Canada); Zeng, Liang; Zhang, Liying; Lochray, Fiona; Korol, Renee; Loblaw, Andrew; Chow, Edward [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada); Sahgal, Arjun, E-mail: arjun.sahgal@sunnybrook.ca [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON (Canada); Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, ON (Canada)

    2013-07-15

    Purpose: To determine the incidence of pain flare after spine stereotactic body radiation therapy (SBRT) in steroid-naïve patients and identify predictive factors. Methods and Materials: Forty-one patients were treated with spine SBRT between February 2010 and April 2012. All patients had their pain assessed at baseline, during, and for 10 days after SBRT using the Brief Pain Inventory. All pain medications were recorded daily and narcotics converted to an oral morphine equivalent dose. Pain flare was defined as a 2-point increase in worst pain score as compared with baseline with no decrease in analgesic intake, a 25% increase in analgesic intake as compared with baseline with no decrease in worst pain score, or if corticosteroids were initiated at any point during or after SBRT because of pain. Results: The median age and Karnofsky performance status were 57.5 years (range, 27-80 years) and 80 (range, 50-100), respectively. Eighteen patients were treated with 20-24 Gy in a single fraction, whereas 23 patients were treated with 24-35 Gy in 2-5 fractions. Pain flare was observed in 68.3% of patients (28 of 41), most commonly on day 1 after SBRT (29%, 8 of 28). Multivariate analysis identified a higher Karnofsky performance status (P=.02) and cervical (P=.049) or lumbar (P=.02) locations as significant predictors of pain flare. In those rescued with dexamethasone, a significant decrease in pain scores over time was subsequently observed (P<.0001). Conclusions: Pain flare is a common adverse event after spine SBRT and occurs most commonly the day after treatment completion. Patients should be appropriately consented for this adverse event.

  5. Health-Related Quality of Life After Stereotactic Body Radiation Therapy for Localized Prostate Cancer: Results From a Multi-institutional Consortium of Prospective Trials

    Energy Technology Data Exchange (ETDEWEB)

    King, Christopher R., E-mail: crking@mednet.ucla.edu [Department of Radiation Oncology, University of California, Los Angeles, California (United States); Collins, Sean [Department of Radiation Oncology, Georgetown University, Washington, District of Columbia (United States); Fuller, Donald [Genesis Healthcare Partners, San Diego, California (United States); Wang, Pin-Chieh; Kupelian, Patrick; Steinberg, Michael [Department of Radiation Oncology, University of California, Los Angeles, California (United States); Katz, Alan [Flushing Radiation Oncology, Flushing, New York (United States)

    2013-12-01

    Purpose: To evaluate the early and late health-related quality of life (QOL) outcomes among prostate cancer patients following stereotactic body radiation therapy (SBRT). Methods and Materials: Patient self-reported QOL was prospectively measured among 864 patients from phase 2 clinical trials of SBRT for localized prostate cancer. Data from the Expanded Prostate Cancer Index Composite (EPIC) instrument were obtained at baseline and at regular intervals up to 6 years. SBRT delivered a median dose of 36.25 Gy in 4 or 5 fractions. A short course of androgen deprivation therapy was given to 14% of patients. Results: Median follow-up was 3 years and 194 patients remained evaluable at 5 years. A transient decline in the urinary and bowel domains was observed within the first 3 months after SBRT which returned to baseline status or better within 6 months and remained so beyond 5 years. The same pattern was observed among patients with good versus poor baseline function and was independent of the degree of early toxicities. Sexual QOL decline was predominantly observed within the first 9 months, a pattern not altered by the use of androgen deprivation therapy or patient age. Conclusion: Long-term outcome demonstrates that prostate SBRT is well tolerated and has little lasting impact on health-related QOL. A transient and modest decline in urinary and bowel QOL during the first few months after SBRT quickly recovers to baseline levels. With a large number of patients evaluable up to 5 years following SBRT, it is unlikely that unexpected late adverse effects will manifest themselves.

  6. Potential dosimetric benefits of adaptive tumor tracking over the internal target volume concept for stereotactic body radiation therapy of pancreatic cancer.

    Science.gov (United States)

    Karava, Konstantina; Ehrbar, Stefanie; Riesterer, Oliver; Roesch, Johannes; Glatz, Stefan; Klöck, Stephan; Guckenberger, Matthias; Tanadini-Lang, Stephanie

    2017-11-09

    Radiotherapy for pancreatic cancer has two major challenges: (I) the tumor is adjacent to several critical organs and, (II) the mobility of both, the tumor and its surrounding organs at risk (OARs). A treatment planning study simulating stereotactic body radiation therapy (SBRT) for pancreatic tumors with both the internal target volume (ITV) concept and the tumor tracking approach was performed. The two respiratory motion-management techniques were compared in terms of doses to the target volume and organs at risk. Two volumetric-modulated arc therapy (VMAT) treatment plans (5 × 5 Gy) were created for each of the 12 previously treated pancreatic cancer patients, one using the ITV concept and one the tumor tracking approach. To better evaluate the overall dose delivered to the moving tumor volume, 4D dose calculations were performed on four-dimensional computed tomography (4DCT) scans. The resulting planning target volume (PTV) size for each technique was analyzed. Target and OAR dose parameters were reported and analyzed for both 3D and 4D dose calculation. Tumor motion ranged from 1.3 to 11.2 mm. Tracking led to a reduction of PTV size (max. 39.2%) accompanied with significant better tumor coverage (p<0.05, paired Wilcoxon signed rank test) both in 3D and 4D dose calculations and improved organ at risk sparing. Especially for duodenum, stomach and liver, the mean dose was significantly reduced (p<0.05) with tracking for 3D and 4D dose calculations. By using an adaptive tumor tracking approach for respiratory-induced pancreatic motion management, a significant reduction in PTV size can be achieved, which subsequently facilitates treatment planning, and improves organ dose sparing. The dosimetric benefit of tumor tracking is organ and patient-specific.

  7. SU-F-R-53: CT-Based Radiomics Analysis of Non-Small Cell Lung Cancer Patients Treated with Stereotactic Body Radiation Therapy

    International Nuclear Information System (INIS)

    Huynh, E; Coroller, T; Narayan, V; Agrawal, V; Hou, Y; Romano, J; Franco, I; Mak, R; Aerts, H

    2016-01-01

    Purpose: Stereotactic body radiation therapy (SBRT) is the standard of care for medically inoperable non-small cell lung cancer (NSCLC) patients and has demonstrated excellent local control and survival. However, some patients still develop distant metastases and local recurrence, and therefore, there is a clinical need to identify patients at high-risk of disease recurrence. The aim of the current study is to use a radiomics approach to identify imaging biomarkers, based on tumor phenotype, for clinical outcomes in SBRT patients. Methods: Radiomic features were extracted from free breathing computed tomography (CT) images of 113 Stage I-II NSCLC patients treated with SBRT. Their association to and prognostic performance for distant metastasis (DM), locoregional recurrence (LRR) and survival was assessed and compared with conventional features (tumor volume and diameter) and clinical parameters (e.g. performance status, overall stage). The prognostic performance was evaluated using the concordance index (CI). Multivariate model performance was evaluated using cross validation. All p-values were corrected for multiple testing using the false discovery rate. Results: Radiomic features were associated with DM (one feature), LRR (one feature) and survival (four features). Conventional features were only associated with survival and one clinical parameter was associated with LRR and survival. One radiomic feature was significantly prognostic for DM (CI=0.670, p<0.1 from random), while none of the conventional and clinical parameters were significant for DM. The multivariate radiomic model had a higher median CI (0.671) for DM than the conventional (0.618) and clinical models (0.617). Conclusion: Radiomic features have potential to be imaging biomarkers for clinical outcomes that conventional imaging metrics and clinical parameters cannot predict in SBRT patients, such as distant metastasis. Development of a radiomics biomarker that can identify patients at high-risk of

  8. Stereotactic Body Radiation Therapy and the Influence of Chemotherapy on Overall Survival for Large (≥5 Centimeter) Non-Small Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Verma, Vivek [Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska (United States); McMillan, Matthew T. [Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania (United States); Grover, Surbhi [Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania (United States); Simone, Charles B., E-mail: charles.simone@uphs.upenn.edu [Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania (United States)

    2017-01-01

    Purpose: Stereotactic body radiation therapy (SBRT) for ≥5 cm lesions is poorly defined, largely owing to the low sample sizes in existing studies. The present analysis examined the SBRT outcomes and assessed the effect of chemotherapy in this population. Methods and Materials: The National Cancer Data Base was queried for primary non-small cell lung cancer ≥5 cm treated with SBRT (≤10 fractions). Patient, tumor, and treatment parameters were extracted. The primary outcome was overall survival (OS). Statistical methods involved Kaplan-Meier analysis and multivariable Cox proportional hazards modeling. Results: From 2004 to 2012, data from 201 patients were analyzed. The median follow-up was 41.1 months. The median tumor size was 5.5 cm (interquartile range 5.0-6.0), with cT2a, cT2b, and cT3 disease in 24.9%, 53.2%, and 21.9%, respectively. The median total SBRT dose and fractionation was 50 Gy in 4 fractions, and 92.5% of the patients underwent SBRT with ≤5 fractions. The median OS was 25.1 months. Of the 201 patients, 15% received chemotherapy. The receipt of chemotherapy was associated with longer OS (median 30.6 vs 23.4 months; P=.027). On multivariable analysis, worse OS was seen with increasing age (hazard ratio [HR] 1.03; P=.012), poorly differentiated tumors (HR 2.06; P=.049), and T3 classification (HR 2.13; P=.005). On multivariable analysis, chemotherapy remained independently associated with improved OS (HR 0.57; P=.039). Conclusions: SBRT has utility in the setting of tumors ≥5 cm, with chemotherapy associated with improved OS in this subset. These hypothesis-generating data now raise the necessity of performing prospective analyses to determine whether chemotherapy confers outcome benefits after SBRT.

  9. Risk of Severe Toxicity According to Site of Recurrence in Patients Treated With Stereotactic Body Radiation Therapy for Recurrent Head and Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ling, Diane C.; Vargo, John A. [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Ferris, Robert L. [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Department of Otolaryngology, Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania (United States); Ohr, James [Division of Medical Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (United States); Clump, David A.; Yau, Wai-Ying Wendy [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Duvvuri, Umamaheswar; Kim, Seungwon; Johnson, Jonas T. [Department of Otolaryngology, Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania (United States); Bauman, Julie E. [Division of Medical Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (United States); Branstetter, Barton F. [Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States); Heron, Dwight E., E-mail: herond2@umpc.edu [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Department of Otolaryngology, Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania (United States)

    2016-07-01

    Purpose: To report a 10-year update of our institutional experience with stereotactic body radiation therapy (SBRT) for reirradiation of locally recurrent head and neck cancer, focusing on predictors of toxicity. Methods and Materials: A retrospective review was performed on 291 patients treated with SBRT for recurrent, previously irradiated head and neck cancer between April 2002 and March 2013. Logistic regression analysis was performed to identify predictors of severe acute and late toxicity. Patients with <3 months of follow-up (n=43) or who died within 3 months of treatment (n=21) were excluded from late toxicity analysis. Results: Median time to death or last clinical follow-up was 9.8 months among the entire cohort and 53.1 months among surviving patients. Overall, 33 patients (11.3%) experienced grade ≥3 acute toxicity and 43 (18.9%) experienced grade ≥3 late toxicity. Compared with larynx/hypopharynx, treatment of nodal recurrence was associated with a lower risk of severe acute toxicity (P=.03), with no significant differences in severe acute toxicity among other sites. Patients treated for a recurrence in the larynx/hypopharynx experienced significantly more severe late toxicity compared with those with oropharyngeal, oral cavity, base of skull/paranasal sinus, salivary gland, or nodal site of recurrence (P<.05 for all). Sixteen patients (50%) with laryngeal/hypopharyngeal recurrence experienced severe late toxicity, compared with 6-20% for other sites. Conclusions: Salvage SBRT is a safe and effective option for most patients with previously irradiated head and neck cancer. However, patients treated to the larynx or hypopharynx experience significantly more late toxicity compared with others and should be carefully selected for treatment, with consideration given to patient performance status, pre-existing organ dysfunction, and goals of care. Treatment toxicity in these patients may be mitigated with more conformal plans to allow for increased

  10. Dosimetric evaluation of the impacts of different heterogeneity correction algorithms on target doses in stereotactic body radiation therapy for lung tumors

    International Nuclear Information System (INIS)

    Narabayashi, Masaru; Mizowaki, Takashi; Matsuo, Yukinori; Nakamura, Mitsuhiro; Takayama, Kenji; Norihisa, Yoshiki; Sakanaka, Katsuyuki; Hiraoka, Masahiro

    2012-01-01

    Heterogeneity correction algorithms can have a large impact on the dose distributions of stereotactic body radiation therapy (SBRT) for lung tumors. Treatment plans of 20 patients who underwent SBRT for lung tumors with the prescribed dose of 48 Gy in four fractions at the isocenter were reviewed retrospectively and recalculated with different heterogeneity correction algorithms: the pencil beam convolution algorithm with a Batho power-law correction (BPL) in Eclipse, the radiological path length algorithm (RPL), and the X-ray Voxel Monte Carlo algorithm (XVMC) in iPlan. The doses at the periphery (minimum dose and D95) of the planning target volume (PTV) were compared using the same monitor units among the three heterogeneity correction algorithms, and the monitor units were compared between two methods of dose prescription, that is, an isocenter dose prescription (IC prescription) and dose-volume based prescription (D95 prescription). Mean values of the dose at the periphery of the PTV were significantly lower with XVMC than with BPL using the same monitor units (P<0.001). In addition, under IC prescription using BPL, RPL and XVMC, the ratios of mean values of monitor units were 1, 0.959 and 0.986, respectively. Under D95 prescription, they were 1, 0.937 and 1.088, respectively. These observations indicated that the application of XVMC under D95 prescription results in an increase in the actually delivered dose by 8.8% on average compared with the application of BPL. The appropriateness of switching heterogeneity correction algorithms and dose prescription methods should be carefully validated from a clinical viewpoint. (author)

  11. Evaluation of useful treatment which uses dual-energy when curing lung-cancer patient with stereotactic body radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Hyeong Jun; Lee, Yeong Gyu; Kim, Yeong Jae; Park, Yeong Gyu [Dept. of Radiation Oncology, Catholic University Seoul St Mary' s hospital, Seoul (Korea, Republic of)

    2016-12-15

    This study will evaluate the clinical utility by applying clinical schematic that uses monoenergy or dual energy as according to the location of tumors to the stereotactic radiotherapy to compare the change in actual dose given to the real tumor and the dose that locates adjacent to the tumor. CT images from a total of 10 patients were obtained and the clinical planning were planned based on the volumetric modulated arc therapy on monoenergy and dual energy. To analyze the change factor in the tumor, Conformity Index(CI) and Homogeneity Index(HI) and maximum dose quantity were each calculated and comparing the dose distribution on normal tissues, v{sub 10} and v{sub 5}, first ⁓ fourth ribs closest to the tumor (1st ⁓ 4th Rib), Spinal Cord, Esophagus and Trachea were selected. Also, in order to confirm the accuracy on which the planned dose distribution is really measured, the 2-dimensional ion chamber array was used to measure the dose distribution. As of the tumor factor, CI and HI showed a number close to 1 when the two energies were used. As of the maximum dose, the front chest wall showed 2% and the dorsal tumor showed equivalent value. As of normal tissue, the front chest wall tumors were reduced by 4%, 5% when both energies were used in the adjacent rib and as of trachea, reduced by 11%, 17%. As of the dose in the lung, as of v{sub 10}, it reduced by 1.5%, v{sub 5} by 1%. As of the rear chest wall, when both energies were used, the ribs adjacent to the tumors showed 6%, 1%, 4%, 12% reduction, and in the lung dose distribution, v{sub 10} reduced by 3%, and v{sub 5} reduced by 3.1%. The dose measurement in all energies were in accordance to the results of Gamma Index 3mm/3%. Conclusion : It is considered that rather than using monoenergy, utilizing double energy in the clinical setting can be more effectively applied to the superficial tumors.

  12. Stereotactic Body Radiation Therapy for Spinal Metastases in the Postoperative Setting: A Secondary Analysis of Mature Phase 1-2 Trials

    Energy Technology Data Exchange (ETDEWEB)

    Tao, Randa; Bishop, Andrew J.; Brownlee, Zachary; Allen, Pamela K.; Settle, Stephen H. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Chang, Eric L. [Department of Radiation Oncology, USC Norris Cancer Hospital, Keck School of Medicine of USC, Los Angeles, California (United States); Wang, Xin [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Amini, Behrang [Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Tannir, Nizar M. [Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Tatsui, Claudio; Rhines, Laurence D. [Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Brown, Paul D. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Ghia, Amol J., E-mail: ajghia@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2016-08-01

    Purpose: To evaluate the outcomes in patients treated on prospective phase 1-2 protocols with postoperative stereotactic body radiation therapy (SBRT) and identify the associated prognostic variables. Methods and Materials: Sixty-six patients with 69 tumors were treated with SBRT on prospective phase 1-2 studies for spinal metastases between 2002 and 2010. All patients underwent SBRT after spine surgery, which included laminectomy, vertebrectomy, or a combination of these techniques. Renal cell carcinoma was the most common histology represented (n=35, 53%) followed by sarcomas (n=13, 20%). Thirty-one patients (47%) were treated with prior conventional radiation to the spine (median dose 30 Gy). Patients were followed up with spinal magnetic resonance imaging (MRI) studies to determine the treated tumor control (TC). Pain and other symptom data were collected prospectively to determine treatment response and toxicity. Results: The median follow-up time was 30 months (range, 1-145 months) for all patients and 75 months for living patients (range, 6-145 months). The actuarial 1-year rate of TC was 85%, adjacent vertebral body control was 85%, and overall survival (OS) was 74% (median 29 months). On multivariate competing-risks analysis, sarcoma histology (subhazard ratio [SHR] = 2.38, 95% confidence interval [CI] 1.05-5.6, P=.04) and larger preoperative tumor volumes (SHR=1.01, 95% CI 1.0-1.01, P=.006) were significantly associated with worse TC. Karnofsky performance status was the only significant predictor for OS on multivariate analysis. There were no differences in TC between patients treated with different surgical techniques or different preoperative or postoperative Bilsky grades. There were no grade 3 or higher neurologic toxicities. Conclusion: This study represents a large series of prospective data available on patients treated with SBRT in the postoperative setting. The combination of surgery with SBRT can offer patients with metastatic disease

  13. Stereotactic Body Radiation Therapy for Spinal Metastases in the Postoperative Setting: A Secondary Analysis of Mature Phase 1-2 Trials

    International Nuclear Information System (INIS)

    Tao, Randa; Bishop, Andrew J.; Brownlee, Zachary; Allen, Pamela K.; Settle, Stephen H.; Chang, Eric L.; Wang, Xin; Amini, Behrang; Tannir, Nizar M.; Tatsui, Claudio; Rhines, Laurence D.; Brown, Paul D.; Ghia, Amol J.

    2016-01-01

    Purpose: To evaluate the outcomes in patients treated on prospective phase 1-2 protocols with postoperative stereotactic body radiation therapy (SBRT) and identify the associated prognostic variables. Methods and Materials: Sixty-six patients with 69 tumors were treated with SBRT on prospective phase 1-2 studies for spinal metastases between 2002 and 2010. All patients underwent SBRT after spine surgery, which included laminectomy, vertebrectomy, or a combination of these techniques. Renal cell carcinoma was the most common histology represented (n=35, 53%) followed by sarcomas (n=13, 20%). Thirty-one patients (47%) were treated with prior conventional radiation to the spine (median dose 30 Gy). Patients were followed up with spinal magnetic resonance imaging (MRI) studies to determine the treated tumor control (TC). Pain and other symptom data were collected prospectively to determine treatment response and toxicity. Results: The median follow-up time was 30 months (range, 1-145 months) for all patients and 75 months for living patients (range, 6-145 months). The actuarial 1-year rate of TC was 85%, adjacent vertebral body control was 85%, and overall survival (OS) was 74% (median 29 months). On multivariate competing-risks analysis, sarcoma histology (subhazard ratio [SHR] = 2.38, 95% confidence interval [CI] 1.05-5.6, P=.04) and larger preoperative tumor volumes (SHR=1.01, 95% CI 1.0-1.01, P=.006) were significantly associated with worse TC. Karnofsky performance status was the only significant predictor for OS on multivariate analysis. There were no differences in TC between patients treated with different surgical techniques or different preoperative or postoperative Bilsky grades. There were no grade 3 or higher neurologic toxicities. Conclusion: This study represents a large series of prospective data available on patients treated with SBRT in the postoperative setting. The combination of surgery with SBRT can offer patients with metastatic disease

  14. Stereotactic radiation therapy for large vestibular schwannomas

    International Nuclear Information System (INIS)

    Mandl, Ellen S.; Meijer, Otto W.M.; Slotman, Ben J.; Vandertop, W. Peter; Peerdeman, Saskia M.

    2010-01-01

    Background and purpose: To evaluate the morbidity and tumor-control rate in the treatment of large vestibular schwannomas (VS) after stereotactic radiation therapy in our institution. Material and methods: Twenty-five consecutive patients (17 men, 8 women) with large VS (diameter 3.0 cm or larger), treated with stereotactic radiotherapy (SRT) or stereotactic radiosurgery (SRS) between 1992 and 2007, were retrospectively studied after a mean follow-up period of three years with respect to tumor-control rate and complications. Results: Actuarial 5-year maintenance of pre-treatment hearing level probability of 30% was achieved. Five of 17 patients suffered permanent new facial nerve dysfunction. The actuarial 5-year facial nerve preservation probability was 80%. Permanent new trigeminal nerve neuropathy occurred in two of 15 patients, resulting in an actuarial 5-year trigeminal nerve preservation probability of 85%. Tumor progression occurred in four of 25 (16%) patients. The overall 5-year tumor control probability was 82%. Conclusion: Increased morbidity rates were found in patients with large VS treated with SRT or SRS compared to the published series on regular sized VS and other smaller retrospective studies on large VS.

  15. Stereotactic body radiotherapy: current strategies and future development

    Science.gov (United States)

    2016-01-01

    Stereotactic body radiotherapy (SBRT) has emerged as the standard treatment for medically inoperable early-staged non-small cell lung cancer (NSCLC). The local control rate after SBRT is over 90%. Some forms of tumour motion management and image-guided radiation delivery techniques are the prerequisites for fulfilment of its goal to deliver a high radiation dose to the tumour target without overdosing surrounding normal tissues. In this review, the current strategies of tumour motion management will be discussed, followed by an overview of various image-guided radiotherapy (RT) systems and devices available for clinical practice. Besides medically inoperable stage I NSCLC, SBRT has also been widely adopted for treatment of oligometastasis involving the lungs. Its possible applications in various other cancer illnesses are under extensive exploration. The progress of SBRT is critically technology-dependent. With advancement of technology, the ideal of personalised, effective and yet safe SBRT is already on the horizon. PMID:27606082

  16. Complications from Stereotactic Body Radiotherapy for Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Kylie H. [School of Medicine, Case Western Reserve University, Cleveland, OH 44106 (United States); Okoye, Christian C.; Patel, Ravi B. [Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106 (United States); Siva, Shankar [Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria 3002 (Australia); Biswas, Tithi; Ellis, Rodney J.; Yao, Min; Machtay, Mitchell; Lo, Simon S., E-mail: Simon.Lo@uhhospitals.org [Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH 44106 (United States)

    2015-06-15

    Stereotactic body radiotherapy (SBRT) has become a standard treatment option for early stage, node negative non-small cell lung cancer (NSCLC) in patients who are either medically inoperable or refuse surgical resection. SBRT has high local control rates and a favorable toxicity profile relative to other surgical and non-surgical approaches. Given the excellent tumor control rates and increasing utilization of SBRT, recent efforts have focused on limiting toxicity while expanding treatment to increasingly complex patients. We review toxicities from SBRT for lung cancer, including central airway, esophageal, vascular (e.g., aorta), lung parenchyma (e.g., radiation pneumonitis), and chest wall toxicities, as well as radiation-induced neuropathies (e.g., brachial plexus, vagus nerve and recurrent laryngeal nerve). We summarize patient-related, tumor-related, dosimetric characteristics of these toxicities, review published dose constraints, and propose strategies to reduce such complications.

  17. Stereotactic Body Radiotherapy for the Treatment of Renal Tumors

    Directory of Open Access Journals (Sweden)

    Michael Hanzly

    2014-09-01

    Full Text Available The purpose of this study was to evaluate the response of actively growing renal masses to stereotactic body radiation therapy (SBRT. We retrospectively reviewed our institutional review board–approved kidney database and identified 4 patients who underwent SBRT, 15 Gy dose, for their rapidly growing renal masses. Three patients had a decreased tumor size after radiation treatment by 20.8%, 38.1%, and 20%. The other patient had a size gain of 5.6%. This patient maintained a similar tumor growth rate before and after SBRT. Mean follow-up time was 13.8 months. SBRT represents an effective management option in select patients with larger rapidly growing kidney masses.

  18. Complications from Stereotactic Body Radiotherapy for Lung Cancer

    Directory of Open Access Journals (Sweden)

    Kylie H. Kang

    2015-06-01

    Full Text Available Stereotactic body radiotherapy (SBRT has become a standard treatment option for early stage, node negative non-small cell lung cancer (NSCLC in patients who are either medically inoperable or refuse surgical resection. SBRT has high local control rates and a favorable toxicity profile relative to other surgical and non-surgical approaches. Given the excellent tumor control rates and increasing utilization of SBRT, recent efforts have focused on limiting toxicity while expanding treatment to increasingly complex patients. We review toxicities from SBRT for lung cancer, including central airway, esophageal, vascular (e.g., aorta, lung parenchyma (e.g., radiation pneumonitis, and chest wall toxicities, as well as radiation-induced neuropathies (e.g., brachial plexus, vagus nerve and recurrent laryngeal nerve. We summarize patient-related, tumor-related, dosimetric characteristics of these toxicities, review published dose constraints, and propose strategies to reduce such complications.

  19. A Phase 1 Study of Stereotactic Body Radiation Therapy Dose Escalation for Borderline Resectable Pancreatic Cancer After Modified FOLFIRINOX (NCT01446458).

    Science.gov (United States)

    Shaib, Walid L; Hawk, Natalyn; Cassidy, Richard J; Chen, Zhengjia; Zhang, Chao; Brutcher, Edith; Kooby, David; Maithel, Shishir K; Sarmiento, Juan M; Landry, Jerome; El-Rayes, Bassel F

    2016-10-01

    A challenge in borderline resectable pancreatic cancer (BRPC) management is the high rate of positive posterior margins (PM). Stereotactic body radiation therapy (SBRT) allows for higher radiation delivery dose with conformity. This study evaluated the maximal tolerated dose with a dose escalation plan level up to 45 Gy using SBRT in BRPC. A single-institution, 3 + 3 phase 1 clinical trial design was used to evaluate 4 dose levels of SBRT delivered in 3 fractions to the planning target volume (PTV) with a simultaneous in-field boost (SIB) to the PM. Dose level (DL) 1 was 30 Gy to the PTV, and for dose levels 2 through 4 (DL2-DL4) the dose was 36 Gy. The SIB dose to the PM was 6, 6, 7.5, and 9 Gy for DL-1, DL-2, DL-3, and DL-4, respectively. All patients received 4 treatments of modified FOLFIRINOX (fluorouracil, leucovorin, irinotecan, oxaliplatin) before SBRT. Thirteen patients with a median age of 64 years were enrolled. The median follow-up time was 18 months. The locations of the cancer were head (n=12) and uncinate/neck (n=1). One patient did not undergo SBRT. There were no grade 3 or 4 toxicities. Five patients did not undergo resection because of disease progression (1 local, 4 distant); 8 had R0 resection in the PM, and 5 of 8 had vessel reconstruction. Two patients had disease downstaged to T1 and T2 from T3 disease. Four patients are still alive, and 3 are disease free. The median overall survival for resected patients was not reached (9.3: not reached). The SBRT dose of 36 Gy with a 9-Gy SIB to the PM (total 45 Gy) delivered in 3 fractions is safe and well tolerated. The dose-limiting toxicity for a 45-Gy dose was not reached, and further dose escalations are needed in future trials. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. A Phase 1 Study of Stereotactic Body Radiation Therapy Dose Escalation for Borderline Resectable Pancreatic Cancer After Modified FOLFIRINOX (NCT01446458)

    International Nuclear Information System (INIS)

    Shaib, Walid L.; Hawk, Natalyn; Cassidy, Richard J.; Chen, Zhengjia; Zhang, Chao; Brutcher, Edith; Kooby, David; Maithel, Shishir K.; Sarmiento, Juan M.; Landry, Jerome; El-Rayes, Bassel F.

    2016-01-01

    Purpose: A challenge in borderline resectable pancreatic cancer (BRPC) management is the high rate of positive posterior margins (PM). Stereotactic body radiation therapy (SBRT) allows for higher radiation delivery dose with conformity. This study evaluated the maximal tolerated dose with a dose escalation plan level up to 45 Gy using SBRT in BRPC. Methods and Materials: A single-institution, 3 + 3 phase 1 clinical trial design was used to evaluate 4 dose levels of SBRT delivered in 3 fractions to the planning target volume (PTV) with a simultaneous in-field boost (SIB) to the PM. Dose level (DL) 1 was 30 Gy to the PTV, and for dose levels 2 through 4 (DL2-DL4) the dose was 36 Gy. The SIB dose to the PM was 6, 6, 7.5, and 9 Gy for DL-1, DL-2, DL-3, and DL-4, respectively. All patients received 4 treatments of modified FOLFIRINOX (fluorouracil, leucovorin, irinotecan, oxaliplatin) before SBRT. Results: Thirteen patients with a median age of 64 years were enrolled. The median follow-up time was 18 months. The locations of the cancer were head (n=12) and uncinate/neck (n=1). One patient did not undergo SBRT. There were no grade 3 or 4 toxicities. Five patients did not undergo resection because of disease progression (1 local, 4 distant); 8 had R0 resection in the PM, and 5 of 8 had vessel reconstruction. Two patients had disease downstaged to T1 and T2 from T3 disease. Four patients are still alive, and 3 are disease free. The median overall survival for resected patients was not reached (9.3: not reached). Conclusion: The SBRT dose of 36 Gy with a 9-Gy SIB to the PM (total 45 Gy) delivered in 3 fractions is safe and well tolerated. The dose-limiting toxicity for a 45-Gy dose was not reached, and further dose escalations are needed in future trials.

  1. A Study of volumetric modulated arc therapy for stereotactic body radiation therapy in case of multi-target liver cancer using flattening filter free beam

    International Nuclear Information System (INIS)

    Yeom, Mi Sook; Yoon, In Ha; Hong, Dong Gi; Back, Geum Mun

    2015-01-01

    Stereotactic body radiation therapy (SBRT) has proved its efficacy in several patient populations with primary and metastatic limited tumors. Because SBRT prescription is high dose level than Conventional radiation therapy. SBRT plan is necessary for effective Organ at risk (OAR) protection and sufficient Planning target volume (PTV) dose coverage. In particular, multi-target cases may result excessive doses to OAR and hot spot due to dose overlap. This study evaluate usefulness of Volumetric modulated arc therapy (VMAT) in dosimetric and technical considerations using Flattening filter free (FFF) beam. The treatment plans for five patients, being treated on TrueBeam STx(Varian™, USA) with VMAT using 10MV FFF beam and Standard conformal radiotherapy (CRT) using 15MV Flattening filter (FF) beam. PTV, liver, duodenum, bowel, spinal cord, esophagus, stomach dose were evaluated using the dose volume histogram(DVH). Conformity index(CI), homogeneity index(HI), Paddick's index(PCI) for the PTV was assessed. Total Monitor unit (MU) and beam on time was assessed. Average value of CI, HI and PCI for PTV was 1.381±0.028, 1.096±0.016, 0.944±0.473 in VMAT and 1.381± 0.042, 1.136±0.042, 1.534±0.465 in CRT respectively. OAR dose in CRT plans evaluated 1.8 times higher than VMAT. Total MU in VMAT evaluated 1.3 times increase than CRT. Average beam on time was 6.8 minute in VMAT and 21.3 minute in CRT respectively. OAR dose in CRT plans evaluated 1.8 times higher than VMAT. Total MU in VMAT evaluated 1.3 times increase than CRT. Average beam on time was 6.8 minute in VMAT and 21.3 minute in CRT. VMAT for SBRT in multi-target liver cancer using FFF beam is effective treatment techniqe in dosimetric and technical considerations. VMAT decrease intra-fraction error due to treatment time shortening using high dose rate of FFF beam

  2. High-dose-rate stereotactic body radiation therapy for postradiation therapy locally recurrent prostatic carcinoma: Preliminary prostate-specific antigen response, disease-free survival, and toxicity assessment.

    Science.gov (United States)

    Fuller, Donald B; Wurzer, James; Shirazi, Reza; Bridge, Stephen S; Law, Jonathan; Mardirossian, George

    2015-01-01

    Patients with locally recurrent adenocarcinoma of the prostate following radiation therapy (RT) present a challenging problem. We prospectively evaluated the use of "high-dose-rate-like" prostate stereotactic body RT (SBRT) salvage for this circumstance, evaluating prostate-specific antigen response, disease-free survival, and toxicity. Between February 2009 and March 2014, 29 patients with biopsy-proven recurrent locally prostate cancer >2 years post-RT were treated. Median prior RT dose was 73.8 Gy and median interval to SBRT salvage was 88 months. Median recurrence Gleason score was 7 (79% was ≥7). Pre-existing RT toxicity >grade 1 was a reason for exclusion. Magnetic resonance imaging-defined prostate volume including any suspected extraprostatic extension, comprising the planning target volume. A total of 34 Gy/5 fractions was given, delivering a heterogeneous, high-dose-rate-like dose-escalation pattern. Toxicities were assessed using Common Terminology Criteria for Adverse Events, version 3.0, criteria. Twenty-nine treated patients had a median 24-month follow-up (range, 3-60 months). A median pre-SBRT salvage baseline prostate-specific antigen level of 3.1 ng/mL decreased to 0.65 ng/mL and 0.16 ng/mL at 1 and 2 years, respectively. Actuarial 2-year biochemical disease-free survival measured 82%, with no local failures. Toxicity >grade 1 was limited to the genitourinary domain, with 18% grade 2 or higher and 7% grade 3 or higher. No gastrointestinal toxicity >grade 1 occurred. Two-year disease-free survival is encouraging, and the prostate-specific antigen response kinetic appears comparable with that seen in de novo patients treated with SBRT, albeit still a preliminary finding. Grade ≥2 genitourinary toxicity was occasionally seen with no obvious predictive factor. Noting that our only brachytherapy case was 1 of the 2 cases with ≥grade 3 genitourinary toxicity, caution is recommended treating these patients. SBRT salvage of post-RT local recurrence

  3. A Phase 1 Study of Stereotactic Body Radiation Therapy Dose Escalation for Borderline Resectable Pancreatic Cancer After Modified FOLFIRINOX (NCT01446458)

    Energy Technology Data Exchange (ETDEWEB)

    Shaib, Walid L.; Hawk, Natalyn [Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Cassidy, Richard J. [Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Chen, Zhengjia; Zhang, Chao [Department of Biostatistics, Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Brutcher, Edith [Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Kooby, David; Maithel, Shishir K.; Sarmiento, Juan M. [Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Landry, Jerome [Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); El-Rayes, Bassel F., E-mail: bassel.el-rayes@emoryhealthcare.org [Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia (United States)

    2016-10-01

    Purpose: A challenge in borderline resectable pancreatic cancer (BRPC) management is the high rate of positive posterior margins (PM). Stereotactic body radiation therapy (SBRT) allows for higher radiation delivery dose with conformity. This study evaluated the maximal tolerated dose with a dose escalation plan level up to 45 Gy using SBRT in BRPC. Methods and Materials: A single-institution, 3 + 3 phase 1 clinical trial design was used to evaluate 4 dose levels of SBRT delivered in 3 fractions to the planning target volume (PTV) with a simultaneous in-field boost (SIB) to the PM. Dose level (DL) 1 was 30 Gy to the PTV, and for dose levels 2 through 4 (DL2-DL4) the dose was 36 Gy. The SIB dose to the PM was 6, 6, 7.5, and 9 Gy for DL-1, DL-2, DL-3, and DL-4, respectively. All patients received 4 treatments of modified FOLFIRINOX (fluorouracil, leucovorin, irinotecan, oxaliplatin) before SBRT. Results: Thirteen patients with a median age of 64 years were enrolled. The median follow-up time was 18 months. The locations of the cancer were head (n=12) and uncinate/neck (n=1). One patient did not undergo SBRT. There were no grade 3 or 4 toxicities. Five patients did not undergo resection because of disease progression (1 local, 4 distant); 8 had R0 resection in the PM, and 5 of 8 had vessel reconstruction. Two patients had disease downstaged to T1 and T2 from T3 disease. Four patients are still alive, and 3 are disease free. The median overall survival for resected patients was not reached (9.3: not reached). Conclusion: The SBRT dose of 36 Gy with a 9-Gy SIB to the PM (total 45 Gy) delivered in 3 fractions is safe and well tolerated. The dose-limiting toxicity for a 45-Gy dose was not reached, and further dose escalations are needed in future trials.

  4. A Study of volumetric modulated arc therapy for stereotactic body radiation therapy in case of multi-target liver cancer using flattening filter free beam

    Energy Technology Data Exchange (ETDEWEB)

    Yeom, Mi Sook; Yoon, In Ha; Hong, Dong Gi; Back, Geum Mun [Dept. of Radiation Oncology, ASAN Medical Center, Seoul (Korea, Republic of)

    2015-06-15

    Stereotactic body radiation therapy (SBRT) has proved its efficacy in several patient populations with primary and metastatic limited tumors. Because SBRT prescription is high dose level than Conventional radiation therapy. SBRT plan is necessary for effective Organ at risk (OAR) protection and sufficient Planning target volume (PTV) dose coverage. In particular, multi-target cases may result excessive doses to OAR and hot spot due to dose overlap. This study evaluate usefulness of Volumetric modulated arc therapy (VMAT) in dosimetric and technical considerations using Flattening filter free (FFF) beam. The treatment plans for five patients, being treated on TrueBeam STx(Varian™, USA) with VMAT using 10MV FFF beam and Standard conformal radiotherapy (CRT) using 15MV Flattening filter (FF) beam. PTV, liver, duodenum, bowel, spinal cord, esophagus, stomach dose were evaluated using the dose volume histogram(DVH). Conformity index(CI), homogeneity index(HI), Paddick's index(PCI) for the PTV was assessed. Total Monitor unit (MU) and beam on time was assessed. Average value of CI, HI and PCI for PTV was 1.381±0.028, 1.096±0.016, 0.944±0.473 in VMAT and 1.381± 0.042, 1.136±0.042, 1.534±0.465 in CRT respectively. OAR dose in CRT plans evaluated 1.8 times higher than VMAT. Total MU in VMAT evaluated 1.3 times increase than CRT. Average beam on time was 6.8 minute in VMAT and 21.3 minute in CRT respectively. OAR dose in CRT plans evaluated 1.8 times higher than VMAT. Total MU in VMAT evaluated 1.3 times increase than CRT. Average beam on time was 6.8 minute in VMAT and 21.3 minute in CRT. VMAT for SBRT in multi-target liver cancer using FFF beam is effective treatment techniqe in dosimetric and technical considerations. VMAT decrease intra-fraction error due to treatment time shortening using high dose rate of FFF beam.

  5. SU-F-T-621: Impact of Vacuum and Treatment Couch On Surface Dose in Stereotactic Body Radiation Therapy With and Without a Flattening Filter

    Energy Technology Data Exchange (ETDEWEB)

    Lan, HT; Lu, SH; Kuo, SH; Tsai, YC; Chen, LH; Wen, SY; Wang, CW [National Taiwan University Hospital, Taipei City, Taiwan (China)

    2016-06-15

    Purpose: When treating lung cancer patients with stereotactic body radiation therapy (SBRT), better immobilization is needed for accurate delivery of high-dose radiation. However, using a treatment couch (TrueBeamTM) and vacuum bag (BlueBAGTM) may increase the surface dose and skin toxicity. This study investigated the influence of couch and vacuum bag on the surface dose. Methods: The relative surface dose (D{sub 0}/DMAX) was measured in an ion-chamber (Markus-type PTW, 0.05cm{sup 3}) with a solid water phantom and SSD to 100 cm. A comprehensive comparison of different parameter settings, including the different energies (6MV-FFF, 10MV-FF, and 10MV-FFF), field sizes (3 X 3 cm{sup 2}, 5 × 5 cm{sup 2}, 8 × x cm{sup 2} , 10 × 10 cm{sup 2}, and 15 × 15 cm{sup 2}), thickness of the vacuum bag (5mm, 15mm, 30mm, 39mm and 55mm), and couch (with and without), was performed. Results: The FFF increases the surface dose as compared to FF mode. In a similar setting with field of 10 × 10 cm{sup 2}, FFF mode increases the surface dose from 26.0% to 32.8% for 6 MV, and 17.4% to 21.5% for 10 MV. When the beam passes through the couch, the surface dose increases to 3.6, 4.6, 2.9, and 3.7 times for 6 MV-FF, 10 MV-FF, 6 MV-FFF, and 10 MV-FFF, respectively. At the same energy, the surface dose increases to 3.93, 4.11, 4.23, 4.16 and 4.24 times at 5 mm, 15 mm, 30 mm, 39 mm and 55 mm thickness of the vacuum, respectively. Conclusion: Using a couch and vacuum significantly increases the surface dose. For SBRT with a superficial target close to the couch and immobilization vacuum, reduction of vacuum thickness and careful attention to skin dose in planning would be helpful in avoiding severe skin toxicity.

  6. A unified dose response relationship to predict high dose fractionation response in the lung cancer stereotactic body radiation therapy

    Directory of Open Access Journals (Sweden)

    Than S Kehwar

    2017-01-01

    Full Text Available Aim: This study is designed to investigate the superiority and applicability of the model among the linear-quadratic (LQ, linear-quadratic-linear (LQ-L and universal-survival-curve (USC models by fitting published radiation cell survival data of lung cancer cell lines. Materials and Method: The radiation cell survival data for small cell (SC and non-small cell (NSC lung cancer cell lines were obtained from published reports, and were used to determine the LQ and cell survival curve parameters, which ultimately were used in the curve fitting of the LQ, LQ-L and USC models. Results: The results of this study demonstrate that the LQ-L(Dt-mt model, compared with the LQ and USC models, provides best fit with smooth and gradual transition to the linear portion of the curve at transition dose Dt-mt, where the LQ model loses its validity, and the LQ-L(Dt-2α/β and USC(Dt-mt models do not transition smoothly to the linear portion of the survival curve. Conclusion: The LQ-L(Dt-mt model is able to fit wide variety of cell survival data over a very wide dose range, and retains the strength of the LQ model in the low-dose range.

  7. CT appearance of radiation injury of the lung and clinical symptoms after stereotactic body radiation therapy (SBRT) for lung cancers: Are patients with pulmonary emphysema also candidates for SBRT for lung cancers?

    International Nuclear Information System (INIS)

    Kimura, Tomoki; Matsuura, Kanji; Murakami, Yuji; Hashimoto, Yasutoshi; Kenjo, Masahiro; Kaneyasu, Yuko; Wadasaki, Koichi; Hirokawa, Yutaka; Ito, Katsuhide; Okawa, Motoomi

    2006-01-01

    Purpose: The purpose of this study was to analyze the computed tomographic (CT) appearance of radiation injury to the lung and clinical symptoms after stereotactic body radiation therapy (SBRT) and evaluate the difference by the presence of pulmonary emphysema (PE) for small lung cancers. Methods and Materials: In this analysis, 45 patients with 52 primary or metastatic lung cancers were enrolled. We evaluated the CT appearance of acute radiation pneumonitis (within 6 months) and radiation fibrosis (after 6 months) after SBRT. Clinical symptoms were evaluated by Common Terminology Criteria for Adverse Events, version 3.0. We also evaluated the relationship between CT appearance, clinical symptoms, and PE. Results: CT appearance of acute radiation pneumonitis was classified as follows: (1) diffuse consolidation, 38.5%; (2) patchy consolidation and ground-glass opacities (GGO), 15.4%; (3) diffuse GGO, 11.5%; (4) patchy GGO, 2.0%; (5) no evidence of increasing density, 32.6%. CT appearance of radiation fibrosis was classified as follows: (1) modified conventional pattern, 61.5%; (2) mass-like pattern, 17.3%; (3) scar-like pattern, 21.2%. Patients who were diagnosed with more than Grade 2 pneumonitis showed significantly less no evidence of increased density pattern and scar-like pattern than any other pattern (p = 0.0314, 0.0297, respectively). Significantly, most of these patients with no evidence of increased density pattern and scar-like pattern had PE (p = 0.00038, 0.00044, respectively). Conclusion: Computed tomographic appearance after SBRT was classified into five patterns of acute radiation pneumonitis and three patterns of radiation fibrosis. Our results suggest that SBRT can be also safely performed even in patients with PE

  8. TU-A-304-00: Imaging, Treatment Planning, and QA for Stereotactic Body Radiation Therapy (SBRT)

    International Nuclear Information System (INIS)

    2015-01-01

    Increased use of SBRT and hypo fractionation in radiation oncology practice has posted a number of challenges to medical physicist, ranging from planning, image-guided patient setup and on-treatment monitoring, to quality assurance (QA) and dose delivery. This symposium is designed to provide updated knowledge necessary for the safe and efficient implementation of SBRT in various linac platforms, including the emerging digital linacs equipped with high dose rate FFF beams. Issues related to 4D CT, PET and MRI simulations, 3D/4D CBCT guided patient setup, real-time image guidance during SBRT dose delivery using gated/un-gated VMAT or IMRT, and technical advancements in QA of SBRT (in particular, strategies dealing with high dose rate FFF beams) will be addressed. The symposium will help the attendees to gain a comprehensive understanding of the SBRT workflow and facilitate their clinical implementation of the state-of-art imaging and planning techniques. Learning Objectives: Present background knowledge of SBRT, describe essential requirements for safe implementation of SBRT, and discuss issues specific to SBRT treatment planning and QA. Update on the use of multi-dimensional (3D and 4D) and multi-modality (CT, beam-level X-ray imaging, pre- and on-treatment 3D/4D MRI, PET, robotic ultrasound, etc.) for reliable guidance of SBRT. Provide a comprehensive overview of emerging digital linacs and summarize the key geometric and dosimetric features of the new generation of linacs for substantially improved SBRT. Discuss treatment planning and quality assurance issues specific to SBRT. Research grant from Varian Medical Systems

  9. TU-A-304-00: Imaging, Treatment Planning, and QA for Stereotactic Body Radiation Therapy (SBRT)

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2015-06-15

    Increased use of SBRT and hypo fractionation in radiation oncology practice has posted a number of challenges to medical physicist, ranging from planning, image-guided patient setup and on-treatment monitoring, to quality assurance (QA) and dose delivery. This symposium is designed to provide updated knowledge necessary for the safe and efficient implementation of SBRT in various linac platforms, including the emerging digital linacs equipped with high dose rate FFF beams. Issues related to 4D CT, PET and MRI simulations, 3D/4D CBCT guided patient setup, real-time image guidance during SBRT dose delivery using gated/un-gated VMAT or IMRT, and technical advancements in QA of SBRT (in particular, strategies dealing with high dose rate FFF beams) will be addressed. The symposium will help the attendees to gain a comprehensive understanding of the SBRT workflow and facilitate their clinical implementation of the state-of-art imaging and planning techniques. Learning Objectives: Present background knowledge of SBRT, describe essential requirements for safe implementation of SBRT, and discuss issues specific to SBRT treatment planning and QA. Update on the use of multi-dimensional (3D and 4D) and multi-modality (CT, beam-level X-ray imaging, pre- and on-treatment 3D/4D MRI, PET, robotic ultrasound, etc.) for reliable guidance of SBRT. Provide a comprehensive overview of emerging digital linacs and summarize the key geometric and dosimetric features of the new generation of linacs for substantially improved SBRT. Discuss treatment planning and quality assurance issues specific to SBRT. Research grant from Varian Medical Systems.

  10. Treatment of Sarcoma Lung Metastases with Stereotactic Body Radiotherapy

    Directory of Open Access Journals (Sweden)

    Adam D. Lindsay

    2018-01-01

    Full Text Available Background. The most common site of sarcoma metastasis is the lung. Surgical resection of pulmonary metastases and chemotherapy are treatment options that have been employed, but many patients are poor candidates for these treatments for multiple host or tumor-related reasons. In this group of patients, radiation might provide a less morbid treatment alternative. We sought to evaluate the efficacy of radiotherapy in the treatment of metastatic sarcoma to the lung. Methods. Stereotactic body radiotherapy (SBRT was used to treat 117 pulmonary metastases in 44 patients. Patients were followed with serial computed tomography imaging of the chest. The primary endpoint was failure of control of a pulmonary lesion as measured by continued growth. Radiation-associated complications were recorded. Results. The majority of patients (84% received a total dose of 50 Gy per metastatic nodule utilizing an image-guided SBRT technique. The median interval follow-up was 14.2 months (range 1.6–98.6 months. Overall survival was 82% at two years and 50% at five years. Of 117 metastatic nodules treated, six nodules showed failure of treatment (95% control rate. Twenty patients (27% developed new metastatic lesions and underwent further SBRT. The side effects of SBRT included transient radiation pneumonitis n=6, cough n=2, rib fracture n=1, chronic pain n=1, dermatitis n=1, and dyspnea n=1. Conclusion. Stereotactic body radiotherapy is an effective and safe treatment for the ablation of pulmonary metastasis from sarcoma. Further work is needed to evaluate the optimal role of SBRT relative to surgery or chemotherapy for treatment of metastatic sarcoma.

  11. Stereotactic Body Radiotherapy for Oligometastatic Lung Tumors

    International Nuclear Information System (INIS)

    Norihisa, Yoshiki; Nagata, Yasushi; Takayama, Kenji; Matsuo, Yukinori; Sakamoto, Takashi; Sakamoto, Masato; Mizowaki, Takashi; Yano, Shinsuke; Hiraoka, Masahiro

    2008-01-01

    Purpose: Since 1998, we have treated primary and oligometastatic lung tumors with stereotactic body radiotherapy (SBRT). The term 'oligometastasis' is used to indicate a small number of metastases limited to an organ. We evaluated our clinical experience of SBRT for oligometastatic lung tumors. Methods and Materials: A total of 34 patients with oligometastatic lung tumors were included in this study. The primary involved organs were the lung (n = 15), colorectum (n = 9), head and neck (n = 5), kidney (n = 3), breast (n = 1), and bone (n = 1). Five to seven, noncoplanar, static 6-MV photon beams were used to deliver 48 Gy (n = 18) or 60 Gy (n = 16) at the isocenter, with 12 Gy/fraction within 4-18 days (median, 12 days). Results: The overall survival rate, local relapse-free rate, and progression-free rate at 2 years was 84.3%, 90.0%, and 34.8%, respectively. No local progression was observed in tumors irradiated with 60 Gy. SBRT-related pulmonary toxicities were observed in 4 (12%) Grade 2 cases and 1 (3%) Grade 3 case. Patients with a longer disease-free interval had a greater overall survival rate. Conclusion: The clinical result of SBRT for oligometastatic lung tumors in our institute was comparable to that after surgical metastasectomy; thus, SBRT could be an effective treatment of pulmonary oligometastases

  12. MO-FG-CAMPUS-JeP3-04: Feasibility Study of Real-Time Ultrasound Monitoring for Abdominal Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Su, Lin; Kien Ng, Sook; Zhang, Ying; Herman, Joseph; Wong, John; Ding, Kai [Department of Radiation Oncology, John Hopkins University, Baltimore, MD (United States); Ji, Tianlong [Department of Radiation Oncology, The First Hospital of China Medical University, Shenyang, Liaoning (China); Iordachita, Iulian [Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD (United States); Tutkun Sen, H.; Kazanzides, Peter; Lediju Bell, Muyinatu A. [Department of Computer Science, Johns Hopkins University, Baltimore, MD (United States)

    2016-06-15

    Purpose: Ultrasound is ideal for real-time monitoring in radiotherapy with high soft tissue contrast, non-ionization, portability, and cost effectiveness. Few studies investigated clinical application of real-time ultrasound monitoring for abdominal stereotactic body radiation therapy (SBRT). This study aims to demonstrate the feasibility of real-time monitoring of 3D target motion using 4D ultrasound. Methods: An ultrasound probe holding system was designed to allow clinician to freely move and lock ultrasound probe. For phantom study, an abdominal ultrasound phantom was secured on a 2D programmable respiratory motion stage. One side of the stage was elevated than another side to generate 3D motion. The motion stage made periodic breath-hold movement. Phantom movement tracked by infrared camera was considered as ground truth. For volunteer study three healthy subjects underwent the same setup for abdominal SBRT with active breath control (ABC). 4D ultrasound B-mode images were acquired for both phantom and volunteers for real-time monitoring. 10 breath-hold cycles were monitored for each experiment. For phantom, the target motion tracked by ultrasound was compared with motion tracked by infrared camera. For healthy volunteers, the reproducibility of ABC breath-hold was evaluated. Results: Volunteer study showed the ultrasound system fitted well to the clinical SBRT setup. The reproducibility for 10 breath-holds is less than 2 mm in three directions for all three volunteers. For phantom study the motion between inspiration and expiration captured by camera (ground truth) is 2.35±0.02 mm, 1.28±0.04 mm, 8.85±0.03 mm in LR, AP, SI directly, respectively. The motion monitored by ultrasound is 2.21±0.07 mm, 1.32±0.12mm, 9.10±0.08mm, respectively. The motion monitoring error in any direction is less than 0.5 mm. Conclusion: The volunteer study proved the clinical feasibility of real-time ultrasound monitoring for abdominal SBRT. The phantom and volunteer ABC

  13. Stereotactic Body Radiation Therapy Boost After Concurrent Chemoradiation for Locally Advanced Non-Small Cell Lung Cancer: A Phase 1 Dose Escalation Study

    Energy Technology Data Exchange (ETDEWEB)

    Hepel, Jaroslaw T., E-mail: jhepel@lifespan.org [Department of Radiation Oncology, Rhode Island Hospital, Brown University, Providence, Rhode Island (United States); Department of Radiation Oncology, Tufts Medical Center, Tufts University, Boston, Massachusetts (United States); Leonard, Kara Lynne [Department of Radiation Oncology, Rhode Island Hospital, Brown University, Providence, Rhode Island (United States); Department of Radiation Oncology, Tufts Medical Center, Tufts University, Boston, Massachusetts (United States); Safran, Howard [Division of Medical Oncology, Rhode Island Hospital, Brown University, Providence, Rhode Island (United States); Division of Medical Oncology, Miriam Hospital, Brown University, Providence, Rhode Island (United States); Ng, Thomas [Division of Thoracic Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island (United States); Taber, Angela [Division of Medical Oncology, Miriam Hospital, Brown University, Providence, Rhode Island (United States); Khurshid, Humera; Birnbaum, Ariel [Division of Medical Oncology, Rhode Island Hospital, Brown University, Providence, Rhode Island (United States); Wazer, David E.; DiPetrillo, Thomas [Department of Radiation Oncology, Rhode Island Hospital, Brown University, Providence, Rhode Island (United States); Department of Radiation Oncology, Tufts Medical Center, Tufts University, Boston, Massachusetts (United States)

    2016-12-01

    Purpose: Stereotactic body radiation therapy (SBRT) boost to primary and nodal disease after chemoradiation has potential to improve outcomes for advanced non-small cell lung cancer (NSCLC). A dose escalation study was initiated to evaluate the maximum tolerated dose (MTD). Methods and Materials: Eligible patients received chemoradiation to a dose of 50.4 Gy in 28 fractions and had primary and nodal volumes appropriate for SBRT boost (<120 cc and <60 cc, respectively). SBRT was delivered in 2 fractions after chemoradiation. Dose was escalated from 16 to 28 Gy in 2 Gy/fraction increments, resulting in 4 dose cohorts. MTD was defined when ≥2 of 6 patients per cohort experienced any treatment-related grade 3 to 5 toxicity within 4 weeks of treatment or the maximum dose was reached. Late toxicity, disease control, and survival were also evaluated. Results: Twelve patients (3 per dose level) underwent treatment. All treatment plans met predetermined dose-volume constraints. The mean age was 64 years. Most patients had stage III disease (92%) and were medically inoperable (92%). The maximum dose level was reached with no grade 3 to 5 acute toxicities. At a median follow-up time of 16 months, 1-year local-regional control (LRC) was 78%. LRC was 50% at <24 Gy and 100% at ≥24 Gy (P=.02). Overall survival at 1 year was 67%. Late toxicity (grade 3-5) was seen in only 1 patient who experienced fatal bronchopulmonary hemorrhage (grade 5). There were no predetermined dose constraints for the proximal bronchial-vascular tree (PBV) in this study. This patient's 4-cc PBV dose was substantially higher than that received by other patients in all 4 cohorts and was associated with the toxicity observed: 20.3 Gy (P<.05) and 73.5 Gy (P=.07) for SBRT boost and total treatment, respectively. Conclusions: SBRT boost to both primary and nodal disease after chemoradiation is feasible and well tolerated. Local control rates are encouraging, especially at doses ≥24

  14. SU-F-J-137: Intrafractional Change of the Relationship Between Internal Fiducials and External Breathing Signal in Pancreatic Cancer Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Pettersson, N; Murphy, J; Simpson, D; Cervino, L [University of California, San Diego, La Jolla, CA (United States)

    2016-06-15

    Purpose: The use of respiratory gating for management of breathing motion during stereotactic body radiation therapy (SBRT) relies on a consistent relationship between the breathing signal and the actual position of the internal target. This relationship was investigated in patients treated for pancreatic cancer. Methods: Four patients with pancreatic cancer undergoing SBRT that had implanted fiducials in the tumor were included in this study. Treatment plans were generated based on the exhale phases (30–70%) from the pre-treatment 4DCT. The margin between the internal target volume (ITV) and the planning target volume was three mm. After patient setup using cone-beam CT, simultaneous fluoroscopic imaging and breathing motion monitoring were used during at least three breathing cycles to verify the fiducial position and to optimize the gating window. After treatment, fluoroscopic images were acquired for verification purposes and exported for retrospective analyses. Fiducial positions were determined using a template-matching algorithm. For each dataset, we established a linear relationship between the fiducial position and the anterior-posterior (AP) breathing signal. The relationships before and after treatment were compared and the dose distribution impact evaluated. Results: Seven pre- and post-treatment fluoroscopic pairs were available for fiducial position analyses in the superior-inferior (SI) and left-right (LR) directions, and five in the AP direction. Time between image acquisitions was typically six to eight minutes. An average absolute change of 1.2±0.7 mm (range: 0.1–1.7) of the SI fiducial position relative to the external signal was found. Corresponding numbers for the LR and AP fiducial positions were 0.9±1.0 mm (range: 0.2–3.0) and 0.5±0.4 mm (range: 0.2–1.2), respectively. The dose distribution impact was small in both the ITV and organs-at-risk. Conclusion: The relationship change between fiducial position and external breathing

  15. Prostate-Specific Antigen 5 Years following Stereotactic Body Radiation Therapy for Low- and Intermediate-Risk Prostate Cancer: An Ablative Procedure?

    Directory of Open Access Journals (Sweden)

    Shaan Kataria

    2017-07-01

    Full Text Available BackgroundOur previous work on early PSA kinetics following prostate stereotactic body radiation therapy (SBRT demonstrated that an initial rapid and then slow PSA decline may result in very low PSA nadirs. This retrospective study sought to evaluate the PSA nadir 5 years following SBRT for low- and intermediate-risk prostate cancer (PCa.Methods65 low- and 80 intermediate-risk PCa patients were treated definitively with SBRT to 35–37.5 Gy in 5 fractions at Georgetown University Hospital between January 2008 and October 2011. Patients who received androgen deprivation therapy were excluded from this study. Biochemical relapse was defined as a PSA rise >2 ng/ml above the nadir and analyzed using the Kaplan–Meier method. The PSA nadir was defined as the lowest PSA value prior to biochemical relapse or as the lowest value recorded during follow-up. Prostate ablation was defined as a PSA nadir <0.2 ng/ml. Univariate logistic regression analysis was used to evaluate relevant variables on the likelihood of achieving a PSA nadir <0.2 ng/ml.ResultsThe median age at the start of SBRT was 72 years. These patients had a median prostate volume of 36 cc with a median 25% of total cores involved. At a median follow-up of 5.6 years, 86 and 37% of patients achieved a PSA nadir ≤0.5 and <0.2 ng/ml, respectively. The median time to PSA nadir was 36 months. Two low and seven intermediate risk patients experienced a biochemical relapse. Regardless of the PSA outcome, the median PSA nadir for all patients was 0.2 ng/ml. The 5-year biochemical relapse free survival (bRFS rate for low- and intermediate-risk patients was 98.5 and 95%, respectively. Initial PSA (p = 0.024 and a lower testosterone at the time of the PSA nadir (p = 0.049 were found to be significant predictors of achieving a PSA nadir <0.2 ng/ml.ConclusionSBRT for low- and intermediate-risk PCa is a convenient treatment option with low PSA nadirs and a high rate of

  16. Clinical prognostic factors and grading system for rib fracture following stereotactic body radiation therapy (SBRT) in patients with peripheral lung tumors.

    Science.gov (United States)

    Kim, Su Ssan; Song, Si Yeol; Kwak, Jungwon; Ahn, Seung Do; Kim, Jong Hoon; Lee, Jung Shin; Kim, Woo Sung; Kim, Sang-We; Choi, Eun Kyung

    2013-02-01

    Several studies reported rib fractures following stereotactic body radiation therapy (SBRT) for peripheral lung tumors. We tried to investigate risk factors and grading system for rib fractures after SBRT. Of 375 primary or metastatic lung tumors (296 patients) which were treated with SBRT at the Asan Medical Center (2006-2009), 126 lesions (118 patients) were adjacent to the chest-wall (6 months; these were investigated in the present retrospective study. Three to four fractional doses of 10-20 Gy were delivered to 85-90% iso-dose volume of the isocenter dose. Rib fracture grade was defined from follow-up CT scans as the appearance of a fracture line (Gr1), dislocation of the fractured rib by more than half the rib diameter (Gr2), or the appearance of adjacent soft tissue edema (Gr3). Chest wall pain was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE) v3.0. Correlations between dose-volume data and the development of rib fracture were then analyzed. The Kaplan-Meier method, log-rank tests, and chi-square tests were used for statistical analysis. The median age of the patients was 69 years (range: 19-90). Over a median follow-up period of 22 months (range: 7-62), 48 cases of rib fracture were confirmed. Median time to rib fracture was 17 months (range: 4-52). The 2-year actuarial risk of rib fracture was 42.4%. Maximal grade was Gr1 (n=28), Gr2 (n=8), or Gr3 (n=15). The incidence of moderate to severe chest wall pain (CTCAE Gr ≥ 2) increased with maximal fracture grade (17.5% for Gr0-1 and 60.9% for Gr2-3; prib fracture in the present study. Efforts to decrease chest wall dose should be made to reduce the risk of the rib fracture, particularly in high-risk patients. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  17. Modeling Local Control After Hypofractionated Stereotactic Body Radiation Therapy for Stage I Non-Small Cell Lung Cancer: A Report From the Elekta Collaborative Lung Research Group

    Energy Technology Data Exchange (ETDEWEB)

    Ohri, Nitin, E-mail: ohri.nitin@gmail.com [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Werner-Wasik, Maria [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States); Grills, Inga S. [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan (United States); Belderbos, Jose [Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam (Netherlands); Hope, Andrew [Department of Radiation Oncology, Princess Margaret Hospital and University of Toronto, Toronto, ON (Canada); Yan Di; Kestin, Larry L. [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan (United States); Guckenberger, Matthias [Department of Radiation Oncology, University of Wuerzburg, Wuerzburg (Germany); Sonke, Jan-Jakob [Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam (Netherlands); Bissonnette, Jean-Pierre [Department of Radiation Oncology, Princess Margaret Hospital and University of Toronto, Toronto, ON (Canada); Xiao, Ying [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania (United States)

    2012-11-01

    Purpose: Hypofractionated stereotactic body radiation therapy (SBRT) has emerged as an effective treatment option for early-stage non-small cell lung cancer (NSCLC). Using data collected by the Elekta Lung Research Group, we generated a tumor control probability (TCP) model that predicts 2-year local control after SBRT as a function of biologically effective dose (BED) and tumor size. Methods and Materials: We formulated our TCP model as follows: TCP = e{sup [BED10-c Asterisk-Operator L-TCD50]/k} Division-Sign (1 + e{sup [BED10-c Asterisk-Operator L-TCD50]/k}), where BED10 is the biologically effective SBRT dose, c is a constant, L is the maximal tumor diameter, and TCD50 and k are parameters that define the shape of the TCP curve. Least-squares optimization with a bootstrap resampling approach was used to identify the values of c, TCD50, and k that provided the best fit with observed actuarial 2-year local control rates. Results: Data from 504 NSCLC tumors treated with a variety of SBRT schedules were available. The mean follow-up time was 18.4 months, and 26 local recurrences were observed. The optimal values for c, TCD50, and k were 10 Gy/cm, 0 Gy, and 31 Gy, respectively. Thus, size-adjusted BED (sBED) may be defined as BED minus 10 times the tumor diameter (in centimeters). Our TCP model indicates that sBED values of 44 Gy, 69 Gy, and 93 Gy provide 80%, 90%, and 95% chances of tumor control at 2 years, respectively. When patients were grouped by sBED, the model accurately characterized the relationship between sBED and actuarial 2-year local control (r=0.847, P=.008). Conclusion: We have developed a TCP model that predicts 2-year local control rate after hypofractionated SBRT for early-stage NSCLC as a function of biologically effective dose and tumor diameter. Further testing of this model with additional datasets is warranted.

  18. Magnetic Resonance Imaging Assessment of Spinal Cord and Cauda Equina Motion in Supine Patients With Spinal Metastases Planned for Spine Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Tseng, Chia-Lin [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Sussman, Marshall S. [Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario (Canada); Atenafu, Eshetu G. [Department of Biostatistics, University Health Network, University of Toronto, Toronto, Ontario (Canada); Letourneau, Daniel [Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Ma, Lijun [Department of Radiation Oncology, University of California San Francisco, San Francisco, California (United States); Soliman, Hany; Thibault, Isabelle [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Cho, B. C. John; Simeonov, Anna [Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Yu, Eugene [Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario (Canada); Fehlings, Michael G. [Department of Neurosurgery and Spine Program, Toronto Western Hospital, University of Toronto, Toronto, Ontario (Canada); Sahgal, Arjun, E-mail: arjun.sahgal@sunnybrook.ca [Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario (Canada)

    2015-04-01

    Purpose: To assess motion of the spinal cord and cauda equina, which are critical neural tissues (CNT), which is important when evaluating the planning organ-at-risk margin required for stereotactic body radiation therapy. Methods and Materials: We analyzed CNT motion in 65 patients with spinal metastases (11 cervical, 39 thoracic, and 24 lumbar spinal segments) in the supine position using dynamic axial and sagittal magnetic resonance imaging (dMRI, 3T Verio, Siemens) over a 137-second interval. Motion was segregated according to physiologic cardiorespiratory oscillatory motion (characterized by the average root mean square deviation) and random bulk shifts associated with gross patient motion (characterized by the range). Displacement was evaluated in the anteroposterior (AP), lateral (LR), and superior-inferior (SI) directions by use of a correlation coefficient template matching algorithm, with quantification of random motion measure error over 3 separate trials. Statistical significance was defined according to P<.05. Results: In the AP, LR, and SI directions, significant oscillatory motion was observed in 39.2%, 35.1%, and 10.8% of spinal segments, respectively, and significant bulk motions in all cases. The median oscillatory CNT motions in the AP, LR, and SI directions were 0.16 mm, 0.17 mm, and 0.44 mm, respectively, and the maximal statistically significant oscillatory motions were 0.39 mm, 0.41 mm, and 0.77 mm, respectively. The median bulk displacements in the AP, LR, and SI directions were 0.51 mm, 0.59 mm, and 0.66 mm, and the maximal statistically significant displacements were 2.21 mm, 2.87 mm, and 3.90 mm, respectively. In the AP, LR, and SI directions, bulk displacements were greater than 1.5 mm in 5.4%, 9.0%, and 14.9% of spinal segments, respectively. No significant differences in axial motion were observed according to cord level or cauda equina. Conclusions: Oscillatory CNT motion was observed to be relatively minor. Our results

  19. Quantitative Analysis of {sup 18}F-Fluorodeoxyglucose Positron Emission Tomography Identifies Novel Prognostic Imaging Biomarkers in Locally Advanced Pancreatic Cancer Patients Treated With Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Cui, Yi [Department of Radiation Oncology, Stanford University, Palo Alto, California (United States); Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo (Japan); Song, Jie; Pollom, Erqi; Alagappan, Muthuraman [Department of Radiation Oncology, Stanford University, Palo Alto, California (United States); Shirato, Hiroki [Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo (Japan); Chang, Daniel T.; Koong, Albert C. [Department of Radiation Oncology, Stanford University, Palo Alto, California (United States); Stanford Cancer Institute, Stanford, California (United States); Li, Ruijiang, E-mail: rli2@stanford.edu [Department of Radiation Oncology, Stanford University, Palo Alto, California (United States); Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo (Japan); Stanford Cancer Institute, Stanford, California (United States)

    2016-09-01

    Purpose: To identify prognostic biomarkers in pancreatic cancer using high-throughput quantitative image analysis. Methods and Materials: In this institutional review board–approved study, we retrospectively analyzed images and outcomes for 139 locally advanced pancreatic cancer patients treated with stereotactic body radiation therapy (SBRT). The overall population was split into a training cohort (n=90) and a validation cohort (n=49) according to the time of treatment. We extracted quantitative imaging characteristics from pre-SBRT {sup 18}F-fluorodeoxyglucose positron emission tomography, including statistical, morphologic, and texture features. A Cox proportional hazard regression model was built to predict overall survival (OS) in the training cohort using 162 robust image features. To avoid over-fitting, we applied the elastic net to obtain a sparse set of image features, whose linear combination constitutes a prognostic imaging signature. Univariate and multivariate Cox regression analyses were used to evaluate the association with OS, and concordance index (CI) was used to evaluate the survival prediction accuracy. Results: The prognostic imaging signature included 7 features characterizing different tumor phenotypes, including shape, intensity, and texture. On the validation cohort, univariate analysis showed that this prognostic signature was significantly associated with OS (P=.002, hazard ratio 2.74), which improved upon conventional imaging predictors including tumor volume, maximum standardized uptake value, and total legion glycolysis (P=.018-.028, hazard ratio 1.51-1.57). On multivariate analysis, the proposed signature was the only significant prognostic index (P=.037, hazard ratio 3.72) when adjusted for conventional imaging and clinical factors (P=.123-.870, hazard ratio 0.53-1.30). In terms of CI, the proposed signature scored 0.66 and was significantly better than competing prognostic indices (CI 0.48-0.64, Wilcoxon rank sum test P<1e-6

  20. A Prospective Phase 2 Trial of Reirradiation With Stereotactic Body Radiation Therapy Plus Cetuximab in Patients With Previously Irradiated Recurrent Squamous Cell Carcinoma of the Head and Neck

    Energy Technology Data Exchange (ETDEWEB)

    Vargo, John A. [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Ferris, Robert L. [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Department of Otolaryngology, Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania (United States); Ohr, James [Division Medical Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (United States); Clump, David A. [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Davis, Kara S.; Duvvuri, Umamaheswar; Kim, Seungwon; Johnson, Jonas T. [Department of Otolaryngology, Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania (United States); Bauman, Julie E.; Gibson, Michael K. [Division Medical Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (United States); Branstetter, Barton F. [Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States); Heron, Dwight E., E-mail: herond2@umpc.edu [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Department of Otolaryngology, Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania (United States)

    2015-03-01

    Purpose: Salvage options for unresectable locally recurrent, previously irradiated squamous cell carcinoma of the head and neck (rSCCHN) are limited. Although the addition of reirradiation may improve outcomes compared to chemotherapy alone, significant toxicities limit salvage reirradiation strategies, leading to suboptimal outcomes. We therefore designed a phase 2 protocol to evaluate the efficacy of stereotactic body radiation therapy (SBRT) plus cetuximab for rSCCHN. Methods and Materials: From July 2007 to March 2013, 50 patients >18 years of age with inoperable locoregionally confined rSCCHN within a previously irradiated field receiving ≥60 Gy, with a Zubrod performance status of 0 to 2, and normal hepatic and renal function were enrolled. Patients received concurrent cetuximab (400 mg/m{sup 2} on day −7 and then 250 mg/m{sup 2} on days 0 and +8) plus SBRT (40-44 Gy in 5 fractions on alternating days over 1-2 weeks). Primary endpoints were 1-year locoregional progression-free survival and National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0 graded toxicity. Results: Median follow-up for surviving patients was 18 months (range: 10-70). The 1-year local PFS rate was 60% (95% confidence interval [CI]: 44%-75%), locoregional PFS was 37% (95% CI: 23%-53%), distant PFS was 71% (95% CI: 54%-85%), and PFS was 33% (95% CI: 20%-49%). The median overall survival was 10 months (95% CI: 7-16), with a 1-year overall survival of 40% (95% CI: 26%-54%). At last follow-up, 69% died of disease, 4% died with disease, 15% died without progression, 10% were alive without progression, and 2% were alive with progression. Acute and late grade 3 toxicity was observed in 6% of patients respectively. Conclusions: SBRT with concurrent cetuximab appears to be a safe salvage treatment for rSCCHN of short overall treatment time.

  1. Cone beam CT-based set-up strategies with and without rotational correction for stereotactic body radiation therapy in the liver.

    Science.gov (United States)

    Bertholet, Jenny; Worm, Esben; Høyer, Morten; Poulsen, Per

    2017-06-01

    Accurate patient positioning is crucial in stereotactic body radiation therapy (SBRT) due to a high dose regimen. Cone-beam computed tomography (CBCT) is often used for patient positioning based on radio-opaque markers. We compared six CBCT-based set-up strategies with or without rotational correction. Twenty-nine patients with three implanted markers received 3-6 fraction liver SBRT. The markers were delineated on the mid-ventilation phase of a 4D-planning-CT. One pretreatment CBCT was acquired per fraction. Set-up strategy 1 used only translational correction based on manual marker match between the CBCT and planning CT. Set-up strategy 2 used automatic 6 degrees-of-freedom registration of the vertebrae closest to the target. The 3D marker trajectories were also extracted from the projections and the mean position of each marker was calculated and used for set-up strategies 3-6. Translational correction only was used for strategy 3. Translational and rotational corrections were used for strategies 4-6 with the rotation being either vertebrae based (strategy 4), or marker based and constrained to ±3° (strategy 5) or unconstrained (strategy 6). The resulting set-up error was calculated as the 3D root-mean-square set-up error of the three markers. The set-up error of the spinal cord was calculated for all strategies. The bony anatomy set-up (2) had the largest set-up error (5.8 mm). The marker-based set-up with unconstrained rotations (6) had the smallest set-up error (0.8 mm) but the largest spinal cord set-up error (12.1 mm). The marker-based set-up with translational correction only (3) or with bony anatomy rotational correction (4) had equivalent set-up error (1.3 mm) but rotational correction reduced the spinal cord set-up error from 4.1 mm to 3.5 mm. Marker-based set-up was substantially better than bony-anatomy set-up. Rotational correction may improve the set-up, but further investigations are required to determine the optimal correction

  2. Dose-Escalated Stereotactic Body Radiation Therapy for Patients With Intermediate- and High-Risk Prostate Cancer: Initial Dosimetry Analysis and Patient Outcomes

    International Nuclear Information System (INIS)

    Kotecha, Rupesh; Djemil, Toufik; Tendulkar, Rahul D.; Reddy, Chandana A.; Thousand, Richard A.; Vassil, Andrew; Stovsky, Mark; Berglund, Ryan K.; Klein, Eric A.; Stephans, Kevin L.

    2016-01-01

    Purpose: To report the short-term clinical outcomes and acute and late treatment-related genitourinary (GU) and gastrointestinal (GI) toxicities in patients with intermediate- and high-risk prostate cancer treated with dose-escalated stereotactic body radiation therapy (SBRT). Methods and Materials: Between 2011 and 2014, 24 patients with prostate cancer were treated with SBRT to the prostate gland and proximal seminal vesicles. A high-dose avoidance zone (HDAZ) was created by a 3-mm expansion around the rectum, urethra, and bladder. Patients were treated to a minimum dose of 36.25 Gy in 5 fractions, with a simultaneous dose escalation to a dose of 50 Gy to the target volume away from the HDAZ. Acute and late GU and GI toxicity outcomes were measured according to the National Cancer Institute Common Terminology Criteria for Adverse Events toxicity scale, version 4. Results: The median follow-up was 25 months (range, 18-45 months). Nine patients (38%) experienced an acute grade 2 GU toxicity, which was medically managed, and no patients experienced an acute grade 2 GI toxicity. Two patients (8%) experienced late grade 2 GU toxicity, and 2 patients (8%) experienced late grade 2 GI toxicity. No acute or late grade ≥3 GU or GI toxicities were observed. The 24-month prostate-specific antigen relapse-free survival outcome for all patients was 95.8% (95% confidence interval 75.6%-99.4%), and both biochemical failures occurred in patients with high-risk disease. All patients are currently alive at the time of this analysis and continue to be followed. Conclusions: A heterogeneous prostate SBRT planning technique with differential treatment volumes (low dose: 36.25 Gy; and high dose: 50 Gy) with an HDAZ provides a safe method of dose escalation. Favorable rates of biochemical control and acceptably low rates of acute and long-term GU and GI toxicity can be achieved in patients with intermediate- and high-risk prostate cancer treated with SBRT.

  3. Baseline Metabolic Tumor Volume and Total Lesion Glycolysis Are Associated With Survival Outcomes in Patients With Locally Advanced Pancreatic Cancer Receiving Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Dholakia, Avani S. [Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Chaudhry, Muhammad; Leal, Jeffrey P. [Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Chang, Daniel T. [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Raman, Siva P. [Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Hacker-Prietz, Amy [Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Su, Zheng; Pai, Jonathan [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); Oteiza, Katharine E.; Griffith, Mary E. [Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Wahl, Richard L. [Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Tryggestad, Erik [Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Pawlik, Timothy [Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Laheru, Daniel A. [Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Wolfgang, Christopher L. [Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland (United States); Koong, Albert C. [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States); and others

    2014-07-01

    Purpose: Although previous studies have demonstrated the prognostic value of positron emission tomography (PET) parameters in other malignancies, the role of PET in pancreatic cancer has yet to be well established. We analyzed the prognostic utility of PET for patients with locally advanced pancreatic cancer (LAPC) undergoing fractionated stereotactic body radiation therapy (SBRT). Materials and Methods: Thirty-two patients with LAPC in a prospective clinical trial received up to 3 doses of gemcitabine, followed by 33 Gy in 5 fractions of 6.6 Gy, using SBRT. All patients received a baseline PET scan prior to SBRT (pre-SBRT PET). Metabolic tumor volume (MTV), total lesion glycolysis (TLG), and maximum and peak standardized uptake values (SUV{sub max} and SUV{sub peak}) on pre-SBRT PET scans were calculated using custom-designed software. Disease was measured at a threshold based on the liver SUV, using the equation Liver{sub mean} + [2 × Liver{sub sd}]. Median values of PET parameters were used as cutoffs when assessing their prognostic potential through Cox regression analyses. Results: Of the 32 patients, the majority were male (n=19, 59%), 65 years or older (n=21, 66%), and had tumors located in the pancreatic head (n=27, 84%). Twenty-seven patients (84%) received induction gemcitabine prior to SBRT. Median overall survival for the entire cohort was 18.8 months (95% confidence interval [CI], 15.7-22.0). An MTV of 26.8 cm{sup 3} or greater (hazard ratio [HR] 4.46, 95% CI 1.64-5.88, P<.003) and TLG of 70.9 or greater (HR 3.08, 95% CI 1.18-8.02, P<.021) on pre-SBRT PET scan were associated with inferior overall survival on univariate analysis. Both pre-SBRT MTV (HR 5.13, 95% CI 1.19-22.21, P=.029) and TLG (HR 3.34, 95% CI 1.07-10.48, P=.038) remained independently associated with overall survival in separate multivariate analyses. Conclusions: Pre-SBRT MTV and TLG are potential predictive factors for overall survival in patients with LAPC and may assist in

  4. Modeling Local Control After Hypofractionated Stereotactic Body Radiation Therapy for Stage I Non-Small Cell Lung Cancer: A Report From the Elekta Collaborative Lung Research Group

    International Nuclear Information System (INIS)

    Ohri, Nitin; Werner-Wasik, Maria; Grills, Inga S.; Belderbos, José; Hope, Andrew; Yan Di; Kestin, Larry L.; Guckenberger, Matthias; Sonke, Jan-Jakob; Bissonnette, Jean-Pierre; Xiao, Ying

    2012-01-01

    Purpose: Hypofractionated stereotactic body radiation therapy (SBRT) has emerged as an effective treatment option for early-stage non-small cell lung cancer (NSCLC). Using data collected by the Elekta Lung Research Group, we generated a tumor control probability (TCP) model that predicts 2-year local control after SBRT as a function of biologically effective dose (BED) and tumor size. Methods and Materials: We formulated our TCP model as follows: TCP = e [BED10−c∗L−TCD50]/k ÷ (1 + e [BED10−c∗L−TCD50]/k ), where BED10 is the biologically effective SBRT dose, c is a constant, L is the maximal tumor diameter, and TCD50 and k are parameters that define the shape of the TCP curve. Least-squares optimization with a bootstrap resampling approach was used to identify the values of c, TCD50, and k that provided the best fit with observed actuarial 2-year local control rates. Results: Data from 504 NSCLC tumors treated with a variety of SBRT schedules were available. The mean follow-up time was 18.4 months, and 26 local recurrences were observed. The optimal values for c, TCD50, and k were 10 Gy/cm, 0 Gy, and 31 Gy, respectively. Thus, size-adjusted BED (sBED) may be defined as BED minus 10 times the tumor diameter (in centimeters). Our TCP model indicates that sBED values of 44 Gy, 69 Gy, and 93 Gy provide 80%, 90%, and 95% chances of tumor control at 2 years, respectively. When patients were grouped by sBED, the model accurately characterized the relationship between sBED and actuarial 2-year local control (r=0.847, P=.008). Conclusion: We have developed a TCP model that predicts 2-year local control rate after hypofractionated SBRT for early-stage NSCLC as a function of biologically effective dose and tumor diameter. Further testing of this model with additional datasets is warranted.

  5. Support Vector Machine-Based Prediction of Local Tumor Control After Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer

    International Nuclear Information System (INIS)

    Klement, Rainer J.; Allgäuer, Michael; Appold, Steffen; Dieckmann, Karin; Ernst, Iris; Ganswindt, Ute; Holy, Richard; Nestle, Ursula; Nevinny-Stickel, Meinhard; Semrau, Sabine; Sterzing, Florian; Wittig, Andrea; Andratschke, Nicolaus; Guckenberger, Matthias

    2014-01-01

    Background: Several prognostic factors for local tumor control probability (TCP) after stereotactic body radiation therapy (SBRT) for early stage non-small cell lung cancer (NSCLC) have been described, but no attempts have been undertaken to explore whether a nonlinear combination of potential factors might synergistically improve the prediction of local control. Methods and Materials: We investigated a support vector machine (SVM) for predicting TCP in a cohort of 399 patients treated at 13 German and Austrian institutions. Among 7 potential input features for the SVM we selected those most important on the basis of forward feature selection, thereby evaluating classifier performance by using 10-fold cross-validation and computing the area under the ROC curve (AUC). The final SVM classifier was built by repeating the feature selection 10 times with different splitting of the data for cross-validation and finally choosing only those features that were selected at least 5 out of 10 times. It was compared with a multivariate logistic model that was built by forward feature selection. Results: Local failure occurred in 12% of patients. Biologically effective dose (BED) at the isocenter (BED ISO ) was the strongest predictor of TCP in the logistic model and also the most frequently selected input feature for the SVM. A bivariate logistic function of BED ISO and the pulmonary function indicator forced expiratory volume in 1 second (FEV1) yielded the best description of the data but resulted in a significantly smaller AUC than the final SVM classifier with the input features BED ISO , age, baseline Karnofsky index, and FEV1 (0.696 ± 0.040 vs 0.789 ± 0.001, P<.03). The final SVM resulted in sensitivity and specificity of 67.0% ± 0.5% and 78.7% ± 0.3%, respectively. Conclusions: These results confirm that machine learning techniques like SVMs can be successfully applied to predict treatment outcome after SBRT. Improvements over traditional TCP modeling are

  6. A Prospective Phase 2 Trial of Reirradiation With Stereotactic Body Radiation Therapy Plus Cetuximab in Patients With Previously Irradiated Recurrent Squamous Cell Carcinoma of the Head and Neck

    International Nuclear Information System (INIS)

    Vargo, John A.; Ferris, Robert L.; Ohr, James; Clump, David A.; Davis, Kara S.; Duvvuri, Umamaheswar; Kim, Seungwon; Johnson, Jonas T.; Bauman, Julie E.; Gibson, Michael K.; Branstetter, Barton F.; Heron, Dwight E.

    2015-01-01

    Purpose: Salvage options for unresectable locally recurrent, previously irradiated squamous cell carcinoma of the head and neck (rSCCHN) are limited. Although the addition of reirradiation may improve outcomes compared to chemotherapy alone, significant toxicities limit salvage reirradiation strategies, leading to suboptimal outcomes. We therefore designed a phase 2 protocol to evaluate the efficacy of stereotactic body radiation therapy (SBRT) plus cetuximab for rSCCHN. Methods and Materials: From July 2007 to March 2013, 50 patients >18 years of age with inoperable locoregionally confined rSCCHN within a previously irradiated field receiving ≥60 Gy, with a Zubrod performance status of 0 to 2, and normal hepatic and renal function were enrolled. Patients received concurrent cetuximab (400 mg/m 2 on day −7 and then 250 mg/m 2 on days 0 and +8) plus SBRT (40-44 Gy in 5 fractions on alternating days over 1-2 weeks). Primary endpoints were 1-year locoregional progression-free survival and National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0 graded toxicity. Results: Median follow-up for surviving patients was 18 months (range: 10-70). The 1-year local PFS rate was 60% (95% confidence interval [CI]: 44%-75%), locoregional PFS was 37% (95% CI: 23%-53%), distant PFS was 71% (95% CI: 54%-85%), and PFS was 33% (95% CI: 20%-49%). The median overall survival was 10 months (95% CI: 7-16), with a 1-year overall survival of 40% (95% CI: 26%-54%). At last follow-up, 69% died of disease, 4% died with disease, 15% died without progression, 10% were alive without progression, and 2% were alive with progression. Acute and late grade 3 toxicity was observed in 6% of patients respectively. Conclusions: SBRT with concurrent cetuximab appears to be a safe salvage treatment for rSCCHN of short overall treatment time

  7. MO-FG-CAMPUS-JeP3-04: Feasibility Study of Real-Time Ultrasound Monitoring for Abdominal Stereotactic Body Radiation Therapy

    International Nuclear Information System (INIS)

    Su, Lin; Kien Ng, Sook; Zhang, Ying; Herman, Joseph; Wong, John; Ding, Kai; Ji, Tianlong; Iordachita, Iulian; Tutkun Sen, H.; Kazanzides, Peter; Lediju Bell, Muyinatu A.

    2016-01-01

    Purpose: Ultrasound is ideal for real-time monitoring in radiotherapy with high soft tissue contrast, non-ionization, portability, and cost effectiveness. Few studies investigated clinical application of real-time ultrasound monitoring for abdominal stereotactic body radiation therapy (SBRT). This study aims to demonstrate the feasibility of real-time monitoring of 3D target motion using 4D ultrasound. Methods: An ultrasound probe holding system was designed to allow clinician to freely move and lock ultrasound probe. For phantom study, an abdominal ultrasound phantom was secured on a 2D programmable respiratory motion stage. One side of the stage was elevated than another side to generate 3D motion. The motion stage made periodic breath-hold movement. Phantom movement tracked by infrared camera was considered as ground truth. For volunteer study three healthy subjects underwent the same setup for abdominal SBRT with active breath control (ABC). 4D ultrasound B-mode images were acquired for both phantom and volunteers for real-time monitoring. 10 breath-hold cycles were monitored for each experiment. For phantom, the target motion tracked by ultrasound was compared with motion tracked by infrared camera. For healthy volunteers, the reproducibility of ABC breath-hold was evaluated. Results: Volunteer study showed the ultrasound system fitted well to the clinical SBRT setup. The reproducibility for 10 breath-holds is less than 2 mm in three directions for all three volunteers. For phantom study the motion between inspiration and expiration captured by camera (ground truth) is 2.35±0.02 mm, 1.28±0.04 mm, 8.85±0.03 mm in LR, AP, SI directly, respectively. The motion monitored by ultrasound is 2.21±0.07 mm, 1.32±0.12mm, 9.10±0.08mm, respectively. The motion monitoring error in any direction is less than 0.5 mm. Conclusion: The volunteer study proved the clinical feasibility of real-time ultrasound monitoring for abdominal SBRT. The phantom and volunteer ABC

  8. Differences in dose-volumetric data between the analytical anisotropic algorithm and the x-ray voxel Monte Carlo algorithm in stereotactic body radiation therapy for lung cancer

    International Nuclear Information System (INIS)

    Mampuya, Wambaka Ange; Matsuo, Yukinori; Nakamura, Akira; Nakamura, Mitsuhiro; Mukumoto, Nobutaka; Miyabe, Yuki; Narabayashi, Masaru; Sakanaka, Katsuyuki; Mizowaki, Takashi; Hiraoka, Masahiro

    2013-01-01

    The objective of this study was to evaluate the differences in dose-volumetric data obtained using the analytical anisotropic algorithm (AAA) vs the x-ray voxel Monte Carlo (XVMC) algorithm for stereotactic body radiation therapy (SBRT) for lung cancer. Dose-volumetric data from 20 patients treated with SBRT for solitary lung cancer generated using the iPlan XVMC for the Novalis system consisting of a 6-MV linear accelerator and micro-multileaf collimators were recalculated with the AAA in Eclipse using the same monitor units and identical beam setup. The mean isocenter dose was 100.2% and 98.7% of the prescribed dose according to XVMC and AAA, respectively. Mean values of the maximal dose (D max ), the minimal dose (D min ), and dose received by 95% volume (D 95 ) for the planning target volume (PTV) with XVMC were 104.3%, 75.1%, and 86.2%, respectively. When recalculated with the AAA, those values were 100.8%, 77.1%, and 85.4%, respectively. Mean dose parameter values considered for the normal lung, namely the mean lung dose, V 5 , and V 20 , were 3.7 Gy, 19.4%, and 5.0% for XVMC and 3.6 Gy, 18.3%, and 4.7% for the AAA, respectively. All of these dose-volumetric differences between the 2 algorithms were within 5% of the prescribed dose. The effect of PTV size and tumor location, respectively, on the differences in dose parameters for the PTV between the AAA and XVMC was evaluated. A significant effect of the PTV on the difference in D 95 between the AAA and XVMC was observed (p = 0.03). Differences in the marginal doses, namely D min and D 95 , were statistically significant between peripherally and centrally located tumors (p = 0.04 and p = 0.02, respectively). Tumor location and volume might have an effect on the differences in dose-volumetric parameters. The differences between AAA and XVMC were considered to be within an acceptable range (<5 percentage points)

  9. SU-F-T-622: Comparative Analysis of Pencil Beam and Anisotropic Analytical Algorithm (AAA) for Stereotactic Body Radiation Therapy (SBRT) of Thoracic Spine

    Energy Technology Data Exchange (ETDEWEB)

    Badkul, R; Nicolai, W; Pokhrel, D; Jiang, H; Wang, F; Lominskac, C [University of Kansas Medical Center, Kansas City, KS (United States); Ramanjappa, T [S. K. University, Anantapur, AP (India)

    2016-06-15

    Purpose: To compare the impact of Pencil Beam(PB) and Anisotropic Analytic Algorithm(AAA) dose calculation algorithms on OARs and planning target volume (PTV) in thoracic spine stereotactic body radiation therapy (SBRT). Methods: Ten Spine SBRT patients were planned on Brainlab iPlan system using hybrid plan consisting of 1–2 non-coplanar conformal-dynamic arcs and few IMRT beams treated on NovalisTx with 6MV photon. Dose prescription varied from 20Gy to 30Gy in 5 fractions depending on the situation of the patient. PB plans were retrospectively recalculated using the Varian Eclipse with AAA algorithm using same MUs, MLC pattern and grid size(3mm).Differences in dose volume parameters for PTV, spinal cord, lung, and esophagus were analyzed and compared for PB and AAA algorithms. OAR constrains were followed per RTOG-0631. Results: Since patients were treated using PB calculation, we compared all the AAA DVH values with respect to PB plan values as standard, although AAA predicts the dose more accurately than PB. PTV(min), PTV(Max), PTV(mean), PTV(D99%), PTV(D90%) were overestimated with AAA calculation on average by 3.5%, 1.84%, 0.95%, 3.98% and 1.55% respectively as compared to PB. All lung DVH parameters were underestimated with AAA algorithm mean deviation of lung V20, V10, V5, and 1000cc were 42.81%,19.83%, 18.79%, and 18.35% respectively. AAA overestimated Cord(0.35cc) by mean of 17.3%; cord (0.03cc) by 12.19% and cord(max) by 10.5% as compared to PB. Esophagus max dose were overestimated by 4.4% and 5cc by 3.26% for AAA algorithm as compared to PB. Conclusion: AAA overestimated the PTV dose values by up to 4%.The lung DVH had the greatest underestimation of dose by AAA versus PB. Spinal cord dose was overestimated by AAA versus PB. Given the critical importance of accuracy of OAR and PTV dose calculation for SBRT spine, more accurate algorithms and validation of calculated doses in phantom models are indicated.

  10. Dose-Escalated Stereotactic Body Radiation Therapy for Patients With Intermediate- and High-Risk Prostate Cancer: Initial Dosimetry Analysis and Patient Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Kotecha, Rupesh; Djemil, Toufik; Tendulkar, Rahul D.; Reddy, Chandana A.; Thousand, Richard A.; Vassil, Andrew [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States); Stovsky, Mark; Berglund, Ryan K.; Klein, Eric A. [Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio (United States); Stephans, Kevin L., E-mail: stephak@ccf.org [Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (United States)

    2016-07-01

    Purpose: To report the short-term clinical outcomes and acute and late treatment-related genitourinary (GU) and gastrointestinal (GI) toxicities in patients with intermediate- and high-risk prostate cancer treated with dose-escalated stereotactic body radiation therapy (SBRT). Methods and Materials: Between 2011 and 2014, 24 patients with prostate cancer were treated with SBRT to the prostate gland and proximal seminal vesicles. A high-dose avoidance zone (HDAZ) was created by a 3-mm expansion around the rectum, urethra, and bladder. Patients were treated to a minimum dose of 36.25 Gy in 5 fractions, with a simultaneous dose escalation to a dose of 50 Gy to the target volume away from the HDAZ. Acute and late GU and GI toxicity outcomes were measured according to the National Cancer Institute Common Terminology Criteria for Adverse Events toxicity scale, version 4. Results: The median follow-up was 25 months (range, 18-45 months). Nine patients (38%) experienced an acute grade 2 GU toxicity, which was medically managed, and no patients experienced an acute grade 2 GI toxicity. Two patients (8%) experienced late grade 2 GU toxicity, and 2 patients (8%) experienced late grade 2 GI toxicity. No acute or late grade ≥3 GU or GI toxicities were observed. The 24-month prostate-specific antigen relapse-free survival outcome for all patients was 95.8% (95% confidence interval 75.6%-99.4%), and both biochemical failures occurred in patients with high-risk disease. All patients are currently alive at the time of this analysis and continue to be followed. Conclusions: A heterogeneous prostate SBRT planning technique with differential treatment volumes (low dose: 36.25 Gy; and high dose: 50 Gy) with an HDAZ provides a safe method of dose escalation. Favorable rates of biochemical control and acceptably low rates of acute and long-term GU and GI toxicity can be achieved in patients with intermediate- and high-risk prostate cancer treated with SBRT.

  11. TH-CD-207A-12: Impacts of Inter- and Intra-Fractional Organ Motion for High-Risk Prostate Cancer Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Hassan Rezaeian, N; Chi, Y; Zhou, Y; Tian, Z; Jiang, S; Hannan, R; Jia, X [UT Southwestern Medical Center, Dallas, TX (United States)

    2016-06-15

    Purpose: We are conducting a clinical trial on stereotactic body radiation therapy (SBRT) for high-risk prostate cancer. Doses to three targets, prostate, intra-prostatic lesion, and pelvic lymph node (PLN) region, are escalated to three different levels via simultaneous integrated boost technique. Inter-/intra-fractional organ motions deteriorate planned dose distribution. This study aims at developing a dose reconstruction system to comprehensively understand the impacts of organ motion in our clinical trial. Methods: A 4D dose reconstruction system has been developed for this study. Using a GPU-based Monte-Carlo dose engine and delivery log file, the system is able to reconstruct dose on static or dynamic anatomy. For prostate and intra-prostatic targets, intra-fractional motion is the main concern. Motion trajectory acquired from Calypso in previously treated SBRT patients were used to perform 4D dose reconstructions. For pelvic target, inter-fractional motion is one concern. Eight patients, each with four cone beam CTs, were used to derive fractional motion. The delivered dose was reconstructed on the deformed anatomy. Dosimetric parameters for delivered dose distributions of the three targets were extracted and compared with planned levels. Results: For prostate intra-fractional motion, the mean 3D motion amplitude during beam delivery ranged from 1.5mm to 5.0mm and the average among all patients was 2.61mm. Inter-fractional motion for the PLN target was more significant. The average amplitude among patients was 4mm with the largest amplitude up to 9.6mm. The D95% deviation from planned level for prostate PTVs and GTVs are on average less than<0.1% and this deviation for intra-prostatic lesion PTVs and GTVs were more prominent. The dose at PLN was significantly affected with D{sub 95}% reduced by up to 44%. Conclusion: Intra-/inter-fractional organ motion is a concern for high-risk prostate SBRT, particularly for the PLN target. Our dose reconstruction

  12. Support Vector Machine-Based Prediction of Local Tumor Control After Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Klement, Rainer J., E-mail: rainer_klement@gmx.de [Department of Radiation Oncology, University of Würzburg (Germany); Department of Radiotherapy and Radiation Oncology, Leopoldina Hospital, Schweinfurt (Germany); Allgäuer, Michael [Department of Radiotherapy, Barmherzige Brüder Regensburg, Regensburg (Germany); Appold, Steffen [Department of Radiation Oncology, Technische Universität Dresden (Germany); Dieckmann, Karin [Department of Radiotherapy, Medical University of Vienna (Austria); Ernst, Iris [Department of Radiotherapy, University Hospital Münster (Germany); Ganswindt, Ute [Department of Radiation Oncology, Ludwigs-Maximilians-University Munich, München (Germany); Holy, Richard [Department of Radiation Oncology, RWTH Aachen University, Aachen (Germany); Nestle, Ursula [Department of Radiation Oncology, University Hospital Freiburg, Freiburg i Br (Germany); Nevinny-Stickel, Meinhard [Department of Therapeutic Radiology and Oncology, Innsbruck Medical University (Austria); Semrau, Sabine [Department of Radiation Oncology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen (Germany); Sterzing, Florian [Department of Radiation Oncology, University Hospital Heidelberg (Germany); Wittig, Andrea [Department of Radiotherapy and Radiation Oncology, Philipps-University Marburg (Germany); Andratschke, Nicolaus [Department of Radiation Oncology, Technische Universität München (Germany); Guckenberger, Matthias [Department of Radiation Oncology, University of Würzburg (Germany)

    2014-03-01

    Background: Several prognostic factors for local tumor control probability (TCP) after stereotactic body radiation therapy (SBRT) for early stage non-small cell lung cancer (NSCLC) have been described, but no attempts have been undertaken to explore whether a nonlinear combination of potential factors might synergistically improve the prediction of local control. Methods and Materials: We investigated a support vector machine (SVM) for predicting TCP in a cohort of 399 patients treated at 13 German and Austrian institutions. Among 7 potential input features for the SVM we selected those most important on the basis of forward feature selection, thereby evaluating classifier performance by using 10-fold cross-validation and computing the area under the ROC curve (AUC). The final SVM classifier was built by repeating the feature selection 10 times with different splitting of the data for cross-validation and finally choosing only those features that were selected at least 5 out of 10 times. It was compared with a multivariate logistic model that was built by forward feature selection. Results: Local failure occurred in 12% of patients. Biologically effective dose (BED) at the isocenter (BED{sub ISO}) was the strongest predictor of TCP in the logistic model and also the most frequently selected input feature for the SVM. A bivariate logistic function of BED{sub ISO} and the pulmonary function indicator forced expiratory volume in 1 second (FEV1) yielded the best description of the data but resulted in a significantly smaller AUC than the final SVM classifier with the input features BED{sub ISO}, age, baseline Karnofsky index, and FEV1 (0.696 ± 0.040 vs 0.789 ± 0.001, P<.03). The final SVM resulted in sensitivity and specificity of 67.0% ± 0.5% and 78.7% ± 0.3%, respectively. Conclusions: These results confirm that machine learning techniques like SVMs can be successfully applied to predict treatment outcome after SBRT. Improvements over traditional TCP

  13. Pelvic Nodal Dosing With Registration to the Prostate: Implications for High-Risk Prostate Cancer Patients Receiving Stereotactic Body Radiation Therapy

    International Nuclear Information System (INIS)

    Kishan, Amar U.; Lamb, James M.; Jani, Shyam S.; Kang, Jung J.; Steinberg, Michael L.; King, Christopher R.

    2015-01-01

    Purpose: To determine whether image guidance with rigid registration (RR) to intraprostatic markers (IPMs) yields acceptable coverage of the pelvic lymph nodes in the context of a stereotactic body radiation therapy (SBRT) regimen. Methods and Materials: Four to seven kilovoltage cone-beam CTs (CBCTs) from 12 patients with high-risk prostate cancer were analyzed, allowing approximation of an SBRT regimen. The nodal clinical target volume (CTV N ) and bladder were contoured on all kilovoltage CBCTs. The V 100 CTV N , expressed as a ratio to the same parameter on the initial plan, and the magnitude of translational shift between RR to the IPMs versus RR to the pelvic bones, were computed. The ability of a multimodality bladder filling protocol to minimize bladder height variation was assessed in a separate cohort of 4 patients. Results: Sixty-five CBCTs were assessed. The average V 100 CTV N was 92.6%, but for a subset of 3 patients the average was 80.0%, compared with 97.8% for the others (P<.0001). The average overall and superior–inferior axis magnitudes of the bony-to-fiducial translations were significantly larger in the subgroup with suboptimal nodal coverage (8.1 vs 3.9 mm and 5.8 vs 2.4 mm, respectively; P<.0001). Relative bladder height changes were also significantly larger in the subgroup with suboptimal nodal coverage (42.9% vs 18.5%; P<.05). Use of a multimodality bladder-filling protocol minimized bladder height variation (P<.001). Conclusion: A majority of patients had acceptable nodal coverage after RR to IPMs, even when approximating SBRT. However, a subset of patients had suboptimal nodal coverage. These patients had large bony-to-fiducial translations and large variations in bladder height. Nodal coverage should be excellent if the superior–inferior axis bony-to-fiducial translation and the relative bladder height change (both easily measured on CBCT) are kept to a minimum. Implementation of a strict bladder filling protocol may achieve this

  14. Histologic Subtype in Core Lung Biopsies of Early-Stage Lung Adenocarcinoma is a Prognostic Factor for Treatment Response and Failure Patterns After Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Leeman, Jonathan E.; Rimner, Andreas [Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Montecalvo, Joseph [Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Hsu, Meier; Zhang, Zhigang [Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Reibnitz, Donata von; Panchoo, Kelly [Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Yorke, Ellen [Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Adusumilli, Prasad S. [Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Travis, William [Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Wu, Abraham J., E-mail: wua@mskcc.org [Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (United States)

    2017-01-01

    Purpose: Stereotactic body radiation therapy (SBRT) has emerged as an effective treatment for early-stage lung cancer. The histologic subtype of surgically resected lung adenocarcinoma is recognized as a prognostic factor, with the presence of solid or micropapillary patterns predicting poor outcomes. We describe the outcomes after SBRT for early-stage lung adenocarcinoma stratified by histologic subtype. Methods and Materials: We identified 119 consecutive patients (124 lesions) with stage I to IIA lung adenocarcinoma who had undergone definitive SBRT at our institution from August 2008 to August 2015 and had undergone core biopsy. Histologic subtyping was performed according to the 2015 World Health Organization classification. Of the 124 tumors, 37 (30%) were a high-risk subtype, defined as containing a component of solid and/or micropapillary pattern. The cumulative incidences of local, nodal, regional, and distant failure were compared between the high-risk and non–high-risk adenocarcinoma subtypes using Gray's test, and multivariable-adjusted hazard ratios (HRs) were estimated from propensity score–weighted Cox regression models. Results: The median follow-up for the entire cohort was 17 months and for surviving patients was 21 months. The 1-year cumulative incidence of and adjusted HR for local, nodal, regional, and distant failure in high-risk versus non–high-risk lesions was 7.3% versus 2.7% (HR 16.8; 95% confidence interval [CI] 3.5-81.4), 14.8% versus 2.6% (HR 3.8; 95% CI 0.95-15.0), 4.0% versus 1.2% (HR 20.9; 95% CI 2.3-192.3), and 22.7% versus 3.6% (HR 6.9; 95% CI 2.2-21.1), respectively. No significant difference was seen with regard to overall survival. Conclusions: The outcomes after SBRT for early-stage adenocarcinoma of the lung correlate highly with histologic subtype, with micropapillary and solid tumors portending significantly higher rates of locoregional and metastatic progression. In this context, the histologic subtype

  15. Baseline Metabolic Tumor Volume and Total Lesion Glycolysis Are Associated With Survival Outcomes in Patients With Locally Advanced Pancreatic Cancer Receiving Stereotactic Body Radiation Therapy

    International Nuclear Information System (INIS)

    Dholakia, Avani S.; Chaudhry, Muhammad; Leal, Jeffrey P.; Chang, Daniel T.; Raman, Siva P.; Hacker-Prietz, Amy; Su, Zheng; Pai, Jonathan; Oteiza, Katharine E.; Griffith, Mary E.; Wahl, Richard L.; Tryggestad, Erik; Pawlik, Timothy; Laheru, Daniel A.; Wolfgang, Christopher L.; Koong, Albert C.

    2014-01-01

    Purpose: Although previous studies have demonstrated the prognostic value of positron emission tomography (PET) parameters in other malignancies, the role of PET in pancreatic cancer has yet to be well established. We analyzed the prognostic utility of PET for patients with locally advanced pancreatic cancer (LAPC) undergoing fractionated stereotactic body radiation therapy (SBRT). Materials and Methods: Thirty-two patients with LAPC in a prospective clinical trial received up to 3 doses of gemcitabine, followed by 33 Gy in 5 fractions of 6.6 Gy, using SBRT. All patients received a baseline PET scan prior to SBRT (pre-SBRT PET). Metabolic tumor volume (MTV), total lesion glycolysis (TLG), and maximum and peak standardized uptake values (SUV max and SUV peak ) on pre-SBRT PET scans were calculated using custom-designed software. Disease was measured at a threshold based on the liver SUV, using the equation Liver mean + [2 × Liver sd ]. Median values of PET parameters were used as cutoffs when assessing their prognostic potential through Cox regression analyses. Results: Of the 32 patients, the majority were male (n=19, 59%), 65 years or older (n=21, 66%), and had tumors located in the pancreatic head (n=27, 84%). Twenty-seven patients (84%) received induction gemcitabine prior to SBRT. Median overall survival for the entire cohort was 18.8 months (95% confidence interval [CI], 15.7-22.0). An MTV of 26.8 cm 3 or greater (hazard ratio [HR] 4.46, 95% CI 1.64-5.88, P<.003) and TLG of 70.9 or greater (HR 3.08, 95% CI 1.18-8.02, P<.021) on pre-SBRT PET scan were associated with inferior overall survival on univariate analysis. Both pre-SBRT MTV (HR 5.13, 95% CI 1.19-22.21, P=.029) and TLG (HR 3.34, 95% CI 1.07-10.48, P=.038) remained independently associated with overall survival in separate multivariate analyses. Conclusions: Pre-SBRT MTV and TLG are potential predictive factors for overall survival in patients with LAPC and may assist in tailoring therapy

  16. SU-F-J-137: Intrafractional Change of the Relationship Between Internal Fiducials and External Breathing Signal in Pancreatic Cancer Stereotactic Body Radiation Therapy

    International Nuclear Information System (INIS)

    Pettersson, N; Murphy, J; Simpson, D; Cervino, L

    2016-01-01

    Purpose: The use of respiratory gating for management of breathing motion during stereotactic body radiation therapy (SBRT) relies on a consistent relationship between the breathing signal and the actual position of the internal target. This relationship was investigated in patients treated for pancreatic cancer. Methods: Four patients with pancreatic cancer undergoing SBRT that had implanted fiducials in the tumor were included in this study. Treatment plans were generated based on the exhale phases (30–70%) from the pre-treatment 4DCT. The margin between the internal target volume (ITV) and the planning target volume was three mm. After patient setup using cone-beam CT, simultaneous fluoroscopic imaging and breathing motion monitoring were used during at least three breathing cycles to verify the fiducial position and to optimize the gating window. After treatment, fluoroscopic images were acquired for verification purposes and exported for retrospective analyses. Fiducial positions were determined using a template-matching algorithm. For each dataset, we established a linear relationship between the fiducial position and the anterior-posterior (AP) breathing signal. The relationships before and after treatment were compared and the dose distribution impact evaluated. Results: Seven pre- and post-treatment fluoroscopic pairs were available for fiducial position analyses in the superior-inferior (SI) and left-right (LR) directions, and five in the AP direction. Time between image acquisitions was typically six to eight minutes. An average absolute change of 1.2±0.7 mm (range: 0.1–1.7) of the SI fiducial position relative to the external signal was found. Corresponding numbers for the LR and AP fiducial positions were 0.9±1.0 mm (range: 0.2–3.0) and 0.5±0.4 mm (range: 0.2–1.2), respectively. The dose distribution impact was small in both the ITV and organs-at-risk. Conclusion: The relationship change between fiducial position and external breathing

  17. Validation of High-Risk Computed Tomography Features for Detection of Local Recurrence After Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Peulen, Heike [Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam (Netherlands); Mantel, Frederick [Department of Radiation Oncology, University of Wuerzburg, Wuerzburg (Germany); Department of Radiation Oncology, University Hospital Zurich, Zurich (Switzerland); Guckenberger, Matthias [Department of Radiation Oncology, University of Wuerzburg, Wuerzburg (Germany); Belderbos, José [Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam (Netherlands); Werner-Wasik, Maria [Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania (United States); Hope, Andrew; Giuliani, Meredith [Department of Radiation Oncology University of Toronto and Princess Margaret Cancer Center, Toronto, Ontario (Canada); Grills, Inga [Department of Radiation Oncology Beaumont Hospital, Royal Oak, Michigan (United States); Sonke, Jan-Jakob, E-mail: j.sonke@nki.nl [Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam (Netherlands)

    2016-09-01

    Purpose: Fibrotic changes after stereotactic body radiation therapy (SBRT) for stage I non-small cell lung cancer (NSCLC) are difficult to distinguish from local recurrences (LR), hampering proper patient selection for salvage therapy. This study validates previously reported high-risk computed tomography (CT) features (HRFs) for detection of LR in an independent patient cohort. Methods and Materials: From a multicenter database, 13 patients with biopsy-proven LR were matched 1:2 to 26 non-LR control patients based on dose, planning target volume (PTV), follow-up time, and lung lobe. Tested HRFs were enlarging opacity, sequential enlarging opacity, enlarging opacity after 12 months, bulging margin, linear margin disappearance, loss of air bronchogram, and craniocaudal growth. Additionally, 2 new features were analyzed: the occurrence of new unilateral pleural effusion, and growth based on relative volume, assessed by manual delineation. Results: All HRFs were significantly associated with LR except for loss of air bronchogram. The best performing HRFs were bulging margin, linear margin disappearance, and craniocaudal growth. Receiver operating characteristic analysis of the number of HRFs to detect LR had an area under the curve (AUC) of 0.97 (95% confidence interval [CI] 0.9-1.0), which was identical to the performance described in the original report. The best compromise (closest to 100% sensitivity and specificity) was found at ≥4 HRFs, with a sensitivity of 92% and a specificity of 85%. A model consisting of only 2 HRFs, bulging margin and craniocaudal growth, resulted in a sensitivity of 85% and a specificity of 100%, with an AUC of 0.96 (95% CI 0.9-1.0) (HRFs ≥2). Pleural effusion and relative growth did not significantly improve the model. Conclusion: We successfully validated CT-based HRFs for detection of LR after SBRT for early-stage NSCLC. As an alternative to number of HRFs, we propose a simplified model with the combination of the 2 best HRFs

  18. Simulated Online Adaptive Magnetic Resonance–Guided Stereotactic Body Radiation Therapy for the Treatment of Oligometastatic Disease of the Abdomen and Central Thorax: Characterization of Potential Advantages

    Energy Technology Data Exchange (ETDEWEB)

    Henke, Lauren; Kashani, Rojano; Yang, Deshan; Zhao, Tianyu; Green, Olga; Olsen, Lindsey; Rodriguez, Vivian; Wooten, H. Omar; Li, H. Harold; Hu, Yanle; Bradley, Jeffrey; Robinson, Clifford; Parikh, Parag; Michalski, Jeff; Mutic, Sasa [Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri (United States); Olsen, Jeffrey R., E-mail: Jeffrey.R.Olsen@ucdenver.edu [Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado (United States)

    2016-12-01

    Purpose: To characterize potential advantages of online-adaptive magnetic resonance (MR)-guided stereotactic body radiation therapy (SBRT) to treat oligometastatic disease of the non-liver abdomen and central thorax. Methods and Materials: Ten patients treated with RT for unresectable primary or oligometastatic disease of the non-liver abdomen (n=5) or central thorax (n=5) underwent imaging throughout treatment on a clinical MR image guided RT system. The SBRT plans were created on the basis of tumor/organ at risk (OAR) anatomy at initial computed tomography simulation (P{sub I}), and simulated adaptive plans were created on the basis of observed MR image set tumor/OAR “anatomy of the day” (P{sub A}). Each P{sub A} was planned under workflow constraints to simulate online-adaptive RT. Prescribed dose was 50 Gy/5 fractions, with goal coverage of 95% planning target volume (PTV) by 95% of the prescription, subject to hard OAR constraints. The P{sub I} was applied to each MR dataset and compared with P{sub A} to evaluate changes in dose delivered to tumor/OARs, with dose escalation when possible. Results: Hard OAR constraints were met for all P{sub Is} based on anatomy from initial computed tomography simulation, and all P{sub As} based on anatomy from each daily MR image set. Application of the P{sub I} to anatomy of the day caused OAR constraint violation in 19 of 30 cases. Adaptive planning increased PTV coverage in 21 of 30 cases, including 14 cases in which hard OAR constraints were violated by the nonadaptive plan. For 9 P{sub A} cases, decreased PTV coverage was required to meet hard OAR constraints that would have been violated in a nonadaptive setting. Conclusions: Online-adaptive MRI-guided SBRT may allow PTV dose escalation and/or simultaneous OAR sparing compared with nonadaptive SBRT. A prospective clinical trial is underway at our institution to evaluate clinical outcomes of this technique.

  19. Stereotactic body radiotherapy a practical guide

    CERN Document Server

    Gaya, Andrew

    2015-01-01

    Collecting the key information in this burgeoning field into a single volume, this handbook for clinical oncology trainees and consultants covers all of the basic aspects of stereotactic radiotherapy systems and treatment and includes plenty of case studies.

  20. Correction for ‘artificial’ electron disequilibrium due to cone-beam CT density errors: implications for on-line adaptive stereotactic body radiation therapy of lung

    International Nuclear Information System (INIS)

    Disher, Brandon; Hajdok, George; Craig, Jeff; Gaede, Stewart; Battista, Jerry J; Wang, An

    2013-01-01

    Cone-beam computed tomography (CBCT) has rapidly become a clinically useful imaging modality for image-guided radiation therapy. Unfortunately, CBCT images of the thorax are susceptible to artefacts due to scattered photons, beam hardening, lag in data acquisition, and respiratory motion during a slow scan. These limitations cause dose errors when CBCT image data are used directly in dose computations for on-line, dose adaptive radiation therapy (DART). The purpose of this work is to assess the magnitude of errors in CBCT numbers (HU), and determine the resultant effects on derived tissue density and computed dose accuracy for stereotactic body radiation therapy (SBRT) of lung cancer. Planning CT (PCT) images of three lung patients were acquired using a Philips multi-slice helical CT simulator, while CBCT images were obtained with a Varian On-Board Imaging system. To account for erroneous CBCT data, three practical correction techniques were tested: (1) conversion of CBCT numbers to electron density using phantoms, (2) replacement of individual CBCT pixel values with bulk CT numbers, averaged from PCT images for tissue regions, and (3) limited replacement of CBCT lung pixels values (LCT) likely to produce artificial lateral electron disequilibrium. For each corrected CBCT data set, lung SBRT dose distributions were computed for a 6 MV volume modulated arc therapy (VMAT) technique within the Philips Pinnacle treatment planning system. The reference prescription dose was set such that 95% of the planning target volume (PTV) received at least 54 Gy (i.e. D95). Further, we used the relative depth dose factor as an a priori index to predict the effects of incorrect low tissue density on computed lung dose in regions of severe electron disequilibrium. CT number profiles from co-registered CBCT and PCT patient lung images revealed many reduced lung pixel values in CBCT data, with some pixels corresponding to vacuum (−1000 HU). Similarly, CBCT data in a plastic lung

  1. Stereotactic Body Radiotherapy Reirradiation for Recurrent Epidural Spinal Metastases

    International Nuclear Information System (INIS)

    Mahadevan, Anand; Floyd, Scott; Wong, Eric; Jeyapalan, Suriya; Groff, Michael; Kasper, Ekkehard

    2011-01-01

    Purpose: When patients show progression after conventional fractionated radiation for spine metastasis, further radiation and surgery may not be options. Stereotactic body radiotherapy (SBRT) has been successfully used in treatment of the spine and may be applicable in these cases. We report the use of SBRT for 60 consecutive patients (81 lesions) who had radiological progressive spine metastasis with epidural involvement after previous radiation for spine metastasis. Methods and Materials: SBRT was used with fiducial and vertebral anatomy-based targeting. The radiation dose was prescribed based on the extent of spinal canal involvement; the dose was 8 Gy × 3 = 24 Gy when the tumor did not touch the spinal cord and 5 to 6 Gy x 5 = 25 to 30 Gy when the tumor abutted the cord. The cord surface received up to the prescription dose with no hot spots in the cord. Results: The median overall survival was 11 months, and the median progression-free survival was 9 months. Overall, 93% of patients had stable or improved disease while 7% of patients showed disease progression; 65% of patients had pain relief. There was no significant toxicity other than fatigue. Conclusions: SBRT is feasible and appears to be an effective treatment modality for reirradiation after conventional palliative radiation fails for spine metastasis patients.

  2. Stereotactic Body Radiotherapy Reirradiation for Recurrent Epidural Spinal Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Mahadevan, Anand, E-mail: amahadev@bidmc.harvard.edu [Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts and Harvard Medical School (Israel); Floyd, Scott [Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts and Harvard Medical School (Israel); Wong, Eric; Jeyapalan, Suriya [Department of Neuro-Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts and Harvard Medical School (Israel); Groff, Michael; Kasper, Ekkehard [Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts and Harvard Medical School (Israel)

    2011-12-01

    Purpose: When patients show progression after conventional fractionated radiation for spine metastasis, further radiation and surgery may not be options. Stereotactic body radiotherapy (SBRT) has been successfully used in treatment of the spine and may be applicable in these cases. We report the use of SBRT for 60 consecutive patients (81 lesions) who had radiological progressive spine metastasis with epidural involvement after previous radiation for spine metastasis. Methods and Materials: SBRT was used with fiducial and vertebral anatomy-based targeting. The radiation dose was prescribed based on the extent of spinal canal involvement; the dose was 8 Gy Multiplication-Sign 3 = 24 Gy when the tumor did not touch the spinal cord and 5 to 6 Gy x 5 = 25 to 30 Gy when the tumor abutted the cord. The cord surface received up to the prescription dose with no hot spots in the cord. Results: The median overall survival was 11 months, and the median progression-free survival was 9 months. Overall, 93% of patients had stable or improved disease while 7% of patients showed disease progression; 65% of patients had pain relief. There was no significant toxicity other than fatigue. Conclusions: SBRT is feasible and appears to be an effective treatment modality for reirradiation after conventional palliative radiation fails for spine metastasis patients.

  3. Stereotactic body radiotherapy reirradiation for recurrent epidural spinal metastases.

    Science.gov (United States)

    Mahadevan, Anand; Floyd, Scott; Wong, Eric; Jeyapalan, Suriya; Groff, Michael; Kasper, Ekkehard

    2011-12-01

    When patients show progression after conventional fractionated radiation for spine metastasis, further radiation and surgery may not be options. Stereotactic body radiotherapy (SBRT) has been successfully used in treatment of the spine and may be applicable in these cases. We report the use of SBRT for 60 consecutive patients (81 lesions) who had radiological progressive spine metastasis with epidural involvement after previous radiation for spine metastasis. SBRT was used with fiducial and vertebral anatomy-based targeting. The radiation dose was prescribed based on the extent of spinal canal involvement; the dose was 8 Gy×3=24 Gy when the tumor did not touch the spinal cord and 5 to 6 Gyx5=25 to 30 Gy when the tumor abutted the cord. The cord surface received up to the prescription dose with no hot spots in the cord. The median overall survival was 11 months, and the median progression-free survival was 9 months. Overall, 93% of patients had stable or improved disease while 7% of patients showed disease progression; 65% of patients had pain relief. There was no significant toxicity other than fatigue. SBRT is feasible and appears to be an effective treatment modality for reirradiation after conventional palliative radiation fails for spine metastasis patients. Copyright © 2011 Elsevier Inc. All rights reserved.

  4. Dosimetric and deformation effects of image-guided interventions during stereotactic body radiation therapy of the prostate using an endorectal balloon

    International Nuclear Information System (INIS)

    Jones, Bernard L.; Gan, Gregory; Diot, Quentin; Kavanagh, Brian; Timmerman, Robert D.; Miften, Moyed

    2012-01-01

    Purpose: During stereotactic body radiation therapy (SBRT) for the treatment of prostate cancer, an inflatable endorectal balloon (ERB) may be used to reduce motion of the target and reduce the dose to the posterior rectal wall. This work assessed the dosimetric impact of manual interventions on ERB position in patients receiving prostate SBRT and investigated the impact of ERB interventions on prostate shape. Methods: The data of seven consecutive patients receiving SBRT for the treatment of clinical stage T1cN0M0 prostate cancer enrolled in a multi-institutional, IRB-approved trial were analyzed. The SBRT dose was 50 Gy in five fractions to a planning target volume (PTV) that included the prostate (implanted with three fiducial markers) with a 3–5 mm margin. All plans were based on simulation images that included an ERB inflated with 60 cm 3 of air. Daily kilovoltage cone-beam computed tomography (CBCT) imaging was performed to localize the PTV, and an automated fusion with the planning images yielded displacements required for PTV relocalization. When the ERB volume and/or position were judged to yield inaccurate repositioning, manual adjustment (ERB reinflation and/or repositioning) was performed. Based on all 59 CBCT image sets acquired, a deformable registration algorithm was used to determine the dose received by, displacement of, and deformation of the prostate, bladder (BLA), and anterior rectal wall (ARW). This dose tracking methodology was applied to images taken before and after manual adjustment of the ERB (intervention), and the delivered dose was compared to that which would have been delivered in the absence of intervention. Results: Interventions occurred in 24 out of 35 (69%) of the treated fractions. The direct effect of these interventions was an increase in the prostate radiation dose that included 95% of the PTV (D95) from 9.6 ± 1.0 to 10.0 ± 0.2 Gy (p = 0.06) and an increase in prostate coverage from 94.0% ± 8.5% to 97.8% ± 1.9% (p = 0

  5. Helical Tomotherapy-Based STAT Stereotactic Body Radiation Therapy: Dosimetric Evaluation for a Real-Time SBRT Treatment Planning and Delivery Program

    International Nuclear Information System (INIS)

    Dunlap, Neal; McIntosh, Alyson; Sheng Ke; Yang Wensha; Turner, Benton; Shoushtari, Asal; Sheehan, Jason; Jones, David R.; Lu Weigo; Ruchala, Keneth; Olivera, Gustavo; Parnell, Donald; Larner, James L.; Benedict, Stanley H.; Read, Paul W.

    2010-01-01

    Stereotactic body radiation therapy (SBRT) treatments have high-dose gradients and even slight patient misalignment from the simulation to treatment could lead to target underdosing or organ at risk (OAR) overdosing. Daily real-time SBRT treatment planning could minimize the risk of geographic miss. As an initial step toward determining the clinical feasibility of developing real-time SBRT treatment planning, we determined the calculation time of helical TomoTherapy-based STAT radiation therapy (RT) treatment plans for simple liver, lung, and spine SBRT treatments to assess whether the planning process was fast enough for practical clinical implementation. Representative SBRT planning target volumes for hypothetical liver, peripheral lung, and thoracic spine lesions and adjacent OARs were contoured onto a planning computed tomography scan (CT) of an anthropomorphic phantom. Treatment plans were generated using both STAT RT 'full scatter' and conventional helical TomoTherapy 'beamlet' algorithms. Optimized plans were compared with respect to conformality index (CI), heterogeneity index (HI), and maximum dose to regional OARs to determine clinical equivalence and the number of required STAT RT optimization iterations and calculation times were determined. The liver and lung dosimetry for the STAT RT and standard planning algorithms were clinically and statistically equivalent. For the liver lesions, 'full scatter' and 'beamlet' algorithms showed a CI of 1.04 and 1.04 and HI of 1.03 and 1.03, respectively. For the lung lesions, 'full scatter' and 'beamlet' algorithms showed a CI of 1.05 and 1.03 and HI of 1.05and 1.05, respectively. For spine lesions, 'full scatter' and 'beamlet' algorithms showed a CI of 1.15 and 1.14 and HI of 1.22 and 1.14, respectively. There was no difference between treatment algorithms with respect to maximum doses to the OARs. The STAT RT iteration time with current treatment planning systems is 45 sec, and the treatment planning required 3

  6. Circumferential or sectored beam arrangements for stereotactic body radiation therapy (SBRT) of primary lung tumors: Effect on target and normal-structure dose-volume metrics

    Energy Technology Data Exchange (ETDEWEB)

    Rosenberg, Mara W. [Broad Institute of MIT and Harvard, Cambridge, MA (United States); Department of Physics, Brandeis University, Waltham, MA (United States); Kato, Catherine M. [Macalester College, St. Paul, MN (United States); Carson, Kelly M.P. [The University of North Carolina, Chapel Hill, NC (United States); Matsunaga, Nathan M. [Santa Clara University, Santa Clara, CA (United States); Arao, Robert F. [Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR (United States); Doss, Emily J. [Department of Internal Medicine, Providence St. Vincent Medical Center, Portland, OR (United States); McCracken, Charles L. [Department of Radiation Medicine, Oregon Health and Science University, Portland, OR (United States); Meng, Lu Z. [Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA (United States); Chen, Yiyi [Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR (United States); Laub, Wolfram U.; Fuss, Martin [Department of Radiation Medicine, Oregon Health and Science University, Portland, OR (United States); Department of Nuclear Engineering and Radiation Health Physics, Oregon State University, Corvallis, OR (United States); Tanyi, James A., E-mail: tanyij@ohsu.edu [Department of Radiation Medicine, Oregon Health and Science University, Portland, OR (United States); Department of Nuclear Engineering and Radiation Health Physics, Oregon State University, Corvallis, OR (United States)

    2013-01-01

    To compare 2 beam arrangements, sectored (beam entry over ipsilateral hemithorax) vs circumferential (beam entry over both ipsilateral and contralateral lungs), for static-gantry intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) delivery techniques with respect to target and organs-at-risk (OAR) dose-volume metrics, as well as treatment delivery efficiency. Data from 60 consecutive patients treated using stereotactic body radiation therapy (SBRT) for primary non–small-cell lung cancer (NSCLC) formed the basis of this study. Four treatment plans were generated per data set: IMRT/VMAT plans using sectored (-s) and circumferential (-c) configurations. The prescribed dose (PD) was 60 Gy in 5 fractions to 95% of the planning target volume (PTV) (maximum PTV dose ∼ 150% PD) for a 6-MV photon beam. Plan conformality, R{sub 50} (ratio of volume circumscribed by the 50% isodose line and the PTV), and D{sub 2} {sub cm} (D{sub max} at a distance ≥2 cm beyond the PTV) were evaluated. For lungs, mean doses (mean lung dose [MLD]) and percent V{sub 30}/V{sub 20}/V{sub 10}/V{sub 5} Gy were assessed. Spinal cord and esophagus D{sub max} and D{sub 5}/D{sub 50} were computed. Chest wall (CW) D{sub max} and absolute V{sub 30}/V{sub 20}/V{sub 10}/V{sub 5} {sub Gy} were reported. Sectored SBRT planning resulted in significant decrease in contralateral MLD and V{sub 10}/V{sub 5} {sub Gy}, as well as contralateral CW D{sub max} and V{sub 10}/V{sub 5} {sub Gy} (all p < 0.001). Nominal reductions of D{sub max} and D{sub 5}/D{sub 50} for the spinal cord with sectored planning did not reach statistical significance for static-gantry IMRT, although VMAT metrics did show a statistically significant decrease (all p < 0.001). The respective measures for esophageal doses were significantly lower with sectored planning (p < 0.001). Despite comparable dose conformality, irrespective of planning configuration, R{sub 50} significantly improved with IMRT

  7. Hope for progress after 40 years of futility? Novel approaches in the treatment of advanced stage III and IV non-small-cell-lung cancer: Stereotactic body radiation therapy, mediastinal lymphadenectomy, and novel systemic therapy

    Directory of Open Access Journals (Sweden)

    Simon Fung Kee Fung

    2012-01-01

    Full Text Available Non-small-cell lung cancer (NSCLC remains a leading cause of cancer mortality. The majority of patients present with advanced (stage III-IV disease. Such patients are treated with a variety of therapies including surgery, radiation, and chemotherapy. Despite decades of work, however, overall survival in this group has been resistant to any substantial improvement. This review briefly details the evolution to the current standard of care for advanced NSCLC, advances in systemic therapy, and novel techniques (stereotactic body radiation therapy [SBRT], and transcervical extended mediastinal lymphadenectomy [TEMLA] or video-assisted mediastinal lymphadenectomy [VAMLA] that have been used in localized NSCLC. The utility of these techniques in advanced stage therapy and potential methods of combining these novel techniques with systemic therapy to improve survival are discussed.

  8. Optical Tracking Technology in Stereotactic Radiation Therapy

    International Nuclear Information System (INIS)

    Wagner, Thomas H.; Meeks, Sanford L.; Bova, Frank J.; Friedman, William A.; Willoughby, Twyla R.; Kupelian, Patrick A.; Tome, Wolfgang

    2007-01-01

    The last decade has seen the introduction of advanced technologies that have enabled much more precise application of therapeutic radiation. These relatively new technologies include multileaf collimators, 3-dimensional conformal radiotherapy planning, and intensity modulated radiotherapy in radiotherapy. Therapeutic dose distributions have become more conformal to volumes of disease, sometimes utilizing sharp dose gradients to deliver high doses to target volumes while sparing nearby radiosensitive structures. Thus, accurate patient positioning has become even more important, so that the treatment delivered to the patient matches the virtual treatment plan in the computer treatment planning system. Optical and image-guided radiation therapy systems offer the potential to improve the precision of patient treatment by providing a more robust fiducial system than is typically used in conventional radiotherapy. The ability to accurately position internal targets relative to the linac isocenter and to provide real-time patient tracking theoretically enables significant reductions in the amount of normal tissue irradiated. This report reviews the concepts, technology, and clinical applications of optical tracking systems currently in use for stereotactic radiation therapy. Applications of radiotherapy optical tracking technology to respiratory gating and the monitoring of implanted fiducial markers are also discussed

  9. Rib fracture following stereotactic body radiotherapy: a potential pitfall.

    Science.gov (United States)

    Stanic, Sinisa; Boike, Thomas P; Rule, William G; Timmerman, Robert D

    2011-11-01

    Although the incidence of rib fractures after conventional radiotherapy is generally low (rib fractures are a relatively common complication of stereotactic body radiotherapy. For malignancy adjacent to the chest wall, the incidence of rib fractures after stereotactic body radiotherapy is as high as 10%. Unrecognized bone fractures can mimic bone metastases on bone scintigraphy, can lead to extensive workup, and can even lead to consideration of unnecessary systemic chemotherapy, as treatment decisions can be based on imaging findings alone. Nuclear medicine physicians and diagnostic radiologists should always consider rib fracture in the differential diagnosis.

  10. Stereotactic body radiation therapy versus conventional radiation therapy in patients with early stage non-small cell lung cancer - An updated retrospective study on local failure and survival rates

    International Nuclear Information System (INIS)

    Jeppesen, Stefan S.; Schytte, Tine; Hansen, Olfred; Jensen, Henrik R.; Brink, Carsten

    2013-01-01

    Introduction: Stereotactic body radiation therapy (SBRT) for early stage non-small cell lung cancer (NSCLC) is now an accepted and patient friendly treatment, but still controversy exists about its comparability to conventional radiation therapy (RT). The purpose of this single-institutional report is to describe survival outcome for medically inoperable patients with early stage NSCLC treated with SBRT compared with high dose conventional RT. Material and methods: From August 2005 to June 2012, 100 medically inoperable patients were treated with SBRT at Odense Univ. Hospital. The thoracic RT consisted of 3 fractions (F) of 15-22 Gy delivered in nine days. For comparison a group of 32 medically inoperable patients treated with conventional RT with 80 Gy/35-40 F (5 F/week) in the period of July 1998 to August 2011 were analyzed. All tumors had histological or cytological proven NSCLC T1-2N0M0. Results: The median overall survival was 36.1 months versus 24.4 months for SBRT and conventional RT, respectively (p = 0.015). Local failure-free survival rates at one year were in SBRT group 93 % versus 89 % in the conventional RT group and at five years 69 % versus 66 %, SBRT and conventional RT respectively (p = 0.99). On multivariate analysis, female gender and performance status of 0-1 and SBRT predicted improved prognosis. Conclusion: In a cohort of patients with NSCLC there was a significant difference in overall survival favoring SBRT. Performance status of 0-1, female gender and SBRT predicted improved prognosis. However, staging procedure, confirmation procedure of recurrence and technical improvements of radiation treatment is likely to influence outcomes. However, SBRT seems to be as efficient as conventional RT and is a more convenient treatment for the patients

  11. Accuracy of marketing claims by providers of stereotactic radiation therapy.

    Science.gov (United States)

    Narang, Amol K; Lam, Edwin; Makary, Martin A; Deweese, Theodore L; Pawlik, Timothy M; Pronovost, Peter J; Herman, Joseph M

    2013-01-01

    Direct-to-consumer advertising by industry has been criticized for encouraging overuse of unproven therapies, but advertising by health care providers has not been as carefully scrutinized. Stereotactic radiation therapy is an emerging technology that has sparked controversy regarding the marketing campaigns of some manufacturers. Given that this technology is also being heavily advertised on the Web sites of health care providers, the accuracy of providers' marketing claims should be rigorously evaluated. We reviewed the Web sites of all U.S. hospitals and private practices that provide stereotactic radiation using two leading brands of stereotactic radiosurgery technology. Centers were identified by using data from the manufacturers. Centers without Web sites were excluded. The final study population consisted of 212 centers with online advertisements for stereotactic radiation. Web sites were evaluated for advertisements that were inconsistent with advertising guidelines provided by the American Medical Association. Most centers (76%) had individual pages dedicated to the marketing of their brand of stereotactic technology that frequently contained manufacturer-authored images (50%) or text (55%). Advertising for the treatment of tumors that have not been endorsed by professional societies was present on 66% of Web sites. Centers commonly claimed improved survival (22%), disease control (20%), quality of life (17%), and toxicity (43%) with stereotactic radiation. Although 40% of Web sites championed the center's regional expertise in delivering stereotactic treatments, only 15% of Web sites provided data to support their claims. Provider advertisements for stereotactic radiation were prominent and aggressive. Further investigation of provider advertising, its effects on quality of care, and potential oversight mechanisms is needed.

  12. Clinical outcomes of a phase I/II study of 48 Gy of stereotactic body radiotherapy in 4 fractions for primary lung cancer using a stereotactic body frame

    International Nuclear Information System (INIS)

    Nagata, Yasushi; Takayama, Kenji; Matsuo, Yukinori; Norihisa, Yoshiki; Mizowaki, Takashi; Sakamoto, Takashi; Sakamoto, Masato; Mitsumori, Michihide; Shibuya, Keiko; Araki, Norio; Yano, Shinsuke; Hiraoka, Masahiro

    2005-01-01

    Purpose: To evaluate the clinical outcomes of 48 Gy of three-dimensional stereotactic radiotherapy in four fractions for treating Stage I lung cancer using a stereotactic body frame. Methods and Materials: Forty-five patients who were treated between September 1998 and February 2004 were included in this study. Thirty-two patients had Stage IA lung cancer, and the other 13 had Stage IB lung cancer where tumor size was less than 4 cm in diameter. Three-dimensional treatment planning using 6-10 noncoplanar beams was performed to maintain the target dose homogeneity and to decrease the irradiated lung volume >20 Gy. All patients were irradiated using a stereotactic body frame and received four single 12 Gy high doses of radiation at the isocenter over 5-13 (median = 12) days. Results: Seven tumors (16%) completely disappeared after treatment (CR) and 38 tumors (84%) decreased in size by 30% or more (PR). Therefore, all tumors showed local response. During the follow-up of 6-71 (median = 30) months, no pulmonary complications greater than an National Cancer Institute-Common Toxicity Criteria of Grade 3 were noted. No other vascular, cardiac, esophageal, or neurologic toxicities were encountered. Forty-four (98%) of 45 tumors were locally controlled during the follow-up period. However, regional recurrences and distant metastases occurred in 3 and 5 of T1 patients and zero and 4 of T2 patients, respectively. For Stage IA lung cancer, the disease-free survival and overall survival rates after 1 and 3 years were 80% and 72%, and 92% and 83%, respectively, whereas for Stage IB lung cancer, the disease-free survival and overall survival rates were 92% and 71%, and 82% and 72%, respectively. Conclusion: Forty-eight Gy of 3D stereotactic radiotherapy in 4 fractions using a stereotactic body frame is useful for the treatment of Stage I lung tumors

  13. Short communication: timeline of radiation-induced kidney function loss after stereotactic ablative body radiotherapy of renal cell carcinoma as evaluated by serial 99mTc-DMSA SPECT/CT

    International Nuclear Information System (INIS)

    Jackson, Price; Foroudi, Farshad; Pham, Daniel; Hofman, Michael S; Hardcastle, Nicholas; Callahan, Jason; Kron, Tomas; Siva, Shankar

    2014-01-01

    Stereotactic ablative body radiotherapy (SABR) has been proposed as a definitive treatment for patients with inoperable primary renal cell carcinoma. However, there is little documentation detailing the radiobiological effects of hypofractionated radiation on healthy renal tissue. In this study we describe a methodology for assessment of regional change in renal function in response to single fraction SABR of 26 Gy. In a patient with a solitary kidney, detailed follow-up of kidney function post-treatment was determined through 3-dimensional SPECT/CT imaging and 51 Cr-EDTA measurements. Based on measurements of glomerular filtration rate, renal function declined rapidly by 34% at 3 months, plateaued at 43% loss at 12 months, with minimal further decrease to 49% of baseline by 18 months. The pattern of renal functional change in 99m Tc-DMSA uptake on SPECT/CT imaging correlates with dose delivered. This study demonstrates a dose effect relationship of SABR with loss of kidney function

  14. The role of stereotactic body radiation therapy in oligometastatic colorectal cancer: Clinical case report of a long-responder patient treated with regorafenib beyond progression.

    Science.gov (United States)

    Roberto, Michela; Falcone, Rosa; Mazzuca, Federica; Archibugi, Livia; Castaldi, Nadia; Botticelli, Andrea; Osti, Mattia Falchetto; Marchetti, Paolo

    2017-12-01

    Regorafenib is the new standard third-line therapy in metastatic colorectal cancer (mCRC). However, the reported 1-year overall survival rate does not exceed 25%. A 55-year-old man affected by mCRC, treated with regorafenib combined with stereotactic body radiotherapy (SBRT), showing a durable response. After 6 months of regorafenib, a PET/CT scan revealed a focal uptake in a solid lung nodule which was treated with SBRT, whereas continuing regorafenib administration. Fourteen months later, the patient had further progression in a parasternal lymph node, but treatment with regorafenib was continued. The regorafenib-associated side effects, such us the hand-foot syndrome, were favorable managed by reducing the dose from 160 to 120 mg/day. Patient-reported outcome was characterized by a progression-free survival of approximately 3 years. in presence of oligometastatic progression, a local SBRT while retaining the same systemic therapy may be a better multidisciplinary approach. Moreover, disease progression is no longer an absolute contraindication for continuing the regorafenib treatment.

  15. Prospective Trial of Stereotactic Body Radiation Therapy for Both Operable and Inoperable T1N0M0 Non-Small Cell Lung Cancer: Japan Clinical Oncology Group Study JCOG0403

    Energy Technology Data Exchange (ETDEWEB)

    Nagata, Yasushi, E-mail: nagat@hiroshima-u.ac.jp [Department of Radiation Oncology, Hiroshima University, Hiroshima (Japan); Hiraoka, Masahiro [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University, Kyoto (Japan); Shibata, Taro [Japan Clinical Oncology Group Data Center, Center for Research Administration and Support, National Cancer Center, Tokyo (Japan); Onishi, Hiroshi [Department of Radiology, University of Yamanashi, Chuo (Japan); Kokubo, Masaki [Department of Image-Based Medicine, Institute of Biomedical Research and Innovation, Kobe (Japan); Karasawa, Katsuyuki [Department of Radiation Oncology, Tokyo Metropolitan Komagome Hospital, Tokyo (Japan); Shioyama, Yoshiyuki [Department of Clinical Radiology, Kyushu University, Fukuoka (Japan); Onimaru, Rikiya [Department of Radiology, Hokkaido University, Sapporo (Japan); Kozuka, Takuyo [Department of Radiation Oncology, The Cancer Institute Hospital, Tokyo (Japan); Kunieda, Etsuo [Department of Radiation Oncology, Keio University, Tokyo (Japan); Saito, Tsutomu [Department of Radiology, Nihon University Itabashi Hospital, Tokyo (Japan); Nakagawa, Keiichi [Department of Radiology, The University of Tokyo Hospital, Tokyo (Japan); Hareyama, Masato [Department of Radiology, Sapporo Medical University, Sapporo (Japan); Takai, Yoshihiro [Department of Radiation Oncology, Tohoku University, Sendai (Japan); Hayakawa, Kazushige [Department of Radiology and Radiation Oncology, Kitasato University, Sagamihara (Japan); Mitsuhashi, Norio [Department of Radiation Oncology, Tokyo Women' s Medical University, Tokyo (Japan); Ishikura, Satoshi [Department of Radiology, Koshigaya Municipal Hospital, Koshigaya (Japan)

    2015-12-01

    Purpose: To evaluate, in Japan Clinical Oncology Group study 0403, the safety and efficacy of stereotactic body radiation therapy (SBRT) in patients with T1N0M0 non-small cell lung cancer (NSCLC). Methods and Materials: Eligibility criteria included histologically or cytologically proven NSCLC, clinical T1N0M0. Prescribed dose was 48 Gy at the isocenter in 4 fractions. The primary endpoint was the percent (%) 3-year overall survival. The threshold % 3-year survival to be rejected was set at 35% for inoperable patients, whereas the expected % 3-year survival was 80% for operable patients. Results: Between July 2004 and November 2008, 169 patients from 15 institutions were registered. One hundred inoperable and 64 operable patients (total 164) were eligible. Patients' characteristics were 122 male, 47 female; median age 78 years (range, 50-91 years); adenocarcinomas, 90; squamous cell carcinomas, 61; others, 18. Of the 100 inoperable patients, the % 3-year OS was 59.9% (95% confidence interval 49.6%-68.8%). Grade 3 and 4 toxicities were observed in 10 and 2 patients, respectively. No grade 5 toxicity was observed. Of the 64 operable patients, the % 3-year OS was 76.5% (95% confidence interval 64.0%-85.1%). Grade 3 toxicities were observed in 5 patients. No grade 4 and 5 toxicities were observed. Conclusions: Stereotactic body radiation therapy for stage I NSCLC is effective, with low incidences of severe toxicity. This treatment can be considered a standard treatment for inoperable stage I NSCLC. This treatment is promising as an alternative to surgery for operable stage I NSCLC.

  16. Prospective Trial of Stereotactic Body Radiation Therapy for Both Operable and Inoperable T1N0M0 Non-Small Cell Lung Cancer: Japan Clinical Oncology Group Study JCOG0403

    International Nuclear Information System (INIS)

    Nagata, Yasushi; Hiraoka, Masahiro; Shibata, Taro; Onishi, Hiroshi; Kokubo, Masaki; Karasawa, Katsuyuki; Shioyama, Yoshiyuki; Onimaru, Rikiya; Kozuka, Takuyo; Kunieda, Etsuo; Saito, Tsutomu; Nakagawa, Keiichi; Hareyama, Masato; Takai, Yoshihiro; Hayakawa, Kazushige; Mitsuhashi, Norio; Ishikura, Satoshi

    2015-01-01

    Purpose: To evaluate, in Japan Clinical Oncology Group study 0403, the safety and efficacy of stereotactic body radiation therapy (SBRT) in patients with T1N0M0 non-small cell lung cancer (NSCLC). Methods and Materials: Eligibility criteria included histologically or cytologically proven NSCLC, clinical T1N0M0. Prescribed dose was 48 Gy at the isocenter in 4 fractions. The primary endpoint was the percent (%) 3-year overall survival. The threshold % 3-year survival to be rejected was set at 35% for inoperable patients, whereas the expected % 3-year survival was 80% for operable patients. Results: Between July 2004 and November 2008, 169 patients from 15 institutions were registered. One hundred inoperable and 64 operable patients (total 164) were eligible. Patients' characteristics were 122 male, 47 female; median age 78 years (range, 50-91 years); adenocarcinomas, 90; squamous cell carcinomas, 61; others, 18. Of the 100 inoperable patients, the % 3-year OS was 59.9% (95% confidence interval 49.6%-68.8%). Grade 3 and 4 toxicities were observed in 10 and 2 patients, respectively. No grade 5 toxicity was observed. Of the 64 operable patients, the % 3-year OS was 76.5% (95% confidence interval 64.0%-85.1%). Grade 3 toxicities were observed in 5 patients. No grade 4 and 5 toxicities were observed. Conclusions: Stereotactic body radiation therapy for stage I NSCLC is effective, with low incidences of severe toxicity. This treatment can be considered a standard treatment for inoperable stage I NSCLC. This treatment is promising as an alternative to surgery for operable stage I NSCLC.

  17. The Effect of Biologically Effective Dose and Radiation Treatment Schedule on Overall Survival in Stage I Non-Small Cell Lung Cancer Patients Treated With Stereotactic Body Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Stahl, John M. [Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (United States); Ross, Rudi [21st Century Oncology, Fort Myers, Florida (United States); Harder, Eileen M.; Mancini, Brandon R. [Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (United States); Soulos, Pamela R. [Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut (United States); Finkelstein, Steven E.; Shafman, Timothy D.; Dosoretz, Arie P. [21st Century Oncology, Fort Myers, Florida (United States); Evans, Suzanne B.; Husain, Zain A.; Yu, James B. [Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (United States); Gross, Cary P. [Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, Connecticut (United States); Decker, Roy H., E-mail: roy.decker@yale.edu [Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut (United States)

    2016-12-01

    Purpose: To determine the effect of biologically effective dose (BED{sub 10}) and radiation treatment schedule on overall survival (OS) in patients with early-stage non-small cell lung cancer (NSCLC) undergoing stereotactic body radiation therapy (SBRT). Methods and Materials: Using data from 65 treatment centers in the United States, we retrospectively reviewed the records of T1-2 N0 NSCLC patients undergoing SBRT alone from 2006 to 2014. Biologically relevant covariates, including dose per fraction, number of fractions, and time between fractions, were used to quantify BED{sub 10} and radiation treatment schedule. The linear-quadratic equation was used to calculate BED{sub 10} and to generate a dichotomous dose variable of <105 Gy versus ≥105 Gy BED{sub 10}. The primary outcome was OS. We used the Kaplan-Meier method, the log–rank test, and Cox proportional hazards regression with propensity score matching to determine whether prescription BED{sub 10} was associated with OS. Results: We identified 747 patients who met inclusion criteria. The median BED{sub 10} was 132 Gy, and 59 (7.7%) had consecutive-day fractions. Median follow-up was 41 months, and 452 patients (60.5%) had died by the conclusion of the study. The 581 patients receiving ≥105 Gy BED{sub 10} had a median survival of 28 months, whereas the 166 patients receiving <105 Gy BED{sub 10} had a median survival of 22 months (log–rank, P=.01). Radiation treatment schedule was not a significant predictor of OS on univariable analysis. After adjusting for T stage, sex, tumor histology, and Eastern Cooperative Oncology Group performance status, BED{sub 10} ≥105 Gy versus <105 Gy remained significantly associated with improved OS (hazard ratio 0.78, 95% confidence interval 0.62-0.98, P=.03). Propensity score matching on imbalanced variables within high- and low-dose cohorts confirmed a survival benefit with higher prescription dose. Conclusions: We found that dose escalation to 105 Gy BED

  18. Cost-Effectiveness Analysis of Single Fraction of Stereotactic Body Radiation Therapy Compared With Single Fraction of External Beam Radiation Therapy for Palliation of Vertebral Bone Metastases

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hayeon, E-mail: kimh2@upmc.edu [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Rajagopalan, Malolan S.; Beriwal, Sushil; Huq, M. Saiful [Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Smith, Kenneth J. [Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (United States)

    2015-03-01

    Purpose: Stereotactic body radiation therapy (SBRT) has been proposed for the palliation of painful vertebral bone metastases because higher radiation doses may result in superior and more durable pain control. A phase III clinical trial (Radiation Therapy Oncology Group 0631) comparing single fraction SBRT with single fraction external beam radiation therapy (EBRT) in palliative treatment of painful vertebral bone metastases is now ongoing. We performed a cost-effectiveness analysis to compare these strategies. Methods and Materials: A Markov model, using a 1-month cycle over a lifetime horizon, was developed to compare the cost-effectiveness of SBRT (16 or 18 Gy in 1 fraction) with that of 8 Gy in 1 fraction of EBRT. Transition probabilities, quality of life utilities, and costs associated with SBRT and EBRT were captured in the model. Costs were based on Medicare reimbursement in 2014. Strategies were compared using the incremental cost-effectiveness ratio (ICER), and effectiveness was measured in quality-adjusted life years (QALYs). To account for uncertainty, 1-way, 2-way and probabilistic sensitivity analyses were performed. Strategies were evaluated with a willingness-to-pay (WTP) threshold of $100,000 per QALY gained. Results: Base case pain relief after the treatment was assumed as 20% higher in SBRT. Base case treatment costs for SBRT and EBRT were $9000 and $1087, respectively. In the base case analysis, SBRT resulted in an ICER of $124,552 per QALY gained. In 1-way sensitivity analyses, results were most sensitive to variation of the utility of unrelieved pain; the utility of relieved pain after initial treatment and median survival were also sensitive to variation. If median survival is ≥11 months, SBRT cost <$100,000 per QALY gained. Conclusion: SBRT for palliation of vertebral bone metastases is not cost-effective compared with EBRT at a $100,000 per QALY gained WTP threshold. However, if median survival is ≥11 months, SBRT costs ≤$100

  19. Cost-Effectiveness Analysis of Single Fraction of Stereotactic Body Radiation Therapy Compared With Single Fraction of External Beam Radiation Therapy for Palliation of Vertebral Bone Metastases

    International Nuclear Information System (INIS)

    Kim, Hayeon; Rajagopalan, Malolan S.; Beriwal, Sushil; Huq, M. Saiful; Smith, Kenneth J.

    2015-01-01

    Purpose: Stereotactic body radiation therapy (SBRT) has been proposed for the palliation of painful vertebral bone metastases because higher radiation doses may result in superior and more durable pain control. A phase III clinical trial (Radiation Therapy Oncology Group 0631) comparing single fraction SBRT with single fraction external beam radiation therapy (EBRT) in palliative treatment of painful vertebral bone metastases is now ongoing. We performed a cost-effectiveness analysis to compare these strategies. Methods and Materials: A Markov model, using a 1-month cycle over a lifetime horizon, was developed to compare the cost-effectiveness of SBRT (16 or 18 Gy in 1 fraction) with that of 8 Gy in 1 fraction of EBRT. Transition probabilities, quality of life utilities, and costs associated with SBRT and EBRT were captured in the model. Costs were based on Medicare reimbursement in 2014. Strategies were compared using the incremental cost-effectiveness ratio (ICER), and effectiveness was measured in quality-adjusted life years (QALYs). To account for uncertainty, 1-way, 2-way and probabilistic sensitivity analyses were performed. Strategies were evaluated with a willingness-to-pay (WTP) threshold of $100,000 per QALY gained. Results: Base case pain relief after the treatment was assumed as 20% higher in SBRT. Base case treatment costs for SBRT and EBRT were $9000 and $1087, respectively. In the base case analysis, SBRT resulted in an ICER of $124,552 per QALY gained. In 1-way sensitivity analyses, results were most sensitive to variation of the utility of unrelieved pain; the utility of relieved pain after initial treatment and median survival were also sensitive to variation. If median survival is ≥11 months, SBRT cost <$100,000 per QALY gained. Conclusion: SBRT for palliation of vertebral bone metastases is not cost-effective compared with EBRT at a $100,000 per QALY gained WTP threshold. However, if median survival is ≥11 months, SBRT costs ≤$100

  20. SU-F-P-28: A Method of Maximize the Noncoplanar Beam Orientations and Assure the Beam Delivery Clearance for Stereotactic Body Radiation Therapy (SBRT)

    Energy Technology Data Exchange (ETDEWEB)

    Zhu, J [Presence St. Joseph Medical Ctr., Joliet, IL (United States)

    2016-06-15

    Purpose: Develop a method to maximize the noncoplanar beam orientations and assure the beam delivery clearance for SBRT, therefore, optimize the dose conformality to the target, increase the dose sparing to the critical normal organs and reduce the hot spots in the body. Methods: A SBRT body frame (Elekta, Stockholm, Sweden) was used for patient immobilization and target localization. The SBRT body frame has CT fiducials on its side frames. After patient’s CT scan, the radiation treatment isocenter was defined and its coordinators referring to the body frame was calculated in the radiation treatment planning process. Meanwhile, initial beam orientations were designed based on the patient target and critical organ anatomy. The body frame was put on the linear accelerator couch and positioned to the calculated isocenter. Initially designed beam orientations were manually measured by tuning the body frame position on the couch, the gantry and couch angles. The finalized beam orientations were put into the treatment planning for dosimetric calculations. Results: Without patient presence, an optimal set of beam orientations were designed and validated. The radiation treatment plan was optimized and guaranteed for delivery clearance. Conclusion: The developed method is beneficial and effective in SBRT treatment planning for individual patient. It first allows maximizing the achievable noncoplanar beam orientation space, therefore, optimize the treatment plan for specific patient. It eliminates the risk that a plan needs to be modified due to the gantry and couch collision during patient setup.

  1. Stereotactic Body Radiotherapy for Recurrent or Oligometastatic Uterine Cervix Cancer: A Cooperative Study of the Korean Radiation Oncology Group (KROG 14-11).

    Science.gov (United States)

    Park, Hae Jin; Chang, Ah Ram; Seo, Youngseok; Cho, Chul Koo; Jang, Won-Il; Kim, Mi Sook; Choi, Chulwon

    2015-09-01

    To evaluate local control and patient survival for recurrent or oligometastatic uterine cervical cancer treated with stereotactic body radiotherapy (SBRT) using CyberKnife, and to demonstrate the safety of SBRT. Between 2002 and 2013, 100 recurrent or oligometastatic lesions in 85 patients were treated with SBRT at three Institutions. SBRT sites were within the previous RT field in 59 and partially overlapped in nine. SBRT sites included three local recurrences, 89 lymph node metastases, and eight distant metastases. Patients were treated with a median dose of 39 Gy in three fractions, which was equivalent to a biologically effective dose (BED) of 90 Gy. The median follow-up period was 20.4 months. Local failure occurred in 17 out of 100 SBRT-treated sites. The 2-year and 5-year local progression-free survival rates were 82.5% and 78.8%, respectively. Eleven local failures occurred within the previous RT field. The 2-year and 5-year overall survival rates were 57.5% and 32.9%, respectively. BED >90 Gy (p=0.072) and >69 Gy (p=0.059) and longer disease-free interval (p=0.065) predicted marginally superior local control. Re-irradiation appeared to be related to inferior local control (p<0.001), but the SBRT BED in this group was much lower than the dose in the other group (median BED, 79 Gy vs. 90 Gy). Chronic toxicities of grade 3 or more occurred in five cases. SBRT for recurrent or oligometastatic cervical cancer resulted in excellent local control, especially with a long disease-free interval and high BED treatment, with acceptable toxicities. Therefore, SBRT can be considered a therapeutic option for these patients. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  2. Low incidence of chest wall pain with a risk-adapted lung stereotactic body radiation therapy approach using three or five fractions based on chest wall dosimetry.

    Directory of Open Access Journals (Sweden)

    Thibaud P Coroller

    Full Text Available PURPOSE: To examine the frequency and potential of dose-volume predictors for chest wall (CW toxicity (pain and/or rib fracture for patients receiving lung stereotactic body radiotherapy (SBRT using treatment planning methods to minimize CW dose and a risk-adapted fractionation scheme. METHODS: We reviewed data from 72 treatment plans, from 69 lung SBRT patients with at least one year of follow-up or CW toxicity, who were treated at our center between 2010 and 2013. Treatment plans were optimized to reduce CW dose and patients received a risk-adapted fractionation of 18 Gy×3 fractions (54 Gy total if the CW V30 was less than 30 mL or 10-12 Gy×5 fractions (50-60 Gy total otherwise. The association between CW toxicity and patient characteristics, treatment parameters and dose metrics, including biologically equivalent dose, were analyzed using logistic regression. RESULTS: With a median follow-up of 20 months, 6 (8.3% patients developed CW pain including three (4.2% grade 1, two (2.8% grade 2 and one (1.4% grade 3. Five (6.9% patients developed rib fractures, one of which was symptomatic. No significant associations between CW toxicity and patient and dosimetric variables were identified on univariate nor multivariate analysis. CONCLUSIONS: Optimization of treatment plans to reduce CW dose and a risk-adapted fractionation strategy of three or five fractions based on the CW V30 resulted in a low incidence of CW toxicity. Under these conditions, none of the patient characteristics or dose metrics we examined appeared to be predictive of CW pain.

  3. Tumor Control Probability Modeling for Stereotactic Body Radiation Therapy of Early-Stage Lung Cancer Using Multiple Bio-physical Models

    Science.gov (United States)

    Liu, Feng; Tai, An; Lee, Percy; Biswas, Tithi; Ding, George X.; El Naqa, Isaam; Grimm, Jimm; Jackson, Andrew; Kong, Feng-Ming (Spring); LaCouture, Tamara; Loo, Billy; Miften, Moyed; Solberg, Timothy; Li, X Allen

    2017-01-01

    Purpose To analyze pooled clinical data using different radiobiological models and to understand the relationship between biologically effective dose (BED) and tumor control probability (TCP) for stereotactic body radiotherapy (SBRT) of early-stage non-small cell lung cancer (NSCLC). Method and Materials The clinical data of 1-, 2-, 3-, and 5-year actuarial or Kaplan-Meier TCP from 46 selected studies were collected for SBRT of NSCLC in the literature. The TCP data were separated for Stage T1 and T2 tumors if possible, otherwise collected for combined stages. BED was calculated at isocenters using six radiobiological models. For each model, the independent model parameters were determined from a fit to the TCP data using the least chi-square (χ2) method with either one set of parameters regardless of tumor stages or two sets for T1 and T2 tumors separately. Results The fits to the clinic data yield consistent results of large α/β ratios of about 20 Gy for all models investigated. The regrowth model that accounts for the tumor repopulation and heterogeneity leads to a better fit to the data, compared to other 5 models where the fits were indistinguishable between the models. The models based on the fitting parameters predict that the T2 tumors require about additional 1 Gy physical dose at isocenters per fraction (≤5 fractions) to achieve the optimal TCP when compared to the T1 tumors. Conclusion This systematic analysis of a large set of published clinical data using different radiobiological models shows that local TCP for SBRT of early-stage NSCLC has strong dependence on BED with large α/β ratios of about 20 Gy. The six models predict that a BED (calculated with α/β of 20) of 90 Gy is sufficient to achieve TCP ≥ 95%. Among the models considered, the regrowth model leads to a better fit to the clinical data. PMID:27871671

  4. Feasibility of magnetic resonance imaging-guided liver stereotactic body radiation therapy: A comparison between modulated tri-cobalt-60 teletherapy and linear accelerator-based intensity modulated radiation therapy.

    Science.gov (United States)

    Kishan, Amar U; Cao, Minsong; Wang, Pin-Chieh; Mikaeilian, Argin G; Tenn, Stephen; Rwigema, Jean-Claude M; Sheng, Ke; Low, Daniel A; Kupelian, Patrick A; Steinberg, Michael L; Lee, Percy

    2015-01-01

    The purpose of this study was to investigate the dosimetric feasibility of liver stereotactic body radiation therapy (SBRT) using a teletherapy system equipped with 3 rotating (60)Co sources (tri-(60)Co system) and a built-in magnetic resonance imager (MRI). We hypothesized tumor size and location would be predictive of favorable dosimetry with tri-(60)Co SBRT. The primary study population consisted of 11 patients treated with SBRT for malignant hepatic lesions whose linear accelerator (LINAC)-based SBRT plans met all mandatory Radiation Therapy Oncology Group (RTOG) 1112 organ-at-risk (OAR) constraints. The secondary study population included 5 additional patients whose plans did not meet the mandatory constraints. Patients received 36 to 60 Gy in 3 to 5 fractions. Tri-(60)Co system SBRT plans were planned with ViewRay system software. All patients in the primary study population had tri-(60)Co SBRT plans that passed all RTOG constraints, with similar planning target volume coverage and OAR doses to LINAC plans. Mean liver doses and V10Gy to the liver, although easily meeting RTOG 1112 guidelines, were significantly higher with tri-(60)Co plans. When the 5 additional patients were included in a univariate analysis, the tri-(60)Co SBRT plans were still equally able to pass RTOG constraints, although they did have inferior ability to pass more stringent liver and kidney constraints (P < .05). A multivariate analysis found the ability of a tri-(60)Co SBRT plan to meet these constraints depended on lesion location and size. Patients with smaller or more peripheral lesions (as defined by distance from the aorta, chest wall, liver dome, and relative lesion volume) were significantly more likely to have tri-(60)Co plans that spared the liver and kidney as well as LINAC plans did (P < .05). It is dosimetrically feasible to perform liver SBRT with a tri-(60)Co system with a built-in MRI. Patients with smaller or more peripheral lesions are more likely to have optimal liver

  5. The Comparison of Stereotactic Body Radiation Therapy (SBRT andIntensity Modulated Radiation Therapy (IMRT for prostate cancer byNCCN risk groups

    Directory of Open Access Journals (Sweden)

    Anthony Ricco

    2016-08-01

    Full Text Available OBJECTIVES: The primary objective of this study is to compare freedom from biochemical failure (FFBF between SBRT and IMRT for patients with organ confined prostate cancer treated between 2007 through 2012 utilizing the 2015 National Comprehensive Cancer Network (NCCN risk stratification guidelines. A secondary objective is to compare our updated toxicity at last follow up compared to pretreatment with respect to bowel, bladder, sexual functioning, and need for invasive procedures between the two groups.METHODS: We retrospectively reviewed 270 consecutive men treated with either SBRT (n=150 or IMRT (120 at a community hospital with two distinct radiation departments and referral patterns. Charts were reviewed for pretreatment and treatment factors including race, age, clinical T stage, initial PSA, Gleason score, use of androgen deprivation therapy (ADT, treatment with SBRT vs. IMRT as well as stratification by 2015 NCCN guidelines. Kaplan Meier (KM methodology was used to estimate freedom from biochemical failure, with statistical comparisons accomplished using log rank tests. Multivariable Cox proportional hazard modeling was used to establish independent factors prognostic of biochemical failure. Descriptive statistics were used to describe toxicity graded by a modified RTOG late radiation morbidity scoring system. RESULTS: Significant prognostic factors in univariate analysis for FFBF included NCCN risk groups (p=0.0032, grade (p=0.019, and PSA (p=0.008. There was no significant difference in FFBF between SBRT vs. IMRT (p=0.46 with 6 year actuarial FFBF of 91.9% for SBRT and 88.9% for IMRT. Multivariable analysis revealed only the NCCN risk stratification to be significant predictor for FFBF (p=0.04. 4 year actuarial FFBF by NCCN risk stratification was 100% very low risk, 100% low risk, 96.5% intermediate risk, 94.5% high risk, and 72.7% very high risk. There were no grade 3 gastrointestinal (GI or genitourinary (GU toxicities for either

  6. Stereotactic body radiotherapy for liver tumors. Principles and practical guidelines of the DEGRO Working Group on Stereotactic Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Sterzing, Florian [Deutsches Krebsforschungszentrum (DKFZ), Klinische Kooperationseinheit Strahlentherapie, Heidelberg (Germany); Radiologische Universitaetsklinik, Abteilung fuer Radioonkologie und Strahlentherapie, Heidelberg (Germany); Brunner, Thomas B. [Universitaetsklinikum Freiburg, Klinik fuer Strahlenheilkunde, Radiologische Klinik, Freiburg (Germany); Ernst, Iris; Greve, Burkhard [Universitaetsklinikum Muenster, Klinik fuer Strahlentherapie - Radioonkologie, Muenster (Germany); Baus, Wolfgang W. [Universitaetsklinikum Koeln, Klinik und Poliklinik fuer Strahlentherapie, Koeln (Germany); Herfarth, Klaus [Radiologische Universitaetsklinik, Abteilung fuer Radioonkologie und Strahlentherapie, Heidelberg (Germany); Guckenberger, Matthias [UniversitaetsSpital Zuerich, Klinik fuer Radio-Onkologie, Zuerich (Switzerland)

    2014-10-15

    This report of the Working Group on Stereotactic Radiotherapy of the German Society of Radiation Oncology (DEGRO) aims to provide a practical guideline for safe and effective stereotactic body radiotherapy (SBRT) of liver tumors. The literature on the clinical evidence of SBRT for both primary liver tumors and liver metastases was reviewed and analyzed focusing on both physical requirements and special biological characteristics. Recommendations were developed for patient selection, imaging, planning, treatment delivery, motion management, dose reporting, and follow-up. Radiation dose constraints to critical organs at risk are provided. SBRT is a well-established treatment option for primary and secondary liver tumors associated with low morbidity. (orig.) [German] Die Arbeitsgruppe Stereotaxie der Deutschen Gesellschaft fuer Radioonkologie (DEGRO) legt hier eine Empfehlung zur sicheren und effektiven Durchfuehrung der SBRT von Lebertumoren vor. Eine Literaturrecherche zur Untersuchung der Evidenz der SBRT sowohl fuer primaere Lebertumore als auch fuer Lebermetastasen wurde durchgefuehrt. Auf dieser Basis werden Empfehlungen fuer technisch-physikalische Voraussetzungen wie auch fuer die taegliche Praxis der Leber-SBRT gegeben. Weiterhin werden radiobiologische Besonderheiten dieses Verfahrens dargestellt. Praktische Vorgaben werden fuer Patientenselektion, Bildgebung, Planung, Applikation, Bewegungsmanagement, Dosisdokumentation und Follow-up gegeben. Dosisempfehlungen fuer die kritischen Risikoorgane werden dargestellt. Die SBRT stellt eine etablierte Behandlungsmethode fuer primaere und sekundaere Lebertumore dar und ist mit niedriger Morbiditaet assoziiert. (orig.)

  7. Stereotactic body radiotherapy in lung cancer: an update

    Energy Technology Data Exchange (ETDEWEB)

    Abreu, Carlos Eduardo Cintra Vita; Ferreira, Paula Pratti Rodrigues; Moraes, Fabio Ynoe de; Neves Junior, Wellington Furtado Pimenta; Carvalho, Heloisa de Andrade, E-mail: heloisa.carvalho@hc.fm.usp.br [Hospital Sirio-Libanes, Sao Paulo, SP (Brazil). Departamento de Radioterapia; Gadia, Rafael [Hospital Sirio-Libanes, Brasilia, DF (Brazil). Departamento de Radioterapia; Universidade de Sao Paulo (USP), Sao Paulo, SP (Brazil). Departamento de Radiologia e Oncologia. Servico de Radioterapia

    2015-07-15

    For early-stage lung cancer, the treatment of choice is surgery. In patients who are not surgical candidates or are unwilling to undergo surgery, radiotherapy is the principal treatment option. Here, we review stereotactic body radiotherapy, a technique that has produced quite promising results in such patients and should be the treatment of choice, if available. We also present the major indications, technical aspects, results, and special situations related to the technique. (author)

  8. Stereotactic Body Radiotherapy for Centrally Located Non-small Cell Lung Cancer

    Directory of Open Access Journals (Sweden)

    Yuming WAN

    2018-05-01

    Full Text Available A few study has proven that about 90% of local control rates might be benefit from stereotactic body radiotherapy (SBRT for patients with medically inoperable stage I non-small cell lung cancer (NSCLC, it is reported SBRT associated overall survival and tumor specific survival is comparable with those treated with surgery. SBRT has been accepted as the first line treatment for inoperable patients with peripheral located stage I NSCLC. However, the role of SBRT in centrally located lesions is controversial for potential toxic effects from the adjacent anatomical structure. This paper will review the definition, indication, dose regimens, dose-volume constraints for organs at risk, radiation technology, treatment side effect of centrally located NSCLC treated with SBRT and stereotactic body proton therapy.

  9. Utility Estimation of the Manufactured Stereotactic Body Radiotherapy Immobilization

    International Nuclear Information System (INIS)

    Lee, Dong Hoon; Ahn, Jong Ho; Seo, Jeong Min; Shin, Eun Hyeak; Choi, Byeong Gi; Song, Gi Won

    2011-01-01

    Immobilizations used in order to maintain the reproducibility of a patient set-up and the stable posture for a long period are important more than anything else for the accurate treatment when the stereotactic body radiotherapy is underway. So the purpose of this study is to adapt the optimum immobilizations for the stereotactic body radiotherapy by comparing two commercial immobilizations with the self-manufactured immobilizations. Five people were selected for the experiment and three different immobilizations (A: Wing-board, B: BodyFix system, C: Arm up holder with vac-lock) were used to each target. After deciding on the target's most stable respiratory cycles, the targets were asked to wear a goggle monitor and maintain their respiration regularly for thirty minutes to obtain the respiratory signals. To analyze the respiratory signal, the standard deviation and the variation value of the peak value and the valley value of the respiratory signal were separated by time zone with the self-developed program at the hospital and each tie-downs were compared for the estimation by calculating a comparative index using the above. The stability of each immobilizations were measured in consideration of deviation changes studied in each respiratory time lapse. Comparative indexes of each immobilizations of each experimenter are shown to be A: 11.20, B: 4.87, C: 1.63 / A: 3.94, B: 0.67, C: 0.13 / A: 2.41, B: 0.29, C: 0.04 / A: 0.16, B: 0.19, C: 0.007 / A: 35.70, B: 2.37, C: 1.86. And when all five experimenters wore the immobilizations C, the test proved the most stable value while four people wearing A and one man wearing D expressed relatively the most unstable respiratory outcomes. The self-developed immobilizations, so called the arm up holder vac-lock for the stereotactic body radiotherapy is expected to improve the effect of the treatment by decreasing the intra-fraction organ motions because it keeps the respiration more stable than other two immobilizations

  10. Short interactive workshops reduce variability in contouring treatment volumes for spine stereotactic body radiation therapy: Experience with the ESTRO FALCON programme and EduCase™ training tool.

    Science.gov (United States)

    De Bari, Berardino; Dahele, Max; Palmu, Miika; Kaylor, Scott; Schiappacasse, Luis; Guckenberger, Matthias

    2017-11-20

    We report the results of 4, 2-h contouring workshops on target volume definition for spinal stereotactic radiotherapy. They combined traditional teaching methods with a web-based contouring/contour-analysis platform and led to a significant reduction in delineation variability. Short, interactive workshops can reduce interobserver variability in spine SBRT target volume delineation. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. Dosimetric implications associated to heterogeneity dose correction in stereotactic body radiation therapy (SBRT) of lung cancer; Implicaciones dosimetricas asociadas al calculo de dosis con correccion de heterogeneidad en radioterapia estereotaxica extracraneal (SBRT) de pulmon

    Energy Technology Data Exchange (ETDEWEB)

    Zucca Aparicio, D.; Perez Moreno, J. M.; Fernandez Leton, P.; Garcia Ruiz-Zorrila

    2016-10-01

    Treatment of lung lesions using stereotactic body radiation therapy (SBRT) requires algorithms with corrections that adequately model the behavior of narrow beams in the presence of tissue heterogeneities, although protocols such as RTOG 0236 excluded these kind of corrections. 100 cases were evaluated retrospectively following the RTOG 0813 and RTOG 0915 guidelines, by obtaining the deviations of the relevant dosimetric indicators from Monte Carlo (MC) and Pencil Beam (PB), maintaining the same configuration and monitor units (MU). Deviations between MC and PB have been classifie