No abstract

Updated data analysis confirms that radiation therapy provides excellent palliation for painful bone metastases and that retreatment is safe and effective. Although adherence to evidence-based medicine is critical, thorough expert radiation oncology physician judgment and discretion regarding number of fractions and advanced techniques are also essential to optimize outcomes when considering the patient's overall health, life expectancy, comorbidities, tumor biology, anatomy, previous treatment including prior radiation at or near current site of treatment, tumor and normal tissue response history to local and systemic therapies, and other factors related to the patient, tumor characteristics, or treatment.

SBRT has an important role to play in treating early-stage NSCLC, particularly for medically inoperable patients with limited other treatment options. Shared decision-making with patients should be performed in all cases to ensure the patient understands the risks related to SBRT, the side effects, and the alternative treatments available.

SABR is well tolerated and locally effective for treating patients who have primary renal cell carcinoma and has an acceptable impact on renal function. An interesting observation is that patients who receive single-fraction SABR appear to be less likely to progress distantly or to die of cancer. Cancer 2018;124:934-42. © 2017 American Cancer Society.

Conventional radiation therapy for cancer usually consists of multiple treatments (called fractions) with low doses of radiation. These dose schemes are planned with the guidance of the linear-quadratic (LQ) model, which has been the most prevalent model for designing dose schemes in radiation therapy. The high-dose fractions used in newer advanced radiosurgery, stereotactic radiation therapy, and high-dose rate brachytherapy techniques, however, cannot be accurately calculated with the traditional LQ model. To address this problem, we developed a generalized LQ (gLQ) model that encompasses the entire range of possible dose delivery patterns and derived formulas for special radiotherapy schemes. We show that the gLQ model can naturally derive the traditional LQ model for low-dose and low-dose rate irradiation and the target model for high-dose irradiation as two special cases of gLQ. LQ and gLQ models were compared with published data obtained in vitro from Chinese hamster ovary cells across a wide dose range [0 to approximately 11.5 gray (Gy)] and from animals with dose fractions up to 13.5 Gy. The gLQ model provided consistent interpretation across the full dose range, whereas the LQ model generated parameters that depended on dose range, fitted only data with doses of 3.25 Gy or less, and failed to predict high-dose responses. Therefore, the gLQ model is useful for analyzing experimental radiation response data across wide dose ranges and translating common low-dose clinical experience into high-dose radiotherapy schemes for advanced radiation treatments.