Chest Wall Toxicity After Stereotactic Body Radiation Therapy: A Pooled Analysis of 57 Studies

Ma, Jie-Tao; Liu, Yang; Sun, Li; Milano, Michael T.; Zhang, Shuling; Huang, Le-Tian; Wei, Jing; Zhao, Jianwen; Han, Cheng-Bo; Kong, Feng-Ming

doi:10.1016/j.ijrobp.2018.11.036

Cited by 33 publications

(21 citation statements)

References 70 publications

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“…The rate of grade 3 chest wall toxicity with SABR from a large meta-analysis (combining several different dose and fractionations) is 1.2% [10]. Individual papers have found that the tumour to chest wall distance is a significant factor, as well as the maximum dose (Dmax) and the volume of chest wall receiving 30 Gy (V30) [11e14].…”

Section: Evidencementioning

confidence: 99%

Reduced Fractionation in Lung Cancer Patients Treated with Curative-intent Radiotherapy during the COVID-19 Pandemic

et al. 2020

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Patients treated with curative-intent lung radiotherapy are in the group at highest risk of severe complications and death from COVID-19. There is therefore an urgent need to reduce the risks associated with multiple hospital visits and their anti-cancer treatment. One recommendation is to consider alternative dosefractionation schedules or radiotherapy techniques. This would also increase radiotherapy service capacity for operable patients with stage I-III lung cancer, who might be unable to have surgery during the pandemic.Here we identify reduced-fractionation for curative-intent radiotherapy regimes in lung cancer, from a literature search carried out between 20/03/2020 and 30/ 03/2020 as well as published and unpublished audits of hypofractionated regimes from UK centres. Evidence, practical considerations and limitations are discussed for early-stage NSCLC, stage III NSCLC, early-stage and locally advanced SCLC. We recommend discussion of this guidance document with other specialist lung MDT members to disseminate the potential changes to radiotherapy practices that could be made to reduce pressure on other departments such as thoracic surgery. It is also a crucial part of the consent process to ensure that the risks and benefits of undergoing cancer treatment during the COVID-19 pandemic and the uncertainties surrounding toxicity from reduced fractionation have been adequately discussed with patients. Furthermore, centres should

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Section: Evidencementioning

confidence: 99%

Reduced Fractionation in Lung Cancer Patients Treated with Curative-intent Radiotherapy during the COVID-19 Pandemic

et al. 2020

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“…Stereotactic body radiation therapy (SBRT) involving extreme hypofractionation with high-dose radiation to the target volume and low doses to the surrounding normal tissues is considered superior compared with EBRT. However, SBRT is most suitable for small lesions (typically <5 cm), and the accuracy and reproducibility of treatments are essential (24,25). In addition, SBRT is contraindicated for lesions within 2 cm from the bronchial tree, and a marked prevalence of complications such as pulmonary toxicity and rib toxicity have been reported (24,25).…”

Section: Discussionmentioning

confidence: 99%

“…However, SBRT is most suitable for small lesions (typically <5 cm), and the accuracy and reproducibility of treatments are essential (24,25). In addition, SBRT is contraindicated for lesions within 2 cm from the bronchial tree, and a marked prevalence of complications such as pulmonary toxicity and rib toxicity have been reported (24,25). 125 I seed implantation is a minimally invasive treatment for tumors that has been rapidly developed in the past decade and has been listed as a treatment for prostate cancer (26).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of CT‑guided 125I brachytherapy in elderly patients with non‑small cell lung cancer

et al. 2020

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Non-small cell lung cancer (NSCLC) has become the most common cancer type and the leading cause of cancer-associated mortality worldwide. The aim of the present retrospective study was to evaluate the efficacy and safety of computed tomography (CT)-guided 125 I brachytherapy alone in elderly patients with NSCLC. A total of 26 elderly patients with NSCLC stage I-III who had an inoperable lesion or progressive disease following radio-chemotherapy were treated with CT-guided 125 I seed implantation for lung lesions and included in the present study. The prescribed dose of 125 I brachytherapy was 80-140 Gy, and dosimetric verification was performed immediately after the procedure. The response rate (RR) and local control rate (LCR) were analyzed according to the Response Evaluation Criteria in Solid Tumors (version 1.1). Survival was estimated using the Kaplan-Meier method. Safety and complications were also documented. All patients were aged 65-85 years (median age, 77 years) and successfully completed the procedure, and the median follow-up time was 9.4 months (range, 3-31 months). After a 6-month follow-up, for pulmonary lesions, complete response (CR) was achieved in 11 (42.3%) cases, partial response in 9 (34.6%) cases, stable disease in 4 (15.4%) cases and progressive disease in 2 (7.7%) cases. The 6-month RR and LCR were 76.9 (20/26) and 92.3% (24/26), respectively. The mean overall survival (OS) time was 11.7±7.6 months and the 0.5-and 1-year OS rates were 90.1 and 73.3%, respectively. Tumor-related symptoms in patients were significantly alleviated following the procedure. No severe complications occurred during and after the procedure of 125 I seed implantation. In conclusion, CT-guided 125 I brachytherapy is a feasible, effective and safe therapy and may be considered as an alternative option to surgery and radiotherapy for elderly patients with NSCLC.

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“…This approach (DCA as opposed to VMAT or IMRT) was preferred for many patients whose DCA plans met institutional dosimetric constraints, as the delivery time is relatively fast (<2 minutes) in part assisted by the auto setup of gantry and couch, so that the possibility of respiratory baseline shifts is minimized [16]. The constrains were V20 Gy < 10% for total lung minus GTV, ≤30 Gy max for spinal cord, ≤40 Gy max for esophagus, and V30 Gy ≤ 30 mL for chest wall (CW) [17]. They were practically relevant and used across all patients at our institution.…”

Section: ) Patient Selectionmentioning

confidence: 99%

Acuros-Based Planning with Density Override for Lung SBRT by a Dynamic Conformal Arc Technique: Comparative Evaluation with AAA-Based Planning in Four-Dimensional Dose

Yeo¹,

Joyce²,

Singh³

et al. 2021

IJMPCERO

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The purpose of this study was to evaluate a planning strategy based on Acuros with density override in comparison with AAA without and with the override. Ten lung-tumor patients were selected with each PTV size around 2 -4 cm and were imaged using slow scan, followed by four-dimensional (4D) imaging limited to the target. On each phase-specific image, gross tumor volume (GTV) was contoured. Summed over all phases, an integrated GTV (iGTV) was generated and copied to the slow scan. A treatment plan was created using a dynamic-conformal-arc technique with AAA to prescribe 60 Gy to 95% of PTV (iGTV + 0.5 cm). Each AAA-based plan was regenerated by overriding the density of the setup margin of PTV by GTV density (modeling tumor-position uncertainty). It was also regenerated with Acuros and the override. The three plans were validated in 4D dose to PTV, after similarly overriding PTV density (phase-specific), accurately calculating with Acuros, and summing the phase-specific plans through organ/dose registration. The Acuros-based plan with the override, the AAA-based plan, and the AAAbased plan with the override provided 4D PTV doses of 63.9, 67.9, and 62 Gy at D95%, respectively, averaged over all patients. The override with Acuros and AAA produced lesser 4D doses, closer to the associated 3D doses, respectively, than that without the override, with better conformity and inhomogeneity. With the override in common, Acuros provided a greater dose to PTV than that by AAA. The Acuros with the override, which was more accurate than the AAA without the override, is clinically recommended.

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Chest Wall Toxicity After Stereotactic Body Radiation Therapy: A Pooled Analysis of 57 Studies

Cited by 33 publications

References 70 publications

Reduced Fractionation in Lung Cancer Patients Treated with Curative-intent Radiotherapy during the COVID-19 Pandemic

Reduced Fractionation in Lung Cancer Patients Treated with Curative-intent Radiotherapy during the COVID-19 Pandemic

Efficacy and safety of CT‑guided 125I brachytherapy in elderly patients with non‑small cell lung cancer

Acuros-Based Planning with Density Override for Lung SBRT by a Dynamic Conformal Arc Technique: Comparative Evaluation with AAA-Based Planning in Four-Dimensional Dose

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