Evaluating Competing and Emerging Technologies for Stereotactic Body Radiotherapy and Other Advanced Radiotherapy Techniques

Martín, A. Gil; Thomas, S J; Harden, Susan; Burnet, N.G.

doi:10.1016/j.clon.2015.01.034

Cited by 21 publications

(16 citation statements)

References 56 publications

(42 reference statements)

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“…Varian, Salt Lake City, UT), TomoTherapy® (Accuray) and MRI-cobalt linac (ViewRay™, Oakwood Village, OH). 35,36 The dose delivered is key to the high local control rates seen with SABR in lung cancer. Previous studies have demonstrated that a biologically equivalent dose (BED) for tissue with an alpha/beta ratio of 10 of .100 gives the best chance of local tumour control.…”

Section: Introductionmentioning

confidence: 99%

A systematic review of outcomes following stereotactic ablative radiotherapy in the treatment of early-stage primary lung cancer

Murray

Franks

Hanna

2017

The British Journal of Radiology

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Stereotactic ablative body radiotherapy (SABR) describes a radiotherapy (RT) technique where high doses of radiation are precisely delivered to an extracranial target within the body, using either a single fraction of RT or using multiple small numbers of fractions. SABR has now become the standard of care treatment for patients with early-stage non-small-cell lung cancer (NSCLC) for whom surgery is not appropriate. This systematic review considers the evidence supporting the use of SABR in early-stage NSCLC, reported toxicity rates, the use of SABR in centrally located NSCLC, the use of SABR as salvage therapy following surgery or RT, and future potential drug combinations with SABR.

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Section: Introductionmentioning

confidence: 99%

A systematic review of outcomes following stereotactic ablative radiotherapy in the treatment of early-stage primary lung cancer

Murray

Franks

Hanna

2017

The British Journal of Radiology

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“…The SBRT technique broadened its areas from brain metastases to early-stage lung cancer, oligometastases, and hepatocellular carcinoma. Through the robust advance of linear accelerators [8], liniac-based stereotactic radiosurgery rapidly disseminated in brain metastases in the US [9]. There were a few reports about cost effectiveness that favored the SBRT over open surgery in brain metastases and lobectomy in early lung cancer [10,11].…”

Section: Discussionmentioning

confidence: 99%

Where is clinical research for radiotherapy going? Cross-sectional comparison of past and contemporary phase III clinical trials

2020

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Purpose: The features of past and contemporary phase III clinical trials for radiotherapy were reviewed to activate future clinical trials and to advise on actual clinical practice. Methods and materials: The phase III clinical trials for radiotherapy were searched in the database of 'ClinicalTrials. gov' by the U.S. National Institute of Health. Using the staring date, the studies during each period of 4 years were collected for the past (from Jan 2000 to Dec 2003) and contemporary (July 2014 to June 2018) years. For the investigated subjects, the patterns of studies were classified as: Category A, the comparisons of rival radiotherapy protocols; Category B, the comparisons of multidisciplinary approaches; Category C, the investigation of supplementary agents; and Category D, the investigation of optimal partners for concurrent radiotherapy. Results: The number of studies increased, from 96 past to 158 contemporary studies. The patterns of studies were similar with the mild increase of Category A in the contemporary years (22.9% vs. 29.1%). For the study locations and the funding sources, the Chinese studies (2.1% vs. 34.2%, P < 0.001) and the affiliated institutions of researchers (37.5% vs. 72.2%, P < 0.001) markedly increased in the contemporary years from the past Western studies and nonprofit organization, respectively. The robust radiation techniques were more usual in the contemporary years (11.5% vs. 44.9%, P < 0.001). The fractionation schedule and delivery technique were the common issues in both past and contemporary years of Category A. In Category B, the indications of stereotactic radiotherapy was the rising concern, with eight ongoing studies. Except for the studies of palliative or prophylactic goals and stereotactic radiotherapy, the escape from conventional fraction size was 37.9% (36/95) in the contemporary years with the median fraction size of 2.5 Gy (range 2.05-6.6 Gy) in the comparison with 19.0% (15/79) in the past years (P = 0.006). Conclusions: To activate the clinical trials for radiotherapy, the funding sources would be diversified, including industrial support. Hypofractionated schedules using robust techniques could be preemptively considered in actual clinical practice.

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“…Recent studies have acknowledged the difficulty of assessing patients on randomized trials when they are treated using varying technology and rapidly improving platforms (12). This study provides a unique opportunity to compare/contrast treatment delivery systems in a multi-institutional setting for a challenging planning case.…”

Section: Discussionmentioning

confidence: 99%

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

Al‐Hallaq

Chmura

Salama³

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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Purpose XXXX is the first NCI-sponsored trial to treat multiple (2–4) extracranial metastases with SBRT. Benchmark credentialing is required to ensure adherence to this complex protocol, particularly for metastases in close proximity. This report summarizes dosimetric results and approval rates. Materials/Methods The benchmark used anonymized data from a patient with bilateral adrenal metastases, separated by <5 cm of normal tissue. Because the PTV overlaps with organs-at-risk (OARs), institutions must utilize the planning priority guidelines to balance PTV coverage (45Gy in 3 fractions) against OAR sparing. Submitted plans were processed by IROC and assessed by protocol co-chairs by comparing doses to targets, OARs, and conformity metrics using non-parametric tests. Results Of 63 benchmarks submitted through October, 2015, 94% were approved, with 51% at first attempt. The majority used VMAT (78%), a single plan for both PTVs (90%), and prioritized PTV over stomach (75%). Median D95% was 44.8 ± 1.0 Gy and 44.9 ± 1.0 Gy for right and left PTVs, respectively. Median dose to 0.03 cc was 14.2 ± 2.2 Gy to spinal cord and 46.5 ± 3.1 Gy to stomach. Plans that spared stomach significantly reduced dose to the left PTV and stomach. Conformity metrics were significantly better for single plans that simultaneously treated both PTVs with VMAT/IMRT/3DCRT compared to separate plans. No significant differences existed in dose at 2 cm from PTVs. Conclusions While the majority of plans utilized VMAT, the range of conformity and dose falloff was large. The decision to prioritize either OAR or PTV coverage varied considerably suggesting toxicity outcomes in the trial could be affected. Several benchmarks met DVH metrics while producing unacceptable plans due to low conformity. Dissemination of a frequently-asked-questions document improved the approval rate at first attempt. Benchmark credentialing was found to be a valuable tool for educating institutions about protocol requirements.

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Evaluating Competing and Emerging Technologies for Stereotactic Body Radiotherapy and Other Advanced Radiotherapy Techniques

Cited by 21 publications

References 56 publications

A systematic review of outcomes following stereotactic ablative radiotherapy in the treatment of early-stage primary lung cancer

A systematic review of outcomes following stereotactic ablative radiotherapy in the treatment of early-stage primary lung cancer

Where is clinical research for radiotherapy going? Cross-sectional comparison of past and contemporary phase III clinical trials

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

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