Flattening Filter Free vs. Flattened Beams for Lung Stereotactic Body Radiation Therapy

Annède, Pierre; Darréon, J.; Benkemouche, Ahcene; Valdenaire, Simon; Tyran, Marguerite; Kaeppelin, Bertrand; Macagno, Alban; Barrou, Julien; Cagetti, Leonel Varela; Favrel, V.; Moureau-Zabotto, Laurence; Gonzague, Laurence; Fau, Pierre; Chargari, Cyrus; Tallet, Agnés; Salem, Naji

doi:10.21873/anticanres.11933

Cited by 5 publications

(2 citation statements)

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“…FFF technique permits a considerable increase in the dose rate delivery and reduce treatment time by more than 50% compared to flattening filter (FF) technique without compromising the plan’s quality ( 23 , 25 , 26 ). Our study reported median beam-on-time of less than 2 minutes which was in line with previous VMAT-FFF studies conducted in patients with lung tumors ( 12 , 13 ). Decreased treatment time can improve treatment efficacy for SBRT because it reduces the likelihood of intrafraction motion and reduces the likelihood of undesirable patient motion during treatment.…”

Section: Discussionsupporting

confidence: 92%

Flattening filter free stereotactic body radiation therapy for lung tumors: outcomes and predictive factors

Jaruthien¹,

Kitpanit²,

Kannarunimit³

et al. 2021

Transl Cancer Res TCR

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Background Stereotactic body radiation therapy (SBRT) using flattening filter free (FFF) has been commonly used, however, its outcomes and predictive factors in lung tumors are limiting. Thus, we aim to assess the clinical outcomes of this approach and identify factors associated with outcomes in patients with early stage non-small cell lung cancer (NSCLC) and oligometastatic/oligoprogressive lung tumor (OLT). Methods Patients who underwent lung SBRT with FFF were retrospectively reviewed. All patients were delivered using volumetric modulated arc therapy (VMAT) technique. The primary outcome was local control (LC). The secondary outcomes were overall survival (OS) and toxicities. We assessed the association between LC and various factors in OLT. Results From February 2014 to July 2019, ninety-four patients and 129 lesions with median follow-up time of 30 months were included in the analysis. Twenty-six patients with 26 lesions were early NSCLC, while 68 patients with 103 lesions were OLT, 41.7% of which were from colorectal cancers (CRC) and 18.5% were from primary lung cancers. Two-year LC was 88.9% and 85.7% for early NSCLC and OLT, respectively. Two-year OS was significantly higher for early NSCLC than OLT (83.3% vs. 68.7%, P=0.035). In the multivariate analysis for OLT, CRC origin (hazard ratio, HR 10.59, 95% CI: 2.29–48.95, P=0.003) and gross tumor volume (GTV) mean BED 10 ≤147 Gy (HR 5.16, 95% CI: 1.13–23.59, P=0.034) were significantly associated with higher local failure (LF). Most of the acute grade 1–2 toxicities were radiation pneumonitis (26.5%). No grade 3–5 event was observed. Conclusions This study confirmed the clinical efficacy and safety of lung SBRT using FFF-technique. Our findings support the role of using a high BED 10 regimen to achieve good LC for OLT and the potential role for dose escalation for primary CRC.

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Section: Discussionsupporting

confidence: 92%

Flattening filter free stereotactic body radiation therapy for lung tumors: outcomes and predictive factors

Jaruthien¹,

Kitpanit²,

Kannarunimit³

et al. 2021

Transl Cancer Res TCR

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“…Intra-fraction imaging is recommended as best practice per ESTRO ACROP guidelines[29]. Because a faster treatment delivery time is likely associated with less patient movement and therefore more accurate treatment delivery, the use of a flattening-filter free setting can help to optimize treatment delivery as well[30-32]. The use of heterogeneity corrections has also been shown in RTOG 0236 to have a significant effect on prescription dose and tumor coverage, and should be considered standard in SBRT treatments[33].…”

Section: Discussionmentioning

confidence: 99%

Stereotactic body radiation therapy for non-small cell lung cancer: A review

Prezzano

Jun

Hermann

et al. 2019

WJCO

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Stereotactic body radiation therapy (SBRT) is the treatment of choice for medically inoperable patients with early stage non-small cell lung cancer (NSCLC). A literature search primarily based on PubMed electronic databases was completed in July 2018. Inclusion and exclusion criteria were determined prior to the search, and only prospective clinical trials were included. Nineteen trials from 2005 to 2018 met the inclusion criteria, reporting the outcomes of 1434 patients with central and peripheral early stage NSCLC. Patient eligibility, prescription dose and delivery, and follow up duration varied widely. Three-years overall survival ranged from 43% to 95% with loco-regional control of up to 98% at 3 years. Up to 33% of patients failed distantly after SBRT at 3 years. SBRT was generally well tolerated with 10%-30% grade 3-4 toxicities and a few treatment-related deaths. No differences in outcomes were observed between conventionally fractionated radiation therapy and SBRT, central and peripheral lung tumors, or inoperable and operable patients. SBRT remains a reasonable treatment option for medically inoperable and select operable patients with early stage NSCLC. SBRT has shown excellent local and regional control with toxicity rates equivalent to surgery. Decreasing fractionation schedules have been consistently shown to be both safe and effective. Distant failure is common, and chemotherapy may be considered for select patients. However, the survival benefit of additional interventions, such as chemotherapy, for early stage NSCLC treated with SBRT remains unclear.

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Intrafractional motion in stereotactic body radiotherapy of spinal metastases utilizing cone beam computed tomography image guidance

Svestad

Ramberg

Skår

et al. 2019

Physics and Imaging in Radiation Oncology

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Background and purpose: Spine stereotactic body radiotherapy (SBRT) requires a high degree of accuracy due to steep dose gradients close to the spinal cord. This study aimed to (1) evaluate intrafractional motion in spine SBRT utilizing flattening filter free (FFF) beam delivery and cone beam computed tomography (CBCT) image guidance and (2) evaluate if adding another CBCT acquisition and corrections prior to treatment improves the overall position accuracy. Materials and methods: Intrafractional motion was retrospectively analyzed for 78 fractions in 54 patients. All patients were immobilized with an evacuated cushion. Before treatment, a CBCT was acquired, a bony fusion with the planning CT was performed and translational and rotational errors were corrected. For 30 of the patients (39 fractions) acquisition of another CBCT and corrections were performed before treatment. A post treatment CBCT was acquired for all patients, and translational and rotational errors measured by fusion of the post treatment CBCT with the planning CT were recorded to calculate means and standard deviations (SDs). Results: The positional errors were significantly smaller in 4 out of 6 error values in the patient group treated with verification CBCT. In this group, translational and rotational SDs ranged from 0.5 to 0.6 mm and 0.3°, respectively. Corresponding values in the group treated without verification CBCT were 0.7-1.0 mm and 0.4-0.7°. Conclusion: With proper CBCT image guidance, patient immobilization and FFF-beam delivery, one can obtain very high patient position accuracy in spine SBRT. Inclusion of a verification CBCT prior to treatment increases the overall position accuracy.

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Flattening Filter Free vs. Flattened Beams for Lung Stereotactic Body Radiation Therapy

Abstract: We report a low toxicity rate and a shortened beam on time in patients treated with 3D FFF SBRT for lung neoplastic lesions.

Cited by 5 publications

References 0 publications

Flattening filter free stereotactic body radiation therapy for lung tumors: outcomes and predictive factors

Flattening filter free stereotactic body radiation therapy for lung tumors: outcomes and predictive factors

Stereotactic body radiation therapy for non-small cell lung cancer: A review

Intrafractional motion in stereotactic body radiotherapy of spinal metastases utilizing cone beam computed tomography image guidance

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