How a very large sarcomatoid lung cancer was efficiently managed with lattice radiation therapy: a case report

Iori, Federico; Botti, A.; Ciammella, Patrizia; Cozzi, Salvatore; Orlandi, M.; Iori, Mauro; Iotti, C.

doi:10.21037/apm-22-246

Cited by 16 publications

(8 citation statements)

References 16 publications

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“…Again, a mean tumor regression of around 54% was observed, with no grade ≥3 toxicity. cancer with a T of 19 cm x 16 cm, who received 55 Gy on the hotspots and 20 Gy on the periphery in 5 consecutive fractions, reaching a 70% lesion reduction at 3 months (19). These preliminary data seem to suggest that both LRT approaches could be valid to safely reach a marked T response.…”

Section: Cold Tmementioning

confidence: 75%

“…In recent literature, monocentric studies reported positive feedbacks on LRT for large tumor (18,19); however, no trials about LRT safety were conducted until the recent publication of the "LITE SABR M1 trial" (20). This study highlighted the safety of LRT cytoreduction and its promising results en-In addition, it is hypothesized that the gradient generated in the treated volume could improve host immune system response against neoplastic cells both in irradiated and not irradiated sites (abscopal effect) (8).…”

Section: Lattice Radiation Therapy For Large Metastatic Cold Tumorsmentioning

confidence: 99%

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Lattice Radiation Therapy: a promising option in metastatic cold tumors, with a bulky primary lesion

Iori¹,

Ciammella²,

Cozzi³

et al. 2022

Ann Res Oncol

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Metastatic cold tumors with a large primary site (i.e., >5 cm) represent an open issue as surgery is often excluded and immunotherapy (IT) have reported limited response, because of the immunosuppression present in their microenvironments (cold TME). Due to their dimensions and hypoxia, large tumors are especially radioresistant, requiring to be irradiated with higher doses, not deliverable by conventional radiotherapy (RT) without an increased toxicity to the surrounding tissues. Even stereotactic body radiation therapy (SBRT) is excluded, as it is usually limited to targets with a diameter below 5 cm. Lattice Radiation Therapy (LRT) is a novel RT technique, based on an inhomogeneous dose delivery, that allows to safely achieve an outstanding cytoreduction of large lesions by concurrently administering ablative high doses inside the tumor and controlled doses near the adjacent organs at risk (OARs). In addition, preliminary data suggest that LRT might reengineer tumor microenvironment (TME), making it more immunogenic, and it could boost the host immune system response against irradiated and not irradiated lesions. Hence, LRT could represent an interesting strategy to deal with localized and widespread diseases in metastatic cold tumors with a large primary lesion.Impact statement: Lattice radiation therapy (LRT) is an innovative type of spatially fractionated radiation therapy. In addition to an outstanding cytoreduction, LRT is hypothesized to prime a vigorous immune reaction that could be exploited in cold tumors to rejecet metastatic cancer cells.

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Section: Cold Tmementioning

confidence: 75%

Section: Lattice Radiation Therapy For Large Metastatic Cold Tumorsmentioning

confidence: 99%

Lattice Radiation Therapy: a promising option in metastatic cold tumors, with a bulky primary lesion

Iori¹,

Ciammella²,

Cozzi³

et al. 2022

Ann Res Oncol

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“…Emerging data have established RT as a useful therapeutic option also for oligometastatic and oligorecurrent/oligoprogressive disease [16], rare histologies [17,18], or in combination with new drugs available for hormone-sensitive and castration-resistant PC. In recent years, advances in radiation planning and delivery techniques, in particular the advent of new-generation linac with the FFF mode, have improved treatment accuracy and given rise to the adoption of ultrahypofractionated radiation schedules in the form of SBRT [19] in different oncological settings, with acceptable toxicity [20][21][22][23][24][25]. Despite this, local failure after RT still remains a critical issue.…”

Section: Discussionmentioning

confidence: 99%

Linac-based stereotactic salvage reirradiation for intraprostatic prostate cancer recurrence: toxicity and outcomes

Cozzi

Ghersi

Bardoscia³

et al. 2023

Strahlenther Onkol

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Background The rates of local failure after curative radiotherapy for prostate cancer (PC) remain high despite more accurate locoregional treatments available, with one third of patients experiencing biochemical failure and clinical relapse occurring in 30–47% of cases. Today, androgen deprivation therapy (ADT) is the treatment of choice in this setting, but with not negligible toxicity and low effects on local disease. Therefore, the treatment of intraprostatic PC recurrence represents a challenge for radiation oncologists. Prostate reirradiation (Re-I) might be a therapeutic possibility. We present our series of patients treated with salvage stereotactic Re‑I for intraprostatic recurrence of PC after radical radiotherapy, with the aim of evaluating feasibility and safety of linac-based prostate Re‑I. Materials and methods We retrospectively evaluated toxicities and outcomes of patients who underwent salvage reirradiation using volumetric modulated arc therapy (VMAT) for intraprostatic PC recurrence. Inclusion criteria were age ≥ 18 years, histologically proven diagnosis of PC, salvage Re‑I for intraprostatic recurrence after primary radiotherapy for PC with curative intent, concurrent/adjuvant ADT with stereotactic body radiation therapy (SBRT) allowed, performance status ECOG 0–2, restaging choline/PSMA-PET/TC and prostate MRI after biochemical recurrence, and signed informed consent. Results From January 2019 to April 2022, 20 patients were recruited. Median follow-up was 26.7 months (range 7–50). After SBRT, no patients were lost at follow-up and all are still alive. One- and 2‑year progression free survival (PFS) was 100% and 81.5%, respectively, while 2‑year biochemical progression-free survival (bFFS) was 88.9%. Four patients (20%) experienced locoregional lymph node progression and were treated with a further course of SBRT. Prostate reirradiation allowed the ADT start to be postponed for 12–39 months. Re‑I was well tolerated by all patients and none discontinued the treatment. No cases of ≥ G3 genitourinary (GU) or gastrointestinal (GI) toxicity were reported. Seven (35%) and 2 (10%) patients experienced acute G1 and G2 GU toxicity, respectively. Late GU toxicity was recorded in 10 (50%) patients, including 8 (40%) G1 and 2 (10%) G2. ADT-related side effects were found in 7 patients (hot flashes and asthenia). Conclusion Linac-based SBRT is a safe technique for performing Re‑I for intraprostatic recurrence after primary curative radiotherapy for PC. Future prospective, randomized studies are desirable to better understand the effectiveness of reirradiation and the still open questions in this field.

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“…Two approaches to delivering LRT are commonly used. The first approach consists of a sole LRT treatment course with a simultaneous integrated boost, usually delivered in five fractions 5–7 . The second approach combines one to three upfront LRT fractions followed by consolidation radiation therapy with a conventional palliative prescription 8–11 .…”

Section: Introductionmentioning

confidence: 99%

Development of an automated treatment planning approach for lattice radiation therapy

Gaudreault,

Chang,

Kron

et al. 2023

Medical Physics

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BackgroundLattice radiation therapy (LRT) alternates regions of high and low doses within the target. The heterogeneous dose distribution is delivered to a geometrical structure of vertices segmented inside the tumor. LRT is typically used to treat patients with large tumor volumes with cytoreduction intent. Due to the geometric complexity of the target volume and the required dose distribution, LRT treatment planning demands additional resources, which may limit clinical integration.PurposeWe introduce a fully automated method to (1) generate an ordered lattice of vertices with various sizes and center‐to‐center distances and (2) perform dose optimization and calculation. We aim to report the dosimetry associated with these lattices to help clinical decision‐making.MethodsSarcoma cancer patients with tumor volume between 100 cm3 and 1500 cm3 who received radiotherapy treatment between 2010 and 2018 at our institution were considered for inclusion. Automated segmentation and dose optimization/calculation were performed by using the Eclipse Scripting Application Programming Interface (ESAPI, v16, Varian Medical Systems, Palo Alto, USA). Vertices were modeled by spheres segmented within the gross tumor volume (GTV) with 1 cm/1.5 cm/2 cm diameters (LRT‐1 cm/1.5 cm/2 cm) and 2 to 5 cm center‐to‐center distance on square lattices alternating along the superior‐inferior direction. Organs at risk were modeled by subtracting the GTV from the body structure (body‐GTV). The prescription dose was that 50% of the vertice volume should receive at least 20 Gy in one fraction. The automated dose optimization included three stages. The vertices optimization objectives were refined during optimization according to their values at the end of the first and second stages. Lattices were classified according to a score based on the minimization of body‐GTV max dose and the maximization of GTV dose uniformity (measured with the equivalent uniform dose [EUD]), GTV dose heterogeneity (measured with the GTV D90%/D10% ratio), and the number of patients with more than one vertex inserted in the GTV. Plan complexity was measured with the modulation complexity score (MCS). Correlations were assessed with the Spearman correlation coefficient (r) and its associated p‐value.ResultsThirty‐three patients with GTV volumes between 150 and 1350 cm3 (median GTV volume = 494 cm3, IQR = 272–779 cm3 were included. The median time required for segmentation/planning was 1 min/21 min. The number of vertices was strongly correlated with GTV volume in each LRT lattice for each center‐to‐center distance (r > 0.85, p‐values < 0.001 in each case). Lattices with center‐to‐center distance = 2.5 cm/3 cm/3.5 cm in LRT‐1.5 cm and center‐to‐center distance = 4 cm in LRT‐1 cm had the best scores. These lattices were characterized by high heterogeneity (median GTV D90%/D10% between 0.06 and 0.19). The generated plans were moderately complex (median MCS ranged between 0.19 and 0.40).ConclusionsThe automated LRT planning method allows for the efficacious generation of vertices arranged in an ordered lattice and the refinement of planning objectives during dose optimization, enabling the systematic evaluation of LRT dosimetry from various lattice geometries.

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How a very large sarcomatoid lung cancer was efficiently managed with lattice radiation therapy: a case report

Cited by 16 publications

References 16 publications

Lattice Radiation Therapy: a promising option in metastatic cold tumors, with a bulky primary lesion

Lattice Radiation Therapy: a promising option in metastatic cold tumors, with a bulky primary lesion

Linac-based stereotactic salvage reirradiation for intraprostatic prostate cancer recurrence: toxicity and outcomes

Development of an automated treatment planning approach for lattice radiation therapy

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