Phase I Dose-Escalation Study of Stereotactic Body Radiotherapy in Patients With Hepatic Metastases

Rule, William G.; Timmerman, Robert; Tong, Liyue; Abdulrahman, Ramzi; Meyer, Jeffrey; Boike, Thomas; Schwarz, Roderich E.; Weatherall, Paul T.; Cho, L. Chinsoo

doi:10.1245/s10434-010-1405-5

Cited by 190 publications

(102 citation statements)

References 39 publications

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“…57 This and other phase I trials have confirmed the validity of this dose-volume constraint or have described new limitations for single fraction or five fractions SBRT of hepatic metastases. 17,21 The phase I study of Rule established the safety of delivering 60 Gy in 5 fractions to treat liver metastases if pretreatment hepatic function was adequate and a critical volume of 700 mL of normal liver receives a total dose of no more than 21 Gy in 5 fractions. 21 The situation is completely different for the treatment of hepatocellular carcinoma because associated cirrhosis causes a significant decrease in liver tolerance to radiation.…”

Section: Dose-volume Constraints For Organs At Riskmentioning

confidence: 99%

“…17,21 The phase I study of Rule established the safety of delivering 60 Gy in 5 fractions to treat liver metastases if pretreatment hepatic function was adequate and a critical volume of 700 mL of normal liver receives a total dose of no more than 21 Gy in 5 fractions. 21 The situation is completely different for the treatment of hepatocellular carcinoma because associated cirrhosis causes a significant decrease in liver tolerance to radiation. 52 It should also pay special attention to centrally located hepatic lesions where the central biliary system is a serially functioning organ.…”

Section: Dose-volume Constraints For Organs At Riskmentioning

confidence: 99%

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Radiobiology of stereotactic body radiation therapy (SBRT)

Garau

2017

Reports of Practical Oncology & Radiotherapy

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a b s t r a c tRecent advances in the technology of radiotherapy have enabled the development of new therapeutic modalities that deliver radiation with very high accuracy, reduced margins and high dose conformation, allowing the reduction of healthy tissue irradiated and therefore minimizing the risk of toxicity. The next step was to increase the total tumor dose using conventional fractionation (which remains the best way to relatively radioprotect healthy tissues when large volumes are treated) or to use new fractionation schemes with greater biological effectiveness. Based on the experience gained in radiosurgery, the latter way was chosen for small and well-defined tumors in the body. Stereotactic body radiotherapy delivers high doses of radiation to small and well-defined targets in an extreme hypofractionated (and accelerated) scheme with a very high biological effectiveness obtaining very good initial clinical results in terms of local tumor control and acceptable rate of late complications.In fact, we realize a posteriori that it was not feasible to administer such biologically equivalent dose in a conventional fractionation because the treatment could last several months.So far, these new therapeutic modalities have been developed due to technologic advances in image guidance and treatment delivery but without a solid biological basis. It is the role of traditional radiobiology (and molecular radiobiology) to explain the effects of high doses of ionizing radiation on tumor and normal tissues. Only through a better understanding of how high doses of ionizing radiation act, clinicians will know exactly what we do, allowing us in the future to refine our treatments. This article attempts to describe through simple and understandable concepts the known aspects of the biological action of high doses of radiation on tumor and normal tissues, but it is clear that we need much more basic research to better understand the biology of high doses of radiation.

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Section: Dose-volume Constraints For Organs At Riskmentioning

confidence: 99%

Section: Dose-volume Constraints For Organs At Riskmentioning

confidence: 99%

Radiobiology of stereotactic body radiation therapy (SBRT)

Garau

2017

Reports of Practical Oncology & Radiotherapy

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“…Rule et al studied three dose-escalation cohorts and showed a significant difference in local control between 60 Gy in 5 fractions vs. 30 Gy in 3 fractions. 9 No patient experienced grade III or higher toxicity. Regardless of the above mentioned results, Vautravers-Dewas and colleagues did not find a significant difference in local control between 40 Gy in 4 fractions and 45 Gy in 3 for their cohort treated with SBRT.…”

Section: Introductionmentioning

confidence: 96%

Institutional experience in the treatment of colorectal liver metastases with stereotactic body radiation therapy

Romero

Keskin-Cambay

et al. 2017

Reports of Practical Oncology & Radiotherapy

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Metastases LiverStereotactic body radiation therapy a b s t r a c t Aim: To investigate whether the impact of dose escalation in our patient population represented an improvement in local control without increasing treatment related toxicity. Materials and methods:A cohort of consecutive patients with colorectal liver metastases treated with stereotactic body radiation therapy (SBRT) between December 2002 and December 2013 were eligible for this study. Inclusion criteria were a Karnofsky performance status ≥80% and, according to the multidisciplinary tumor board, ineligibility for surgery or radiofrequency ablation. Exclusion criteria were a lesion size >6 cm, more than 3 metastases, and treatment delivered with other fractionation scheme than 3 times 12.5 Gy or 16.75 Gy prescribed at the 65-67% isodose. To analyze local control, CT or MRI scans were acquired during follow-up. Toxicity was scored using the Common Toxicity Criteria Adverse Events v4.0.Results: A total of 40 patients with 55 colorectal liver metastases were included in this study.We delivered 37.5 Gy to 32 lesions, and 50.25 Gy to 23 lesions. Median follow-up was 26 and 25 months for these two groups. Local control at 2 and 3 years was 74 and 66% in the low dose group while 90 and 81% was reached in the high dose group. No significant difference in local control between the two dose fractionation schemes could be found. Grade 3 toxicity was limited and was not increased in the high dose group.Conclusions: SBRT for colorectal liver metastases offers a high chance of local control at long term. High irradiation doses may contribute to enhance this effect without increasing toxicity.

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“…The prescribed dose to the PTV was 800 cGy per fraction for 5 fractions, leading to a cumulative dose of 4,000 cGy. Liver SBRT planning guidelines were adapted from Andolino et al, (14) Tse et al (2008), (15) and Rule et al (2011) (16) …”

Section: Methodsmentioning

confidence: 99%

Clinical experience with planning, quality assurance, and delivery of burst‐mode modulated arc therapy

Kainz

Prah

Ahunbay

et al. 2016

J Applied Clin Med Phys

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“Burst‐mode” modulated arc therapy (hereafter referred to as “mARC”) is a form of volumetric‐modulated arc therapy characterized by variable gantry rotation speed, static MLCs while the radiation beam is on, and MLC repositioning while the beam is off. We present our clinical experience with the planning techniques and plan quality assurance measurements of mARC delivery. Clinical mARC plans for five representative cases (prostate, low‐dose‐rate brain, brain with partial‐arc vertex fields, pancreas, and liver SBRT) were generated using a Monte Carlo–based treatment planning system. A conventional‐dose‐rate flat 6 MV and a high‐dose‐rate non‐flat 7 MV beam are available for planning and delivery. mARC plans for intact‐prostate cases can typically be created using one 360° arc, and treatment times per fraction seldom exceed 6 min using the flat beam; using the nonflat beam results in slightly higher MU per fraction, but also in delivery times less than 4 min and with reduced mean dose to distal organs at risk. mARC also has utility in low‐dose‐rate brain irradiation; mARC fields can be designed which deliver a uniform 20 cGy dose to the PTV in approximately 3‐minute intervals, making it a viable alternative to conventional 3D CRT. For brain cases using noncoplanar arcs, delivery time is approximately six min using the nonflat beam. For pancreas cases using the nonflat beam, two overlapping 360° arcs are required, and delivery times are approximately 10 min. For liver SBRT, the time to deliver 800 cGy per fraction is at least 12 min. Plan QA measurements indicate that the mARC delivery is consistent with the plan calculation for all cases. mARC has been incorporated into routine practice within our clinic; currently, on average approximately 15 patients per day are treated using mARC; and with the exception of LDR brain cases, all are treated using the nonflat beam.PACS number(s): 87.55.D‐, 87.55.K‐, 87.53.Ay. 87.56.N‐

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Phase I Dose-Escalation Study of Stereotactic Body Radiotherapy in Patients With Hepatic Metastases

Abstract: A dose of 60 Gy in 5 fractions can be safely delivered to selected patients with hepatic metastases as long as the critical liver volume is respected. A dose of 60 Gy in 5 fractions yields an excellent level of LC.

Cited by 190 publications

References 39 publications

Radiobiology of stereotactic body radiation therapy (SBRT)

Radiobiology of stereotactic body radiation therapy (SBRT)

Institutional experience in the treatment of colorectal liver metastases with stereotactic body radiation therapy

Clinical experience with planning, quality assurance, and delivery of burst‐mode modulated arc therapy

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