Radiation Dose‐Volume Effects for Liver SBRT

Miften, Moyed; Vinogradskiy, Yevgeniy; Moiseenko, Vitali; Grimm, Jimm; Yorke, Ellen; Jackson, Andrew; Tomé, Wolfgang A.; Haken, R.K. Ten; Ohri, Nitin; Romero, Alejandra Méndez; Goodman, Karyn A.; Marks, Lawrence B.; Kavanagh, Brian D.; Dawson, Laura A.

doi:10.1016/j.ijrobp.2017.12.290

Cited by 81 publications

(67 citation statements)

References 35 publications

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“…Developing evidence-based dose-volume metrics to generate guidelines for normal tissue sparing is a challenging task assigned to working groups, such as QUANTEC [ 1 ], HyTEC [ 2 , 3 ] or PENTEC [ 5 ]. Selected metrics have to be justified on statistical and mechanistic merits and hypothesis-generating studies taking advantage of detailed patient-specific data provide this justification.…”

Section: Discussionmentioning

confidence: 99%

Dose-Volume Predictors of Radiation Pneumonitis After Lung Stereotactic Body Radiation Therapy (SBRT): Implications for Practice and Trial Design

Moiseenko¹,

Grimm²,

Yorke³

et al. 2020

Cureus

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Background and purpose Recently published HyTEC report summarized lung toxicity data and proposed guidelines of mean lung dose (MLD) <8 Gy and normal lung receiving at least 20 Gy, V 20Gy <10-15% to avoid lung toxicity. Support for preferred use of a particular dosimetric parameter has been limited. We performed a detailed dose-volume analysis of data on radiation pneumonitis (RP) following lung stereotactic body radiation therapy (SBRT) to search for parameters showing the strongest correlation with RP. Materials and methods Two patient cohorts (primary and metastatic lung tumor patients) from previously reported studies were analyzed. Total number of patients was 96, and incidence of grade ≥2 RP was 13.5% (13/96). Fitting to the logistic function was performed to investigate correlation between incidence of RP and reported dosimetric and volumetric parameters. Another independent cohort was used to explore correlation between dosimetric parameters. Results Among normal lung parameters (MLD and reported V x ), only MLD consistently showed significant correlation with incidence of RP. Gross tumor volume (GTV), internal target volume, planning target volume (PTV), and minimum dose covering 95% of GTV or PTV did not show statistical significance. A significant correlation between reported V x and MLD was observed in all cohorts. Conclusions In considering tumor- and target-specific (e.g., GTV, PTV) and normal lung-specific (e.g., MLD, V x ) metrics, MLD was the only parameter that consistently correlated with incidence of RP across both cohorts. Because SBRT planning constraints allow small normal lung volumes to receive high doses, utility of MLD is not obvious. The parallel structure of lung is one possible explanation, but correlation between dosimetric parameters obscures elucidation of the preferred or mechanistically based parameter to guide radiotherapy planning.

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Section: Discussionmentioning

confidence: 99%

Dose-Volume Predictors of Radiation Pneumonitis After Lung Stereotactic Body Radiation Therapy (SBRT): Implications for Practice and Trial Design

Moiseenko¹,

Grimm²,

Yorke³

et al. 2020

Cureus

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“…When it comes to a healthy liver, 80% of the organ can be removed. Although the whole liver exhibits a low radiation tolerance, potentially leading to the serious condition of radiotherapy-induced liver disease (RILD) [43][44][45][46][47][48][49], the regenerative potential and the parallel radiobiological character of the liver allows for application of high doses to a defined volume without compromising liver function [50].…”

Section: Target Volume Definition: Automatic Segmentation Of Target Vmentioning

confidence: 99%

Radiomics for liver tumours

et al. 2020

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Current research, especially in oncology, increasingly focuses on the integration of quantitative, multiparametric and functional imaging data. In this fast-growing field of research, radiomics may allow for a more sophisticated analysis of imaging data, far beyond the qualitative evaluation of visible tissue changes. Through use of quantitative imaging data, more tailored and tumour-specific diagnostic work-up and individualized treatment concepts may be applied for oncologic patients in the future. This is of special importance in cross-sectional disciplines such as radiology and radiation oncology, with already high and still further increasing use of imaging data in daily clinical practice. Liver targets are generally treated with stereotactic body radiotherapy (SBRT), allowing for local dose escalation while preserving surrounding normal tissue. With the introduction of online target surveillance with implanted markers, 3D-ultrasound on conventional linacs and hybrid magnetic resonance imaging (MRI)-linear accelerators, individualized adaptive radiotherapy is heading towards realization. The use of big data such as radiomics and the integration of artificial intelligence techniques have the potential to further improve image-based treatment planning and structured follow-up, with outcome/toxicity prediction and immediate detection of (oligo)progression. The scope of current research in this innovative field is to identify and critically discuss possible application forms of radiomics, which is why this review tries to summarize current knowledge about interdisciplinary integration of radiomics in oncologic patients, with a focus on investigations of radiotherapy in patients with liver cancer or oligometastases including multiparametric, quantitative data into (radio)-oncologic workflow from disease diagnosis, treatment planning, delivery and patient follow-up.

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“…Typically, a goal of sparing 700 mL of liver to less than 15 Gy for 3 fractions, and less than 17 Gy for 5-6 fractions allows for an acceptable level of risk, 27 though final parameters vary based upon the presence of cirrhosis as well as the patient's size. Other parameters include liver mean dose (<18 Gy in 5-6 fractions for healthy liver vs. <13-14 Gy in 5 fractions for cirrhotic patients), 27,28 or the ratio of ablated to spared liver <50% for healthy liver, <40% for Child-Pugh A, and <30% for Child-Pugh B patients (our own institutional guidelines, considering 17 Gy in 5 fractions an ablative dose for normal liver). For serial structures such as the bowel or bile duct, toxicities such as ulceration or stricture are driven by high-dose exposure, rather than the volume of organ treated.…”

Section: Definitive Radiation Therapymentioning

confidence: 99%

Radiation Therapy for Cholangiocarcinoma

et al. 2020

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Cholangiocarcinoma (CC) is a rare disease representing only 3% of the primary gastrointestinal malignancies. CC is classified based on anatomical location (intrahepatic, perihilar, and extrahepatic) and surgery is the preferred definitive treatment, regardless of location. However, a minority of patients is able to undergo complete surgical resection, and thus, nonsurgical locoregional therapy is imperative for tumor control. With the significant evolution of external beam radiation therapy, higher doses can be more precisely delivered, with adequate sparing of surrounding normal tissues, which appear to be associated with improved outcomes. In this review, we discuss the role of radiation therapy for each anatomical subsite of CC including the postoperative setting, neoadjuvant setting prior to liver transplantation, as well as definitive treatment with dose-escalated radiation and stereotactic body radiation therapy. Although there has been substantial improvement in radiation therapy techniques, randomized data are limited given CC remains both a rare and heterogenous disease. A multidisciplinary approach to treatment is essential in order to achieve optimal outcomes, and further investigation into novel therapies remains ongoing.

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Radiation Dose‐Volume Effects for Liver SBRT

Cited by 81 publications

References 35 publications

Dose-Volume Predictors of Radiation Pneumonitis After Lung Stereotactic Body Radiation Therapy (SBRT): Implications for Practice and Trial Design

Dose-Volume Predictors of Radiation Pneumonitis After Lung Stereotactic Body Radiation Therapy (SBRT): Implications for Practice and Trial Design

Radiomics for liver tumours

Radiation Therapy for Cholangiocarcinoma

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