SBRT planning for liver metastases: A focus on immobilization, motion management and planning imaging techniques

Riou, O.; Moscardo, C. Llacer; Fenoglietto, P.; Deshayes, Emmanuel; Tétreau, Raphaël; Molinier, J.; Lenglet, Alexis; Assenat, Éric; Ychou, Marc; Guiu, Boris; Aillères, N.; Bedos, L.; Azria, D.

doi:10.1016/j.rpor.2017.02.006

Cited by 22 publications

(18 citation statements)

References 47 publications

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“…Given the steep dose gradient of SABR, the dosimetric consequences of physiological organ and target movement can impact the actual received dose to the planning target volume (PTV) and OAR with potential clinical consequences. This is particularly important when treating abdominal lesions with SABR due to the degree of motion in this region 2 . For example, liver tumors can move up to several centimeters during respiration 3 .…”

Section: Introductionmentioning

confidence: 99%

“…This is particularly important when treating abdominal lesions with SABR due to the degree of motion in this region. 2 For example, liver tumors can move up to several centimeters during respiration. 3 Realtime dynamic tumor tracking (DTT) is a motion management technique in which the radiation beam follows the target and continuously irradiates it.…”

Section: Introductionmentioning

confidence: 99%

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Four‐dimensional dose calculations for dynamic tumour tracking with a gimbal‐mounted linear accelerator

Carpentier

McDermott²,

Dunne³

et al. 2021

J Applied Clin Med Phys

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Purpose In this study we present a novel method for re‐calculating a treatment plan on different respiratory phases by accurately modeling the panning and tilting beam motion during DTT (the “rotation method”). This method is used to re‐calculate the dose distribution of a plan on multiple breathing phases to accurately assess the dosimetry. Methods sIMRT plans were optimized on a breath hold computed tomography (CT) image taken at exhale (BHexhale) for 10 previous liver stereotactic ablative radiotherapy patients. Our method was used to re‐calculate the plan on the inhale (0%) and exhale (50%) phases of the four‐dimensional CT (4DCT) image set. The dose distributions were deformed to the BHexhale CT and summed together with proper weighting calculated from the patient’s breathing trace. Subsequently, the plan was re‐calculated on all ten phases using our method and the dose distributions were deformed to the BHexhale CT and accumulated together. The maximum dose for certain organs at risk (OARs) was compared between calculating on two phases and all ten phases. Results In total, 26 OARs were examined from 10 patients. When the dose was calculated on the inhale and exhale phases six OARs exceeded their dose limit, and when all 10 phases were used five OARs exceeded their limit. Conclusion Dynamic tumor tracking plans optimized for a single respiratory phase leave an OAR vulnerable to exceeding its dose constraint during other respiratory phases. The rotation method accurately models the beam’s geometry. Using deformable image registration to accumulate dose from all 10 breathing phases provides the most accurate results, however it is a time consuming procedure. Accumulating the dose from two extreme breathing phases (exhale and inhale) and weighting them properly provides accurate results while requiring less time. This approach should be used to confirm the safety of a DTT treatment plan prior to delivery.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Four‐dimensional dose calculations for dynamic tumour tracking with a gimbal‐mounted linear accelerator

Carpentier

McDermott²,

Dunne³

et al. 2021

J Applied Clin Med Phys

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“…For the HCC patients who underwent SBRT, image-guided radiation therapy (IGRT) is mandatory and fundamental to ensure precision. The key to safe SBRT is to match the target in the planning CT to the target itself on the cone-beam CT before each fraction [30]. Since the liver lesions are usually invisible on the cone-beam CT without contrast injection, the use of implanted fiducials in and/or around the tumor as surrogates is a reliable way to assess respiratory motion during treatment, especially for robotic-based liver SBRT [31].…”

Section: Discussionmentioning

confidence: 99%

Combination Therapy after TACE for Hepatocellular Carcinoma with Macroscopic Vascular Invasion: Stereotactic Body Radiotherapy versus Sorafenib

Shen

Zhao

et al. 2018

Cancers

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Stereotactic body radiotherapy (SBRT) has shown promising results in the control of macroscopic vascular invasion in patients with hepatocellular carcinoma (HCC); however, its efficacy in comparison to sorafenib when combined with transarterial chemoembolization (TACE) remains to be determined. Between 2009 and 2017, 77 HCC patients with macroscopic vascular invasion receiving TACE–SBRT or TACE–sorafenib combination therapies were enrolled. The best treatment responses, overall survival (OS), and progression-free survival (PFS) of the two treatment arms were compared. Of the patients enrolled, 26 patients (33.8%) received TACE–SBRT treatment, and 51 (66.2%) received TACE–sorafenib treatment. The patients in the TACE–SBRT group were more frequently classified as elder in age (p = 0.012), having recurrent disease (p = 0.026), and showing lower rates of multiple hepatic lesions (p = 0.005) than patients in TACE–sorafenib group. After propensity score matching (PSM), 26 pairs of well-matched HCC patients were selected; patients in the TACE–SBRT group showed better overall response rates in trend compared to those in the TACE–sorafenib group. The hazard ratio (HR) of OS to PFS for the TACE–SBRT approach and the TACE–sorafenib approach was 0.36 (95% CI, 0.17–0.75; p = 0.007) and 0.35 (95% CI, 0.20–0.62; p < 0.001), respectively. For HCC patients with macrovascular invasion, TACE plus SBRT could provide improved OS and PFS compared to TACE–sorafenib therapy.

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“…Our methodology for Liver SBRT using VMAT and real-time adaptive tumor gating has already been described in detail previously [ 25 , 26 , 27 , 28 ]. Figure 1 gives an overview of our workflow for treatment planning and for adaptive treatment gating.…”

Section: Methodsmentioning

confidence: 99%

Image-Guided Liver Stereotactic Body Radiotherapy Using VMAT and Real-Time Adaptive Tumor Gating: Evaluation of the Efficacy and Toxicity for Hepatocellular Carcinoma

Cantaloube

Castan

Creoff

et al. 2021

Cancers

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Liver SBRT is a therapeutic option for the treatment of HCC in patients not eligible for other local therapies. We retrospectively report the outcomes of a cohort of consecutive patients treated with SBRT for HCC at the Montpellier Cancer Institute. Between March 2013 and December 2018, 66 patients were treated with image-guided liver SBRT using VMAT and real-time adaptive tumor gating in our institute. The main endpoints considered in this study were local control, disease-free survival, overall survival, and toxicity. The median follow-up was 16.8 months. About 66.7% had prior liver treatment. Most patients received 50 Gy in five fractions of 10 Gy. No patient had local recurrence. Overall survival and disease-free survival were, respectively, 83.9% and 46.7% at one year. In multivariate analysis, the diameter of the lesions was a significant prognostic factor associated with disease-free survival (HR = 2.57 (1.19–5.53) p = 0.02). Regarding overall survival, the volume of PTV was associated with lower overall survival (HR = 2.84 (1.14–7.08) p = 0.025). No grade 3 toxicity was observed. One patient developed a grade 4 gastric ulcer, despite the dose constraints being respected. Image-guided liver SBRT with VMAT is an effective and safe treatment in patients with inoperable HCC, even in heavily pre-treated patients. Further prospective evaluation will help to clarify the role of SBRT in the management of HCC patients.

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SBRT planning for liver metastases: A focus on immobilization, motion management and planning imaging techniques

Abstract: We provide a subjective critical analysis of minimal requirements and ideal technique for liver SBRT planning.

Cited by 22 publications

References 47 publications

Four‐dimensional dose calculations for dynamic tumour tracking with a gimbal‐mounted linear accelerator

Four‐dimensional dose calculations for dynamic tumour tracking with a gimbal‐mounted linear accelerator

Combination Therapy after TACE for Hepatocellular Carcinoma with Macroscopic Vascular Invasion: Stereotactic Body Radiotherapy versus Sorafenib

Image-Guided Liver Stereotactic Body Radiotherapy Using VMAT and Real-Time Adaptive Tumor Gating: Evaluation of the Efficacy and Toxicity for Hepatocellular Carcinoma

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