Stereotactic Body Radiation Therapy (SBRT) for lung metastases

Okunieff, Paul; Petersen, Anncatrine Luisa; Philip, Abraham; Milano, Michael T.; Katz, Alan W.; Boros, László G.; Schell, Michael C.

doi:10.1080/02841860600908954

Cited by 221 publications

(138 citation statements)

References 22 publications

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“…Dose escalation and hypofractional dose delivery has the potential to increase patients' survival rates [3] and the probability of local tumor control [4,6,8], while increasing median survival time and long-term progression-free survival [7]. The first dose-response in pulmonary SBRT was reported by Wulf et al [5].…”

Section: Introductionmentioning

confidence: 95%

“…Stereotactic body radiation therapy (SBRT) is emerging as an efficient treatment for Stage I/ II medical inoperable and surgically unresectable non-small-cell and metastatic lung cancer [1][2][3][4][5][6][7][8][9][10][11][12]. Dose escalation and hypofractional dose delivery has the potential to increase patients' survival rates [3] and the probability of local tumor control [4,6,8], while increasing median survival time and long-term progression-free survival [7].…”

Section: Introductionmentioning

confidence: 99%

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An evaluation of planning techniques for stereotactic body radiation therapy in lung tumors

Shekhar

et al. 2008

Radiotherapy and Oncology

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Purpose-To evaluate four planning techniques for stereotactic body radiation therapy (SBRT) in lung tumors.Methods and Materials-Four SBRT plans were performed for 12 patients with stage I/II nonsmall-cell lung cancer under the following conditions: (1) conventional margins on free-breathing CT (plan 1), (2) generation of an internal target volume (ITV) using 4DCT with beam delivery under free-breathing conditions (plan 2), (3) gating at end-exhale (plan 3), and (4) gating at end-inhale (plan 4). Planning was performed following the RTOG 0236 protocol with a prescription dose of 54Gy (3 fractions). For each plan 4D dose was calculated using deformable image registration.Results-There was no significant difference in tumor dose delivered by the 4 plans. However, compared with plan 1, plans 2-4 reduced total lung BED by 1.9±1.2Gy, 3.1±1.6Gy and 3.5±2.1Gy, reduced mean lung dose by 0.8±0.5Gy, 1.5±0.8Gy, and 1.6±1.0Gy, reduced V20 by 1.5±1.0%, 2.7 ±1.4%, and 2.8±1.8% respectively with p<0.01. Compared with plan 2, plans 3-4 reduced lung BED by 1.2±1.0Gy and 1.6±1.5Gy, reduced mean lung dose by 0.6±0.5Gy and 0.8±0.7Gy, reduced V20 by 1.2±1.1% and 1.3±1.5% respectively with p<0.01. The differences in lung BED, mean dose and V20 of plan 4 compared with plan 3 are insignificant.Conclusions-Tumor dose coverage was statistically insignificant between all plans. However, compared with plan 1, plans 2-4 significantly reduced lung doses. Compared with plan 2, plan 3-4 also reduced lung toxicity. The difference in lung doses between plan 3 and plan 4 was not significant.

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Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

An evaluation of planning techniques for stereotactic body radiation therapy in lung tumors

Shekhar

et al. 2008

Radiotherapy and Oncology

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“…Similarly, aggressive treatment to a single site of metastatic disease in the brain has shown improved overall survival (OS) [4,5]. Treatment of oligometastatic disease has become more common among radiation oncologists in recent years [6][7][8]. Salama et al reported on the treatment of 1 to 5 metastatic sites with SBRT to all known cancer sites with long term OS reported [9].…”

Section: Introductionmentioning

confidence: 99%

Differences Between Colon Cancer Primaries and Metastases Utilizing a Molecular Assay for Tumor Radiosensitivity Suggest Implications for Potential Oligometastatic SBRT Patient Selection

Ahmed

Berglund

Shridhar

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

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Purpose/Objectives-We have previously developed a multigene expression model of tumor radiosensitivity (RSI) with clinical validation in multiple independent cohorts (breast, rectal, esophageal, and head and neck). The purpose of this study was to assess differences in RSI scores between primary colon cancer and metastases.Methods and Materials-Patients were identified from our institutional IRB approved prospective observational protocol. A total of 704 metastatic and 1,362 primary lesions were obtained from a de-identified meta-data pool. RSI was calculated using the previously published ranked based algorithm. An independent cohort of 29 lung or liver colon metastases treated with 60 Gy in 5 fractions stereotactic body radiotherapy (SBRT) was used for validation.Results-The most common sites of metastases included liver (n=374; 53%), lung (n=116; 17%), and lymph nodes (n=40; 6%). Sixty percent of metastatic tumors compared with 54% of primaries were in the RSI-radioresistant (RSI-RR) peak, suggesting that, metastatic tumors may be slightly more radioresistant than primaries (p=0.01). In contrast, when we analyzed metastases based on anatomical site, we uncovered large differences in RSI. The median RSIs for metastases Corresponding Author: Javier F. Torres-Roca MD, H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, 12902 Magnolia Dr., Tampa, FL 33612 USA, Telephone: 00-1-813-745-3568, Fax: 00-1-813-745-7231, javier.torresroca@moffitt.org. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conflicts of HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript in descending order of radioresistance were ovary (0.48), abdomen (0.47), liver (0.43), brain (0.42), lung (0.32), and lymph nodes (0.31), p<0.0001. These findings were confirmed when the analysis was restricted to lesions from the same patient (n=139). In our independent cohort of treated lung and liver metastases, lung metastases had an improved local control (LC) rate over patients with liver metastases (2 yr LC 100% vs. 73.0%, p=0.026).Conclusions-Assessment of radiosensitivity between primary and metastatic tissues of colon cancer histology, reveals significant differences based on anatomical location of metastases. These initial results warrant validation in a larger clinical cohort.

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“…Note that

{HI}_{3 normalD / 4 normalD}

of up to 10% for the volume of

{GTV}_{+ 5 mm}

margin highlights potential dosimetric misinterpretations from 3D conventional SBRT planning. There are of course arguments 40 , 41 , 42 , 43 for and against the ‘necessity’ of dose homogeneity, or at least the prioritization thereof but, regardless of the philosophy to which one subscribes, there is the unarguable necessity to know whether or not the dose is homogeneous.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of dosimetric misrepresentations from 3D conventional planning of liver SBRT using 4D deformable dose integration

Yeo

Taylor

Supple

et al. 2014

J Applied Clin Med Phys

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The purpose of this study is to evaluate dosimetric errors in 3D conventional planning of stereotactic body radiotherapy (SBRT) by using a 4D deformable image registration (DIR)‐based dose‐warping and integration technique. Respiratory‐correlated 4D CT image sets with 10 phases were acquired for four consecutive patients with five liver tumors. Average intensity projection (AIP) images were used to generate 3D conventional plans of SBRT. Quasi‐4D path‐integrated dose accumulation was performed over all 10 phases using dose‐warping techniques based on DIR. This result was compared to the conventional plan in order to evaluate the appropriateness of 3D (static) dose calculations. In addition, we consider whether organ dose metrics derived from contours defined on the average intensity projection (AIP), or on a reference phase, provide the better approximation of the 4D values. The impact of using fewer (<10) phases was also explored. The AIP‐based 3D planning approach overestimated doses to targets by 1.4% to 8.7% (mean 4.2%) and underestimated dose to normal liver by up to 8% (mean −5.5%; range −2.3% to −8.0%), compared to the 4D methodology. The homogeneity of the dose distribution was overestimated when using conventional 3D calculations by up to 24%. OAR doses estimated by 3D planning were, on average, within 10% of the 4D calculations; however, differences of up to 100% were observed. Four‐dimensional dose calculation using 3 phases gave a reasonable approximation of that calculated from the full 10 phases for all patients, which is potentially useful from a workload perspective. 4D evaluation showed that conventional 3D planning on an AIP can significantly overestimate target dose (ITV and GTV+5mm), underestimate normal liver dose, and overestimate dose homogeneity. Implementing nonadaptive quasi‐4D dose calculation can highlight the potential limitation of 3D conventional SBRT planning and the resultant misrepresentations of dose in some regions affected by motion and deformation. Where the 4D approach is unavailable, contouring on the full expiration phase may yield more accurate dose calculations, most relevant in the case of the healthy liver, but the absolute dose differences are in general small for the other healthy organs. The technique has the potential to quantify under‐ and over‐dosage and improve treatment plan evaluation, retrospective plan analysis, and clinical outcome correlation.PACS numbers: 87.55.‐x, 87.55.D‐, 87.55.de, 87.55.dk, 87.55.Qr, 87.57.nj

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Stereotactic Body Radiation Therapy (SBRT) for lung metastases

Cited by 221 publications

References 22 publications

An evaluation of planning techniques for stereotactic body radiation therapy in lung tumors

An evaluation of planning techniques for stereotactic body radiation therapy in lung tumors

Differences Between Colon Cancer Primaries and Metastases Utilizing a Molecular Assay for Tumor Radiosensitivity Suggest Implications for Potential Oligometastatic SBRT Patient Selection

Evaluation of dosimetric misrepresentations from 3D conventional planning of liver SBRT using 4D deformable dose integration

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