Stereotactic radiotherapy with real-time tumor tracking for non-small cell lung cancer: Clinical outcome

Zyp, Noëlle C. van der Voort van; Prévost, Jean-Briac; Hoogeman, M.; Praag, J.; Holt, Bronno van der; Levendag, Peter C.; Klaveren, R. J. van; Pattynama, Peter M. T.; Nuyttens, J.

doi:10.1016/j.radonc.2009.02.011

Cited by 190 publications

(126 citation statements)

References 27 publications

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“…Stereotactic radiosurgery (SRS), intensity‐modulated radiation therapy (IMRT), and volumetric‐modulated arc therapy (VMAT) can deliver high doses to targets while minimizing doses to nearby organs at risk (OAR) 1 , 2 , 3 . Owing to the complexity of these techniques and patient exposure to high doses, patient‐specific quality assurance (QA) for these treatment techniques is important for confirming the dose distribution, mainly in areas with high‐dose gradients near OARs.…”

Section: Introductionmentioning

confidence: 99%

Gafchromic EBT‐XD film: Dosimetry characterization in high‐dose, volumetric‐modulated arc therapy

Miura¹,

Ozawa

Hosono³

et al. 2016

J Applied Clin Med Phys

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Radiochromic films are important tools for assessing complex dose distributions. Gafchromic EBT‐XD films have been designed for optimal performance in the 40–4,000 cGy dose range. We investigated the dosimetric characteristics of these films, including their dose‐response, postexposure density growth, and dependence on scanner orientation, beam energy, and dose rate with applications to high‐dose volumetric‐modulated arc therapy (VMAT) verification. A 10 MV beam from a TrueBeam STx linear accelerator was used to irradiate the films with doses in the 0–4,000 cGy range. Postexposure coloration was analyzed at postirradiation times ranging from several minutes to 48 h. The films were also irradiated with 6 MV (dose rate (DR): 600 MU/min), 6 MV flattening filter‐free (FFF) (DR: 1,400 MU/ min), and 10 MV FFF (DR: 2,400 MU/min) beams to determine the energy and dose‐rate dependence. For clinical examinations, we compared the dose distribution measured with EBT‐XD films and calculated by the planning system for four VMAT cases. The red channel of the EBT‐XD film exhibited a wider dynamic range than the green and blue channels. Scanner orientation yielded a variation of ∼3% in the net optical density (OD). The difference between the film front and back scan orientations was negligible, with variation of ∼1.3% in the net OD. The net OD increased sharply within the first 6 hrs after irradiation and gradually afterwards. No significant difference was observed for the beam energy and dose rate, with a variation of ∼1.5% in the net OD. The gamma passing rates (at 3%, 3 mm) between the film‐ measured and treatment planning system (TPS)‐calculated dose distributions under a high dose VMAT plan in the absolute dose mode were more than 98.9%.PACS number(s): 87.56 Fc

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Section: Introductionmentioning

confidence: 99%

Gafchromic EBT‐XD film: Dosimetry characterization in high‐dose, volumetric‐modulated arc therapy

Miura¹,

Ozawa

Hosono³

et al. 2016

J Applied Clin Med Phys

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“…Small margins could result in underdosing, whereas large margins lead to more normal tissue than necessary being irradiated. A range of between 2 mm and 8 mm has been proposed and applied by different members of the CyberKnife community 13 , 14 , 15 , 16 , 17 . At our center, we generally use 5 mm for all three directions (superior/inferior (SI), anterior/posterior (AP), and lateral (LAT)), with manual modifications, depending on the proximity of the organ at risk.…”

Section: Introductionmentioning

confidence: 99%

Retrospective evaluation of CTV to PTV margins using CyberKnife in patients with thoracic tumors

Floriano

García²,

Moreno³

et al. 2014

J Applied Clin Med Phys

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The objectives of this study were to estimate global uncertainty for patients with thoracic tumors treated in our center using the CyberKnife VSI after placement of fiducial markers and to compare our findings with the standard CTV to PTV margins used to date. Datasets for 16 patients (54 fractions) treated with the CyberKnife and the Synchrony Respiratory Tracking System were analyzed retrospectively based on CT planning, tracking information, and movement data generated and saved in the logs files by the system. For each patient, we analyzed all the main uncertainty sources and assigned a value. We also calculated an expanded global uncertainty to ensure a robust estimation of global uncertainty and to enable us to determine the position of 95% of the CTV points with a 95% confidence level during treatment. Based on our estimation of global uncertainty and compared with our general margin criterion (5 mm in all three directions: superior/inferior [SI], anterior/posterior [AP], and lateral [LAT]), 100% were adequately covered in the LAT direction, as were 94% and 94% in the SI and AP directions. We retrospectively analyzed the main sources of uncertainty in the CyberKnife process patient by patient. This individualized approach enabled us to estimate margins for patients with thoracic tumors treated in our unit and compare the results with our standard 5 mm margin.PACS number: 87.55‐x

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“…CK treatment has been shown to be very effective for stage Ⅰ NSCLC in several studies published over the last few years (3,4,6,12,13).…”

Section: Discussionmentioning

confidence: 99%

“…CyberKnife (CK) is a non-invasive robotic system, which allows delivery of SBRT through precise, nearly real-time image-guided tracking of a mobile target. Previous studies (3)(4)(5) demonstrated excellent local control rates of 90-97% at 2-3 years' follow-up, with minimal associated toxicities.…”

Section: Introductionmentioning

confidence: 87%

Advantages of CyberKnife for inoperable stage I peripheral non-small-cell lung cancer compared to three-dimensional conformal radiotherapy

Tong

Yan

Yuan

et al. 2014

Molecular and Clinical Oncology

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Abstract. This study was conducted to compare the clinical curative effect and acute radiation lung reactions between CyberKnife (CK) and three-dimensional conformal radiotherapy (3DCRT) treatment for inoperable stage I peripheral non-small-cell lung cancer (NSCLC). We retrospectively analyzed 68 patients with inoperable stage I peripheral NSCLC between 2012 and 2013 in our institution. The CK patients were treated with 42-60 Gy in three fractions, while the 3DCRT patients were treated with a total of 60 Gy, at 2 Gy per fraction. The patients were followed up and the clinical outcome was evaluated according to the Response Evaluation Criteria in Solid Tumours. We assessed the presence of acute radiation pneumonitis and pulmonary function status by thoracic scan and pulmonary function tests following CK and 3DCRT treatment. The binary univariate logistic regression analysis demonstrated that treatment method and forced expiratory volume in 1 sec̸forced vital capacity (FEV1̸FVC) prior to treatment (pre-FEV1̸FVC) were the main factors affecting the risk of radiation pneumonitis. The analysis of these factors through multivariate logistic regression method demonstrated that treatment method for grade 1 and 2 [odds ratio (OR)=7.866 and 11.334, respectively) and pre-FEV1/FVC for grade 1, 2 and 3 (OR=5.062, 11.498 and 15.042, respectively) were significant factors affecting the risk of radiation pneumonitis (P<0.05). The 68 patients were divided into two subgroups using the threshold of pre-FEV1/FVC selected by the receiver operating characteristic curve. There were significant differences between the 3DCRT and CK treatment in both the pre-FEV1̸FVC <68% and ≥68% subgroups for radiation pneumonitis (P=0.023 and 0.002, respectively). There was no statistically significant change in FVC, FEV1 and carbon monoxide diffusion capacity (DCLO) in the CK group, whereas there was a decrease in DCLO in the 3DCRT group. The complete remission rate was 40 vs. 34.2% at 1 year in the CK and 3DCRT groups, respectively. In conclusion, in this cohort of patients with inoperable stage I peripheral NSCLC, CK appears to be a safe and superior alternative to conventionally fractionated radiotherapy.

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Stereotactic radiotherapy with real-time tumor tracking for non-small cell lung cancer: Clinical outcome

Cited by 190 publications

References 27 publications

Gafchromic EBT‐XD film: Dosimetry characterization in high‐dose, volumetric‐modulated arc therapy

Gafchromic EBT‐XD film: Dosimetry characterization in high‐dose, volumetric‐modulated arc therapy

Retrospective evaluation of CTV to PTV margins using CyberKnife in patients with thoracic tumors

Advantages of CyberKnife for inoperable stage I peripheral non-small-cell lung cancer compared to three-dimensional conformal radiotherapy

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