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Huang CY, Yung SPF, Li TC, Wang J, Yuan J, Poon DMC, Cheung KY, Yu SK, Yang B. Dosimetric comparison of utilizing saline or air-filled endorectal balloons in MR linac-based prostate SBRT. Med Dosim 2025:S0958-3947(25)00019-6. [PMID: 40307070 DOI: 10.1016/j.meddos.2025.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2025] [Revised: 03/12/2025] [Accepted: 03/13/2025] [Indexed: 05/02/2025]
Abstract
In prostate cancer Stereotactic Body Radiation Therapy (SBRT), endorectal balloons are commonly used to reduce rectal exposure to excessive radiation. This study investigates the magnetic field-induced dose effects associated with air-filled endorectal balloons in MR-linac treatments and compares the dosimetric metrics and radiobiological outcomes between air-filled and saline-filled balloons. A retrospective analysis was conducted on 20 prostate cancer patients treated with a 1.5-Tesla MR-linac using a saline-filled rectal balloon. Each patient received a total prescription dose of 36.25 Gy to the Planning Target Volume (PTV) over 5 fractions. The simulation scans and treatments were performed with an 80 mL saline-filled balloon in place. To simulate the use of air-filled balloons, Intensity-Modulated Radiation Therapy (IMRT) plans were generated, adjusting the balloon density to represent air, followed by re-optimization to preserve the target dose. Dosimetric and radiobiological metrics for targets and organs at risk (OARs) were compared between the 2 scenarios. Rectal wall toxicity was assessed using the Lyman-Kutcher-Burman (LKB) normal tissue complication probability (NTCP) model. The introduction of air-filled endorectal balloons during MR-linac treatments intensifies material heterogeneity, leading to dose perturbations within the treatment field. Specifically, the V40 Gy hot spot on the rectal wall increased from 0.55% to 1.51% due to the electron return effect (ERE). A more pronounced impact was observed in patients receiving prostate-only irradiation compared to those with pelvic lymph node involvement, likely due to the reduced number of beam angles. Additionally, undesired dose deposition on the rectal wall outside the treatment field was noted, attributed to increased scatter and the electron streaming effect (ESE), where secondary electrons deflected by the transverse magnetic field deposited energy on the surfaces they encountered. The mean maximal out-of-field rectal wall dose was 4 Gy, ranging from 2 to 7.4 Gy. Consequently, the cohort's rectal wall NTCP increased with the use of air-filled balloons. This study highlights that the use of air-filled endorectal balloons can introduce hot spots to the rectal wall and cause unwanted ESE-related dose depositions outside the treatment field. In contrast, saline-filled balloons provide superior dosimetric performance and better protect the rectum from radiobiological damage in prostate SBRT delivered with MR-linac. These findings suggest that saline-filled balloons may be preferable for this type of therapy to minimize potential adverse effects on the rectum.
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Affiliation(s)
- Chen-Yu Huang
- Medical Physics Department, Hong Kong Sanatorium and Hospital, Hong Kong, China
| | | | - Ting Chuan Li
- Medical Physics Department, Hong Kong Sanatorium and Hospital, Hong Kong, China
| | - Jierong Wang
- Medical Physics Department, Hong Kong Sanatorium and Hospital, Hong Kong, China
| | - Jing Yuan
- Research Department, Hong Kong Sanatorium and Hospital, Hong Kong, China
| | | | - Kin Yin Cheung
- Medical Physics Department, Hong Kong Sanatorium and Hospital, Hong Kong, China
| | - Siu Ki Yu
- Medical Physics Department, Hong Kong Sanatorium and Hospital, Hong Kong, China
| | - Bin Yang
- Medical Physics Department, Hong Kong Sanatorium and Hospital, Hong Kong, China
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Alhaddad L, Osipov AN, Leonov S. FLASH Radiotherapy: Benefits, Mechanisms, and Obstacles to Its Clinical Application. Int J Mol Sci 2024; 25:12506. [PMID: 39684218 DOI: 10.3390/ijms252312506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 11/14/2024] [Accepted: 11/17/2024] [Indexed: 12/18/2024] Open
Abstract
Radiotherapy (RT) has been shown to be a cornerstone of both palliative and curative tumor care. RT has generally been reported to be sharply limited by ionizing radiation (IR)-induced toxicity, thereby constraining the control effect of RT on tumor growth. FLASH-RT is the delivery of ultra-high dose rate (UHDR) several orders of magnitude higher than what is presently used in conventional RT (CONV-RT). The FLASH-RT clinical trials have been designed to examine the UHDR deliverability, the effectiveness of tumor control, the dose tolerance of normal tissue, and the reproducibility of treatment effects across several institutions. Although it is still in its infancy, FLASH-RT has been shown to have potential to rival current RT in terms of safety. Several studies have suggested that the adoption of FLASH-RT is very limited, and the incorporation of this new technique into routine clinical RT will require the use of accurate dosimetry methods and reproducible equipment that enable the reliable and robust measurements of doses and dose rates. The purpose of this review is to highlight the advantages of this technology, the potential mechanisms underpinning the FLASH-RT effect, and the major challenges that need to be tackled in the clinical transfer of FLASH-RT.
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Affiliation(s)
- Lina Alhaddad
- Department of Environmental Sciences, Faculty of Science, Damascus University, Damascus P.O. Box 30621, Syria
| | - Andreyan N Osipov
- N.N. Semenov Federal Research Center for Chemical Physics, Russian Academy of Sciences, Moscow 119991, Russia
- Moscow Center for Advanced Studies, Kulakova Str. 20, Moscow 123592, Russia
- State Research Center-Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency (SRC-FMBC), Moscow 123098, Russia
- CANDLE Synchrotron Research Institute, 31 Acharyan, Yerevan 0040, Armenia
| | - Sergey Leonov
- Moscow Center for Advanced Studies, Kulakova Str. 20, Moscow 123592, Russia
- Institute of Cell Biophysics, Russian Academy of Sciences, Pushchino 142290, Russia
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Martin-Paulpeter RM, Jensen PJ, Perles LA, Sawakuchi GO, Das P, Koay EJ, Koong AC, Ludmir EB, Niedzielski JS, Beddar S. Daily Diagnostic Quality Computed Tomography-on-Rails (CTOR) Image Guidance for Abdominal Stereotactic Body Radiation Therapy (SBRT). Cancers (Basel) 2024; 16:3770. [PMID: 39594725 PMCID: PMC11591933 DOI: 10.3390/cancers16223770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Accepted: 11/06/2024] [Indexed: 11/28/2024] Open
Abstract
BACKGROUND/OBJECTIVES Stereotactic body radiation therapy (SBRT) for abdominal targets faces a variety of challenges, including motion caused by the respiration and digestion and a relatively poor level of contrast between the tumor and the surrounding tissues. Breath-hold treatments with computed tomography-on-rails (CTOR) image guidance is one way of addressing these challenges, allowing for both the tumor and normal tissues to be well-visualized. Using isodose lines (IDLs) from CT simulations as a guide, the anatomical information can be used to shift the alignment or trigger a replan, such that normal tissues receive acceptable doses of radiation. METHODS This study aims to describe the workflow involved when using CTOR for pancreas and liver SBRT and demonstrates its effectiveness through several case studies. RESULTS In these case studies, using the anatomical information gained through diagnostic-quality CT guidance to make slight adjustments to the alignment, resulted in reductions in the maximum dose to the stomach. CONCLUSIONS High-quality imaging, such as CTOR, and the use of IDLs to estimate the doses to OARs, enable the safe delivery of SBRT, without the added complexity and resource commitment required by daily online adaptive planning.
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Affiliation(s)
- Rachael M. Martin-Paulpeter
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (L.A.P.)
| | - P. James Jensen
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (L.A.P.)
| | - Luis A. Perles
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (L.A.P.)
| | - Gabriel O. Sawakuchi
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (L.A.P.)
| | - Prajnan Das
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Eugene J. Koay
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Albert C. Koong
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ethan B. Ludmir
- Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Joshua S. Niedzielski
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (L.A.P.)
| | - Sam Beddar
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (L.A.P.)
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Plant N, Mylonas A, Sengupta C, Nguyen DT, Silvester S, Pryor D, Greer P, Lee YYD, Ramachandran P, Seshadri V, Trada Y, Khor R, Wang T, Hardcastle N, Keall P. Radio-opaque contrast agents for liver cancer targeting with KIM during radiation therapy (ROCK-RT): an observational feasibility study. Radiat Oncol 2024; 19:139. [PMID: 39380004 PMCID: PMC11462695 DOI: 10.1186/s13014-024-02524-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 09/17/2024] [Indexed: 10/10/2024] Open
Abstract
BACKGROUND This observational study aims to establish the feasibility of using x-ray images of radio-opaque chemoembolisation deposits in patients as a method for real-time image-guided radiation therapy of hepatocellular carcinoma. METHODS This study will recruit 50 hepatocellular carcinoma patients who have had or will have stereotactic ablative radiation therapy and have had transarterial chemoembolisation with a radio-opaque agent. X-ray and computed tomography images of the patients will be analysed retrospectively. Additionally, a deep learning method for real-time motion tracking will be developed. We hypothesise that: (i) deep learning software can be developed that will successfully track the contrast agent mass on two thirds of cone beam computed tomography (CBCT) projection and intra-treatment images (ii), the mean and standard deviation (mm) difference in the location of the mass between ground truth and deep learning detection are ≤ 2 mm and ≤ 3 mm respectively and (iii) statistical modelling of study data will predict tracking success in 85% of trial participants. DISCUSSION Developing a real-time tracking method will enable increased targeting accuracy, without the need for additional invasive procedures to implant fiducial markers. TRIAL REGISTRATION Registered to ClinicalTrials.gov (NCT05169177) 12th October 2021.
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Affiliation(s)
- Natalie Plant
- Image X Institute, University of Sydney, Suite 201, Biomedical Building (C81), 1 Central Ave, Eveleigh, NSW, 2015, Australia
| | - Adam Mylonas
- Image X Institute, University of Sydney, Suite 201, Biomedical Building (C81), 1 Central Ave, Eveleigh, NSW, 2015, Australia
| | - Chandrima Sengupta
- Image X Institute, University of Sydney, Suite 201, Biomedical Building (C81), 1 Central Ave, Eveleigh, NSW, 2015, Australia
| | - Doan Trang Nguyen
- Image X Institute, University of Sydney, Suite 201, Biomedical Building (C81), 1 Central Ave, Eveleigh, NSW, 2015, Australia
| | - Shona Silvester
- Image X Institute, University of Sydney, Suite 201, Biomedical Building (C81), 1 Central Ave, Eveleigh, NSW, 2015, Australia
| | - David Pryor
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Peter Greer
- Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, NSW, Australia
| | | | | | | | - Yuvnik Trada
- Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, NSW, Australia
| | - Richard Khor
- Olivia Newton-John Cancer Wellness & Research Centre, Austin Health, Melbourne, VIC, Australia
| | - Tim Wang
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Sydney, NSW, Australia
| | | | - Paul Keall
- Image X Institute, University of Sydney, Suite 201, Biomedical Building (C81), 1 Central Ave, Eveleigh, NSW, 2015, Australia.
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Li C, Guo Y, Lin X, Feng X, Xu D, Yang R. Deep reinforcement learning in radiation therapy planning optimization: A comprehensive review. Phys Med 2024; 125:104498. [PMID: 39163802 DOI: 10.1016/j.ejmp.2024.104498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 07/08/2024] [Accepted: 08/06/2024] [Indexed: 08/22/2024] Open
Abstract
PURPOSE The formulation and optimization of radiation therapy plans are complex and time-consuming processes that heavily rely on the expertise of medical physicists. Consequently, there is an urgent need for automated optimization methods. Recent advancements in reinforcement learning, particularly deep reinforcement learning (DRL), show great promise for automating radiotherapy planning. This review summarizes the current state of DRL applications in this field, evaluates their effectiveness, and identifies challenges and future directions. METHODS A systematic search was conducted in Google Scholar, PubMed, IEEE Xplore, and Scopus using keywords such as "deep reinforcement learning", "radiation therapy", and "treatment planning". The extracted data were synthesized for an overview and critical analysis. RESULTS The application of deep reinforcement learning in radiation therapy plan optimization can generally be divided into three categories: optimizing treatment planning parameters, directly optimizing machine parameters, and adaptive radiotherapy. From the perspective of disease sites, DRL has been applied to cervical cancer, prostate cancer, vestibular schwannoma, and lung cancer. Regarding types of radiation therapy, it has been used in HDRBT, IMRT, SBRT, VMAT, GK, and Cyberknife. CONCLUSIONS Deep reinforcement learning technology has played a significant role in advancing the automated optimization of radiation therapy plans. However, there is still a considerable gap before it can be widely applied in clinical settings due to three main reasons: inefficiency, limited methods for quality assessment, and poor interpretability. To address these challenges, significant research opportunities exist in the future, such as constructing evaluators, parallelized training, and exploring continuous action spaces.
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Affiliation(s)
- Can Li
- Institute of Operations Research and Information Engineering, Beijing University of Technology, Beijing 100124, PR China
| | - Yuqi Guo
- Institute of Operations Research and Information Engineering, Beijing University of Technology, Beijing 100124, PR China
| | - Xinyan Lin
- Department of Radiation Oncology, Cancer Center, Peking University Third Hospital, Beijing, 100191, China; School of Physics, Beihang University, Beijing, 102206, China
| | - Xuezhen Feng
- Department of Radiation Oncology, Cancer Center, Peking University Third Hospital, Beijing, 100191, China; School of Nuclear Science and Technology, University of South China, Hengyang, 421001, China
| | - Dachuan Xu
- Institute of Operations Research and Information Engineering, Beijing University of Technology, Beijing 100124, PR China.
| | - Ruijie Yang
- Department of Radiation Oncology, Cancer Center, Peking University Third Hospital, Beijing, 100191, China.
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Khan AMH, Hashmi SFA, Li B, Shaukat F, Ahmed Y, Alfishawy M, Al‐Amri I, Bashir R, Altaf F, Yilmaz S, Khalid J, Mandhari ZA, Pervez N, Rassou SC, Mula‐Hussain L. Stereotactic radiotherapy: An educational narrative review. PRECISION RADIATION ONCOLOGY 2024; 8:47-58. [PMID: 40336567 PMCID: PMC11935017 DOI: 10.1002/pro6.1222] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/24/2024] [Accepted: 02/17/2024] [Indexed: 05/09/2025] Open
Abstract
Stereotactic radiotherapy is a term collectively used to describe the radiation treatment techniques that allow for the delivery of highly precise ionizing radiation. It is usually a high dose per session in single or few fractions. This treatment approach has been in medical use for over six decades and has primarily evolved in the last two decades. Many patients benefit from this unique non-conventional radiotherapy approach. Its indications include various malignant, benign and functional problems in cranial and body sites. This technique is not widespread in developing countries compared to developed countries. This work is an educational narrative review for learners in radiation oncology. We aim to share the knowledge of this practice to improve precision radiation oncology globally. This review summarizes the basics of stereotactic radiotherapy, the technical prerequisites, the clinical considerations, the practical recommendations and the learning points from each site-specific region.
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Affiliation(s)
- Agha Muhammad Hammad Khan
- Radiation Oncologist, Radiation Oncology DepartmentFaculty of MedicineMcGill UniversityMontrealQuebecCanada
| | - Syed Furqan Ahmad Hashmi
- Radiation Oncologist, Radiation Oncology DepartmentSultan Qaboos Comprehensive Cancer Care and Research CentreMuscatOman
| | - Benjamin Li
- Radiation Oncologist, Radiation Oncology DepartmentUniversity of WashingtonSeattleWashingtonUSA
| | - Fatima Shaukat
- Radiation Oncologist, CyberKnife and Tomotherapy DepartmentJinnah Postgraduate Medical Center (JPMC)KarachiPakistan
| | - Yumna Ahmed
- Radiation Oncologist, CyberKnife and Tomotherapy DepartmentJinnah Postgraduate Medical Center (JPMC)KarachiPakistan
| | - Mahmoud Alfishawy
- Medical Physicist, Radiation Oncology DepartmentSultan Qaboos Comprehensive Cancer Care and Research CentreMuscatOman
| | - Iqbal Al‐Amri
- Medical Physicist, Radiation Oncology DepartmentSultan Qaboos Comprehensive Cancer Care and Research CentreMuscatOman
| | - Rashid Bashir
- Radiotherapy TechnologistRadiation Oncology DepartmentSultan Qaboos Comprehensive Cancer Care and Research CentreMuscatOman
| | - Furhan Altaf
- Radiotherapy TechnologistRadiation Oncology DepartmentSultan Qaboos Comprehensive Cancer Care and Research CentreMuscatOman
| | - Sercan Yilmaz
- Radiation Oncologist, Radiation Oncology DepartmentSultan Qaboos Comprehensive Cancer Care and Research CentreMuscatOman
| | - Jamsari Khalid
- Radiation Oncologist, Radiation Oncology DepartmentSultan Qaboos Comprehensive Cancer Care and Research CentreMuscatOman
| | - Zahid Al Mandhari
- Radiation Oncologist, Radiation Oncology DepartmentSultan Qaboos Comprehensive Cancer Care and Research CentreMuscatOman
| | - Nadeem Pervez
- Radiation Oncologist, Radiation Oncology DepartmentSultan Qaboos Comprehensive Cancer Care and Research CentreMuscatOman
| | - Salim Chaib Rassou
- Radiation Oncologist, Radiation Oncology DepartmentSultan Qaboos Comprehensive Cancer Care and Research CentreMuscatOman
| | - Layth Mula‐Hussain
- Radiation Oncologist, Radiation Oncology DepartmentDalhousie UniversityHalifaxNova ScotiaCanada
- Oncology DepartmentCollege of MedicineNinevah UniversityMosulIraq
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Zabrocka E, Roberson JD, Noldner C, Kim J, Patel R, Ryu S, Stessin A. Stereotactic body radiation therapy (SBRT) for the treatment of primary breast cancer in patients not undergoing surgery. Adv Med Sci 2024; 69:29-35. [PMID: 38306916 DOI: 10.1016/j.advms.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/26/2023] [Accepted: 01/18/2024] [Indexed: 02/04/2024]
Abstract
PURPOSE The purpose was to explore the role of stereotactic body radiation therapy (SBRT) in providing local control (LC) for primary breast cancer in patients unable to undergo surgery. MATERIALS/METHODS Between 2015 and 2019, 13 non-surgical candidates with 14 lesions were treated with SBRT for primary breast cancer. In 4 cases, SBRT was used after whole breast radiation therapy (WBRT; 40-50 Gy/20-25 fractions). SBRT dose was 30-40 Gy in 5 fractions for patients treated with SBRT alone and 25-32 Gy in 4-5 fractions for those treated with SBRT + WBRT. LC and overall survival (OS) were estimated using Kaplan-Meier curves. Response was also assessed using RECIST guidelines. RESULTS Median follow-up was 32 (range: 3.4-70.4) months. Imaging at median 2.2 (0.6-8.1) months post-SBRT showed median 43.2 % (range: 2-100 %) decrease in the largest diameter and median 68.7 % (range: 27.9-100 %) SUV reduction. There were 3 cases of local progression at 8.7-10.6 months. Estimated LC was 100 % at 6 months and 71.6 % at 12, 24 and 36 months. Estimated median OS was 100 % at 6 months, 76.9 % at 12 months, and 61.5 % at 24 and 36 months. Acute toxicity (n = 13; 92.9 %) included grade (G)1 (n = 8), G2 (n = 4), and G4 (necrosis; n = 1). Late toxicity included G2 edema (n = 1) and G4 necrosis (n = 2, including 1 consequential late effect). Only patients treated with SBRT + WBRT experienced acute/late G4 toxicity, managed with resection or steroids. CONCLUSIONS SBRT to primary breast cancer resulted in good LC in non-surgical/metastatic patients. Although necrosis (n = 2) occurred in the SBRT + WBRT group, it was successfully salvaged.
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Affiliation(s)
- Ewa Zabrocka
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - John D Roberson
- Southeast Radiation Oncology Group, Charlotte, NC, USA; Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Collin Noldner
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Jinkoo Kim
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Rushil Patel
- Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Samuel Ryu
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Alexander Stessin
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, USA.
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MasoudKabir F, Bayani R, Mousavi Darzikolaee N, Abdshah A, Moshtaghian M, Farhan F, Aghili M, Kazemian A, Nicosia L, Cuccia F, Rocha AV, Jafari F, Alongi F. The state-of-the-art technic of stereotactic radioablation for the treatment of cardiac arrhythmias: An overview. Health Sci Rep 2023; 6:e1741. [PMID: 38078303 PMCID: PMC10709113 DOI: 10.1002/hsr2.1741] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/23/2023] [Accepted: 11/17/2023] [Indexed: 10/11/2024] Open
Abstract
Introduction Cardiac arrhythmias, including ventricular tachycardia (VT), stand as a significant threat to health, often leading to mortality and sudden cardiac death. While conventional treatments for VT exhibit efficacy, cases of refractory VT pose challenges. Stereotactic Arrhythmia Radioablation (STAR) offers a novel approach, delivering precise high-dose radiation to well-defined targets with minimal collateral damage. This study explores the potential of STAR as an alternative therapy, especially for high-risk patients or those with refractory VT. Methods This research reviews ongoing studies and preliminary investigations into the evaluation of the efficacy and safety of STAR. The method involves targeted radiation delivery, assessing reductions in VT recurrence and the early safety profile in refractory VT patients. However, given STAR's early stage and limited clinical evidence, cautious interpretation is advised. Results Preliminary findings indicate a reduction in VT recurrence with STAR, suggesting promise as a therapeutic option. Early safety profiles are encouraging, but definitive statements on efficacy and safety require further investigation. Positive initial outcomes underscore the need for additional data and long-term studies. Conclusion Stereotactic Arrhythmia Radioablation is recently emerging as a promising treatment for refractory VT. While early results are encouraging, careful interpretation is needed, due to STAR's early stages. Ongoing investigations are critical for a comprehensive understanding of its long-term efficacy and tolerability. This review provides fundamental insights into STAR's background, principles, pre-treatment procedures, clinical implications, and toxicity, setting the stage for future research in this evolving therapeutic field.
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Affiliation(s)
- Farzad MasoudKabir
- Cardiac Primary Prevention Research CenterTehran University of Medical SciencesTehranIran
- Department of Cardiac Electrophysiology, Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Reyhaneh Bayani
- Department of Radiation OncologyHamadan University of Medical SciencesHamadanIran
| | - Nima Mousavi Darzikolaee
- Radiation Oncology Research Center (RORC)Tehran University of Medical SciencesTehranIran
- Department of Radiation Oncology, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Alireza Abdshah
- School of MedicineTehran University of Medical SciencesTehranIran
- Division of BiostatisticsUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Mahsa Moshtaghian
- Cancer Research Center, Cancer institute of Iran, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Farshid Farhan
- Cancer Research Center, Cancer institute of Iran, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Mahdi Aghili
- Cancer Research Center, Cancer institute of Iran, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Ali Kazemian
- Department of Radiation Oncology, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
- Cancer Research Center, Cancer institute of Iran, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Luca Nicosia
- Advanced Radiation Oncology DepartmentIRCCS Ospedale Sacro Cuore Don CalabriaNegrar‐VeronaItaly
| | - Francesco Cuccia
- Advanced Radiation Oncology DepartmentIRCCS Ospedale Sacro Cuore Don CalabriaNegrar‐VeronaItaly
| | | | - Fatemeh Jafari
- Cancer Research Center, Cancer institute of Iran, Imam Khomeini Hospital ComplexTehran University of Medical SciencesTehranIran
| | - Filippo Alongi
- Advanced Radiation Oncology DepartmentIRCCS Ospedale Sacro Cuore Don CalabriaNegrar‐VeronaItaly
- University of BresciaBresciaItaly
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9
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Yang J, Qi W, Wang L, Lu Q, Han L, Wang B, Yan W. Red shell- high risk normal tissue in stereotactic radiosurgery. PRECISION RADIATION ONCOLOGY 2023; 7:273-277. [PMID: 40336873 PMCID: PMC11935186 DOI: 10.1002/pro6.1218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 05/09/2025] Open
Abstract
Due to the ablative nature of high prescription in Stereotactic Radiosurgery or stereotactic body radiation therapy (SRS/SBRT), the normal tissue surrounding the CTV receives the dose higher than tissue's dose constraint. A concept of Red Shell is proposed to define and quantify these tissue damaged in SBRT, using biological equivalent dose (BED) concept. The combination of biological factors and physics factors, including serial and parallel organ, dose gradient, dose distribution and fractionations, are further discussed to interpret the clinical meaning of Red Shell. This concept can also help planner to improve the optimization in planning process.
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Affiliation(s)
- Jun Yang
- Junxin Precision Oncology GroupFoshanGuangdongChina
- Radiation Oncology DeptFoshan Chancheng HospitalFoshanGuangdongChina
| | - Weihua Qi
- Junxin Precision Oncology GroupFoshanGuangdongChina
- Radiation Oncology DeptFoshan Chancheng HospitalFoshanGuangdongChina
| | - Lei Wang
- Junxin Precision Oncology GroupFoshanGuangdongChina
| | - Qiuxia Lu
- Junxin Precision Oncology GroupFoshanGuangdongChina
- Radiation Oncology DeptFoshan Chancheng HospitalFoshanGuangdongChina
| | - Liangfu Han
- Junxin Precision Oncology GroupFoshanGuangdongChina
- Radiation Oncology DeptFoshan Chancheng HospitalFoshanGuangdongChina
| | - Brian Wang
- Junxin Precision Oncology GroupFoshanGuangdongChina
- Radiation Oncology DeptFoshan Chancheng HospitalFoshanGuangdongChina
| | - Weisi Yan
- Junxin Precision Oncology GroupFoshanGuangdongChina
- Baptist healthcare systemKentuckyUSA
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10
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Somasundaram E, Anderson PM, Smile TD, Halima A, Broughman JB, Reddy CA, Parsai S, Scott JG, Chan T, Campbell S, Angelov L, Zahler S, Trucco M, Thomas SM, Johnson S, Qi P, Magnelli A, Murphy ES. Neutrophil to lymphocyte ratio (NTLR) predicts local control and overall survival after stereotactic body radiotherapy (SBRT) in metastatic sarcoma. Sci Rep 2023; 13:19256. [PMID: 37935813 PMCID: PMC10630331 DOI: 10.1038/s41598-023-46476-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 11/01/2023] [Indexed: 11/09/2023] Open
Abstract
The neutrophil to lymphocyte ratio (NTLR) and absolute lymphocyte count (ALC) recovery are prognostic across many cancers. We investigated whether NLTR predicts SBRT success or survival in a metastatic sarcoma cohort treated with SBRT from 2014 and 2020 (N = 42). Wilcox Signed Rank Test and Friedman Test compare NTLR changes with local failure vs. local control (N = 138 lesions). Cox analyses identified factors associated with overall survival. If local control was successful, NLTR change was not significant (p = 0.30). However, NLTR significantly changed in patients with local failure (p = 0.027). The multivariable Cox model demonstrated higher NLTR before SBRT was associated with worse overall survival (p = 0.002). The optimal NTLR cut point was 5 (Youden index: 0.418). One-year overall survival in SBRT metastatic sarcoma cohort was 47.6% (CI 34.3%-66.1%). Patients with an NTLR above 5 had a one-year overall survival of 37.7% (21.4%-66.3%); patients with an NTLR below 5 had a significantly improved overall survival of 63% (43.3%-91.6%, p = 0.014). Since NTLR at the time of SBRT was significantly associated with local control success and overall survival in metastatic sarcoma treated with SBRT, future efforts to reduce tumor inhibitory microenvironment factors and improve lymphocyte recovery should be investigated.
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Affiliation(s)
| | - Peter M Anderson
- Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, OH, USA
| | - Timothy D Smile
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, R3 9500 Euclid Ave, Cleveland, 44195, OH, USA
| | - Ahmed Halima
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, R3 9500 Euclid Ave, Cleveland, 44195, OH, USA
| | - James B Broughman
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, R3 9500 Euclid Ave, Cleveland, 44195, OH, USA
| | - Chandana A Reddy
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, R3 9500 Euclid Ave, Cleveland, 44195, OH, USA
| | - Shireen Parsai
- Department of Radiation Oncology, Ohio Health Riverside Methodist Hospital, Columbus, OH, USA
| | - Jacob G Scott
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, R3 9500 Euclid Ave, Cleveland, 44195, OH, USA
| | - Timothy Chan
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, R3 9500 Euclid Ave, Cleveland, 44195, OH, USA
| | - Shauna Campbell
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, R3 9500 Euclid Ave, Cleveland, 44195, OH, USA
| | - Lilyana Angelov
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, USA
| | - Stacey Zahler
- Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, OH, USA
| | - Matteo Trucco
- Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, OH, USA
| | - Stefanie M Thomas
- Department of Pediatric Hematology Oncology and Blood and Marrow Transplantation, Cleveland Clinic, Cleveland, OH, USA
| | - Shavaughn Johnson
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, R3 9500 Euclid Ave, Cleveland, 44195, OH, USA
| | - Peng Qi
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, R3 9500 Euclid Ave, Cleveland, 44195, OH, USA
| | - Anthony Magnelli
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, R3 9500 Euclid Ave, Cleveland, 44195, OH, USA
| | - Erin S Murphy
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, R3 9500 Euclid Ave, Cleveland, 44195, OH, USA.
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11
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Newman WC, Larsen AG, Bilsky MH. The NOMS approach to metastatic tumors: Integrating new technologies to improve outcomes. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:487-499. [PMID: 37116749 DOI: 10.1016/j.recot.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/23/2023] [Indexed: 04/30/2023] Open
Abstract
Treatment paradigms for patients with spine metastases have evolved significantly over the past two decades. The most transformative change to these paradigms has been the integration of spinal stereotactic radiosurgery (sSRS). sSRS allows for the delivery of tumoricidal radiation doses with sparing of nearby organs at risk, particularly the spinal cord. Evidence supports the safety and efficacy of radiosurgery as it currently offers durable local tumor control with low complication rates even for tumors previously considered radioresistant to conventional external beam radiation therapy. The role for surgical intervention remains consistent, but a trend has been observed toward less aggressive, often minimally invasive techniques. Using modern technologies and improved instrumentation, surgical outcomes continue to improve with reduced morbidity. Additionally, targeted agents such as biologics and checkpoint inhibitors have revolutionized cancer care by improving both local control and patient survival. These advances have brought forth a need for new prognostication tools and a more critical review of long-term outcomes. The complex nature of current treatment schemes necessitates a multidisciplinary approach including surgeons, medical oncologists, radiation oncologists, interventionalists and pain specialists. This review recapitulates the current state-of-the-art, evidence-based data on the treatment of spinal metastases and integrates these data into a decision framework, NOMS, which is based on four sentinel pillars of decision making in metastatic spine tumors: Neurological status, Oncologic tumor behavior, Mechanical stability, and Systemic disease burden and medical co-morbidities.
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Affiliation(s)
- W C Newman
- Memorial Sloan Kettering Cancer Center, India
| | - A G Larsen
- Memorial Sloan Kettering Cancer Center, India; Weill Medical College of Cornell University, India
| | - M H Bilsky
- Memorial Sloan Kettering Cancer Center, India; Weill Medical College of Cornell University, India.
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12
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Newman WC, Larsen AG, Bilsky MH. The NOMS approach to metastatic tumors: Integrating new technologies to improve outcomes. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:S487-S499. [PMID: 37562765 DOI: 10.1016/j.recot.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/23/2023] [Indexed: 08/12/2023] Open
Abstract
Treatment paradigms for patients with spine metastases have evolved significantly over the past two decades. The most transformative change to these paradigms has been the integration of spinal stereotactic radiosurgery (sSRS). sSRS allows for the delivery of tumoricidal radiation doses with sparing of nearby organs at risk, particularly the spinal cord. Evidence supports the safety and efficacy of radiosurgery as it currently offers durable local tumor control with low complication rates even for tumors previously considered radioresistant to conventional external beam radiation therapy. The role for surgical intervention remains consistent, but a trend has been observed toward less aggressive, often minimally invasive techniques. Using modern technologies and improved instrumentation, surgical outcomes continue to improve with reduced morbidity. Additionally, targeted agents such as biologics and checkpoint inhibitors have revolutionized cancer care by improving both local control and patient survival. These advances have brought forth a need for new prognostication tools and a more critical review of long-term outcomes. The complex nature of current treatment schemes necessitates a multidisciplinary approach including surgeons, medical oncologists, radiation oncologists, interventionalists and pain specialists. This review recapitulates the current state-of-the-art, evidence-based data on the treatment of spinal metastases and integrates these data into a decision framework, NOMS, which is based on four sentinel pillars of decision making in metastatic spine tumors: neurological status, Oocologic tumor behavior, mechanical stability and systemic disease burden and medical co-morbidities.
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Affiliation(s)
- W C Newman
- Memorial Sloan Kettering Cancer Center, Chennai, Tamil Nadu, India
| | - A G Larsen
- Memorial Sloan Kettering Cancer Center, Chennai, Tamil Nadu, India; Weill Medical College of Cornell University, India
| | - M H Bilsky
- Memorial Sloan Kettering Cancer Center, Chennai, Tamil Nadu, India; Weill Medical College of Cornell University, India.
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13
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Somasundaram E, Smile TD, Halima A, Broughman JB, Reddy CA, Parsai S, Scott JG, Chan T, Campbell S, Angelov L, Zahler S, Trucco M, Thomas SM, Johnson S, Qi P, Magnelli A, Anderson PM, Murphy ES. Neutrophil to Lymphocyte Ratio (NTLR) Predicts Local Control Failure and Overall Survival after Stereotactic Body Radiotherapy (SBRT) In Metastatic Sarcoma. RESEARCH SQUARE 2023:rs.3.rs-2570832. [PMID: 37333401 PMCID: PMC10275040 DOI: 10.21203/rs.3.rs-2570832/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
The neutrophil to lymphocyte ratio (NTLR) and absolute lymphocyte count (ALC) recovery are prognostic across many cancers. We investigated whether NLTR predicts SBRT success or survival in a metastatic sarcoma cohort treated with SBRT from 2014 and 2020 (N = 42). Wilcox Signed Rank Test and Friedman Test compare NTLR changes with local failure vs. local control (N = 138 lesions). Cox analyses identified factors associated with overall survival. If local control was successful, NLTR change was not significant (p = 0.30). However, NLTR significantly changed in patients local failure (p = 0.027). The multivariable Cox model demonstrated higher NLTR before SBRT was associated with worse overall survival (p = 0.002). The optimal NTLR cut point was 5 (Youden index: 0.418). One-year overall survival in SBRT metastatic sarcoma cohort was 47.6% (CI 34.3%-66.1%). Patients with an NTLR above 5 had a one-year overall survival of 37.7% (21.4%-66.3%); patients with an NTLR below 5 had a significantly improved overall survival of 63% (43.3%-91.6%, p = 0.014). Since NTLR at the time of SBRT was significantly associated with local control success and overall survival in metastatic sarcoma treated with SBRT, future efforts to reduce tumor inhibitory microenvironment factors and improved lymphocyte recovery should be investigated.
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14
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Till BM, Mack S, Whitehorn G, Rahman U, Thosani D, Grenda T, Evans NR, Okusanya O. Impact of stereotactic body radiation therapy volume on surgical patient selection, short-term survival, and long-term survival in early-stage non-small cell lung cancer. J Thorac Cardiovasc Surg 2023; 165:471-479. [PMID: 36088141 DOI: 10.1016/j.jtcvs.2022.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/23/2022] [Accepted: 07/17/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Stereotactic body radiation therapy (SBRT) is increasingly used to treat non-small cell lung cancer. The purpose of this study is to analyze relationships between facility SBRT utilization and surgical patient selection and survival after surgery. METHODS Data on patients with TI/T2N0M0 lesions and treatment facility characteristics were abstracted from the National Cancer Database, 2008 to 2017. Facilities were stratified using an SBRT/surgery ratio previously associated with short-term survival benefit for patients treated surgically, and by a previously identified surgical volume threshold. Multiple regression analyses, Cox proportional-hazard regressions, and Kaplan-Meier log rank test were employed. RESULTS In total, 182,610 patients were included. Proportion of high SBRT:surgery ratio (≥17%) facilities increased from 118 (11.5%) to 558 (48.4%) over the study period. Patients undergoing surgery at high-SBRT facilities had comparable comorbidity scores and tumor sizes to those at low-SBRT facilities, and nonclinically significant differences in age, race, and insurance status. Among low-volume surgical facilities, treatment at a high SBRT-using facility was associated with decreased 30-day mortality (1.8% vs 1.4%, P < .001) and 90-day mortality (3.3% vs 2.6%, P < .001). At high-volume surgical facilities, no difference was observed. At 5 years, a survival advantage was identified for patients undergoing resection at facilities with high surgical volumes (hazard ratio, 0.91; confidence interval, 0.90-0.93 P < .001) but not at high SBRT-utilizing facilities. CONCLUSIONS Differences in short-term survival following resection at facilities with high-SBRT utilization may be attributable to low surgical volume facilities. Patients treated at high volume surgical facilities do not demonstrate differences in short-term or long-term survival based on facility SBRT utilization.
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Affiliation(s)
- Brian M Till
- Division of Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
| | - Shale Mack
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
| | - Gregory Whitehorn
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
| | - Uzma Rahman
- Division of Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
| | - Darshak Thosani
- Division of Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
| | - Tyler Grenda
- Division of Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
| | - Nathaniel R Evans
- Division of Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa
| | - Olugbenga Okusanya
- Division of Thoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pa.
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Till BM, Whitehorn G, Mack SJ, Thosani D, Rahman U, Grenda T, Evans NR, Okusanya OT. Hospital Utilization of Stereotactic Body Radiation Therapy and Rates of Surgical Refusal. Ann Thorac Surg 2023; 115:347-354. [PMID: 36027934 DOI: 10.1016/j.athoracsur.2022.07.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/28/2022] [Accepted: 07/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Increasingly, stereotactic body radiation therapy (SBRT) is used for patients unfit for or unwilling to undergo operation for early-stage non-small cell lung cancer. It remains unclear how SBRT utilization has influenced patient refusal of surgical resection. METHODS A retrospective cohort analysis was completed using the National Cancer Database for patients with T1/T2 N0 M0 lesions from 2008 to 2017. Facilities were categorized into tertiles by SBRT/surgery ratio for each year of analysis. Propensity score matching was used to compare rates of surgical refusal and rates of postrefusal receipt of SBRT. Multivariable regression analysis was performed to evaluate effect size. RESULTS The study included 129 901 patients; 63 048 were treated at low-tertile SBRT/surgery facilities, 41 674 at middle-tertile SBRT/surgery facilities, and 25 179 at high-tertile SBRT/surgery facilities. Patients refusing surgery at high SBRT/surgery facilities had fewer comorbid conditions and smaller tumors. Rates of SBRT after surgical refusal differed (low SBRT/surgery facilities, 17.2%; high SBRT/surgery facilities, 55.9%; P < .001). In a matched cohort of 76 636, surgical refusal differed (low SBRT/surgery facilities, 4.2%; high SBRT/surgery facilities, 6.0%; P < .001). On multivariable regression, treatment at a top-tertile SBRT/surgery facility was the largest risk factor for surgical refusal (odds ratio, 3.82 [3.53-4.13]; P < .001) and was most strongly associated with postrefusal receipt of SBRT (odds ratio, 6.11 [5.09-7.34]; P < .001). CONCLUSIONS Patients treated at high SBRT-using facilities are more likely to refuse surgical resection and more likely to receive radiation therapy after surgical refusal. Further analysis is needed to better understand patient refusal of surgery in the setting of early-stage non-small cell lung cancer.
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Affiliation(s)
- Brian M Till
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | | | - Shale J Mack
- Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Darshak Thosani
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Uzma Rahman
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Tyler Grenda
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Nathaniel R Evans
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Olugbenga T Okusanya
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; Sidney Kimmel Medical College, Philadelphia, Pennsylvania.
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Xiang L, Ren PR, Li HX, Ye H, Pang HW, Wen QL, Zhang JW, He LJH, Shang CL, Yang BY, Lin SL, Wu JBW. Effect of 3-Dimensional Interstitial High-Dose-Rate Brachytherapy With Regional Metastatic Lymph Node Intensity-Modulated Radiation Therapy in Locally Advanced Peripheral Non-Small Cell Lung Cancer: 5-Year Follow-up of a Phase 2 Clinical Trial. Int J Radiat Oncol Biol Phys 2023; 115:347-355. [PMID: 35901979 DOI: 10.1016/j.ijrobp.2022.07.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/29/2022] [Accepted: 07/16/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE We aimed to reveal the 5-year clinical outcomes of 3-dimensional (3D) interstitial high-dose-rate (HDR) brachytherapy with regional metastatic lymph node intensity modulated radiation therapy (IMRT) for locally advanced peripheral non-small cell lung cancer (NSCLC), which has been shown to have low toxicity and improved 2-year survival rates in patients with this disease. METHODS AND MATERIALS In this phase 2, single-arm, open-label clinical trial, 83 patients with locally advanced peripheral NSCLC were enrolled (median follow-up [range], 53.7 [4.3-120.4] months). All eligible patients received 3D interstitial HDR brachytherapy with regional metastatic lymph node IMRT. The primary endpoint was overall survival (OS). Secondary endpoints were local recurrence-free survival, regional recurrence-free survival, progression-free survival, distant metastasis-free survival, toxicities, and quality of life. RESULTS The final analysis included 75 patients (19 [25.3%] females, 56 [74.7%] males; median [range] age, 64 [44-80] years; stage IIIA, 34 [45.3%]; stage IIIB, 41 [54.7%]). At the latest follow-up, 32 (42.7%) patients had survived. The median OS was 38.0 months (5-year OS, 44.5%; 95% confidence interval [CI], 33.8%-58.6%). Local recurrence-free survival, recurrence-free survival, and distant metastasis-free survival at 5 years were 79.2% (95% CI, 68.5%-91.5%), 73.6% (95% CI, 61.5%-88.1%), and 50.3% (95% CI, 38.3%-66.1%), respectively. The dominant failure pattern was distant disease, corresponding to 40% (30 of 75) of patients and 65.2% (30 of 46) of all failures. Two (2.7%) patients developed grade 1 acute pneumonitis. Grade 2 and 3 acute esophagitis occurred in 11 (14.7%) and 4 (5.3%) patients, respectively. No late radiation-related grade ≥2 late adverse events were observed. CONCLUSIONS 3D interstitial HDR brachytherapy with regional metastatic lymph node IMRT for locally advanced peripheral NSCLC shows significant OS and has a low toxicity rate. Additional evaluation in a phase 3 trial is recommended to substantiate these findings.
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Affiliation(s)
- Li Xiang
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Pei-Rong Ren
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hong-Xia Li
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hua Ye
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hao-Wen Pang
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qing-Lian Wen
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jian-Wen Zhang
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Li-Jia He He
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Chang-Ling Shang
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Bo Yang Yang
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Sheng Lin Lin
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China.
| | - Jing-Bo Wu Wu
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China.
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Muacevic A, Adler JR, Golomohammad R, Sherriff J, Czyz M. Separation Surgery, Fixation With Carbon-Fiber Implants, and Stereotactic Body Radiotherapy for Oligometastatic Spinal Disease. Cureus 2022; 14:e31370. [PMID: 36514641 PMCID: PMC9741859 DOI: 10.7759/cureus.31370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 11/13/2022] Open
Abstract
The management of spinal metastases focuses on reducing symptoms and protecting the spinal cord, historically involving extracorporeal radiotherapy alone. The use of separation surgery techniques alongside high-dose radiotherapy to treat spinal metastases is a novel concept and has changed the treatment paradigm. Additionally, titanium implants have been increasingly used in cases of metastatic spinal tumours requiring adjuvant stereotactic radiotherapy (SBRT). We present the case of a 48-year-old female patient who was diagnosed with a metastatic deposit of breast cancer within L1 with an Epidural Spinal Cord Compression score greater than 1a. At the time of the diagnosis, her prognosis was estimated to be more than two years. She underwent a posterior instrumented fusion of T11-L3 vertebrae with a carbon-fibre fixation system and separation surgery (debulking of the tumour around the spinal cord). The patient was discharged on the second postoperative day achieving complete resolution of the mechanical back pain. SBRT was performed 12 weeks after the surgery. The patient regained ECOG status of 1 shortly after but sadly passed away due to multiple brain metastases 36 months following posterior fixation. Her spinal disease remained well-controlled throughout the follow-up. Carbon-fibre implants appear to be safe and relatively easy to apply. Their use, due to limited artefacts in both computed tomography and magnetic resonance imaging, makes SBRT much more straightforward and follow-up imaging easier to be interpreted. Our experience demonstrates that, in conjunction with separation surgery, the translucent, low perturbing properties of these implants can improve SBRT intervention and detection of recurrence on follow-up imaging.
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Borakati A, Froghi F, Bhogal RH, Mavroeidis VK. Stereotactic radiotherapy for intrahepatic cholangiocarcinoma. World J Gastrointest Oncol 2022; 14:1478-1489. [PMID: 36160742 PMCID: PMC9412934 DOI: 10.4251/wjgo.v14.i8.1478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/07/2022] [Accepted: 07/06/2022] [Indexed: 02/05/2023] Open
Abstract
Intrahepatic cholangiocarcinoma (iCCA) is an aggressive malignancy with an increasing incidence worldwide and poor prognosis, despite several advances and continuous efforts to develop effective treatments. Complete surgical resection is the mainstay of treatment and offers a potentially curative option, but is only possible in less than a third of patients, owing to advanced disease. Chemotherapy is a well-established treatment in the adjuvant and palliative setting, however, confers limited benefit. Conventional radiotherapy is challenging due to local toxicity. With recent advances in stereotactic ablative radiotherapy (SABR), it is now possible to focus ablative beams of radiotherapy precisely aimed at tumours to minimise damage to surrounding viscera. This review details the history, technical background and application of SABR to iCCA, with directions for future research suggested.
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Affiliation(s)
- Aditya Borakati
- Department of Surgery, The Royal London Hospital, Barts Health NHS Trust, London E1 1FR, United Kingdom
| | - Farid Froghi
- Department of HPB and Liver Transplantation Surgery, Royal Free Hospital NHS Foundation Trust, London NW3 2QG, United Kingdom
| | - Ricky H Bhogal
- Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, United Kingdom
| | - Vasileios K Mavroeidis
- Department of Academic Surgery, The Royal Marsden NHS Foundation Trust, London SW3 6JJ, United Kingdom
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19
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Kaučić H, Kosmina D, Schwarz D, Mack A, Šobat H, Čehobašić A, Leipold V, Andrašek I, Avdičević A, Mlinarić M. Stereotactic Ablative Radiotherapy Using CALYPSO ® Extracranial Tracking for Intrafractional Tumor Motion Management-A New Potential Local Treatment for Unresectable Locally Advanced Pancreatic Cancer? Results from a Retrospective Study. Cancers (Basel) 2022; 14:cancers14112688. [PMID: 35681668 PMCID: PMC9179494 DOI: 10.3390/cancers14112688] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/24/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The aim of this study was to evaluate the efficacy and safety of SABR for LAPC using Calypso® Extracranial Tracking for intrafractional, fiducial-based motion management, to present this motion management technique, as there are yet no published data on usage of Calypso® during SABR for LAPC, and to report on our clinical outcomes. (2) Methods: Fifty-four patients were treated with SABR in one, three, or five fractions, receiving median BED10 = 112.5 Gy. Thirty-eight patients received systemic treatment. End points were OS, FFLP, PFS, and toxicity. Actuarial survival analysis and univariate analysis were investigated. (3) Results: Median follow-up was 20 months. Median OS was 24 months. One-year FFLP and one-year OS were 100% and 90.7%, respectively. Median PFS was 18 months, and one-year PFS was 72.2%. Twenty-five patients (46.3%) were alive at the time of analysis, and both median FU and OS for this subgroup were 26 months. No acute/late toxicity > G2 was reported. (4) Conclusions: SABR for LAPC using Calypso® presented as an effective and safe treatment and could be a promising local therapeutic option with very acceptable toxicity, either as a single treatment or in a multimodality regimen. Dose escalation to the tumor combined with systemic treatment could yield better clinical outcomes.
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Affiliation(s)
- Hrvoje Kaučić
- Specijalna bolnica Radiochirurgia Zagreb, Ulica Dr. Franje Tuđmana 4, 10431 Sveta Nedelja, Croatia; (D.K.); (D.S.); (H.Š.); (A.Č.); (V.L.); (I.A.); (A.A.); (M.M.)
- Sveučilište Josipa Jurja Strossmayera u Osijeku—Medicinski Fakultet Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia
- Correspondence: ; Tel.: +385-91-5622-191
| | - Domagoj Kosmina
- Specijalna bolnica Radiochirurgia Zagreb, Ulica Dr. Franje Tuđmana 4, 10431 Sveta Nedelja, Croatia; (D.K.); (D.S.); (H.Š.); (A.Č.); (V.L.); (I.A.); (A.A.); (M.M.)
| | - Dragan Schwarz
- Specijalna bolnica Radiochirurgia Zagreb, Ulica Dr. Franje Tuđmana 4, 10431 Sveta Nedelja, Croatia; (D.K.); (D.S.); (H.Š.); (A.Č.); (V.L.); (I.A.); (A.A.); (M.M.)
- Medicinski Fakultet Sveučilišta u Rijeci, Braće Branchetta 20/1, 51000 Rijeka, Croatia
- Sveučilište Josipa Jurja Strossmayera u Osijeku—Fakultet za Dentalnu Medicinu i Zdravstvo Osijek, Crkvena Ulica 21, 31000 Osijek, Croatia
| | - Andreas Mack
- Swiss NeuroRadiosurgery Center, Bürglistrasse 29, 8002 Zürich, Switzerland;
| | - Hrvoje Šobat
- Specijalna bolnica Radiochirurgia Zagreb, Ulica Dr. Franje Tuđmana 4, 10431 Sveta Nedelja, Croatia; (D.K.); (D.S.); (H.Š.); (A.Č.); (V.L.); (I.A.); (A.A.); (M.M.)
| | - Adlan Čehobašić
- Specijalna bolnica Radiochirurgia Zagreb, Ulica Dr. Franje Tuđmana 4, 10431 Sveta Nedelja, Croatia; (D.K.); (D.S.); (H.Š.); (A.Č.); (V.L.); (I.A.); (A.A.); (M.M.)
- Sveučilište Josipa Jurja Strossmayera u Osijeku—Medicinski Fakultet Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia
| | - Vanda Leipold
- Specijalna bolnica Radiochirurgia Zagreb, Ulica Dr. Franje Tuđmana 4, 10431 Sveta Nedelja, Croatia; (D.K.); (D.S.); (H.Š.); (A.Č.); (V.L.); (I.A.); (A.A.); (M.M.)
- Sveučilište Josipa Jurja Strossmayera u Osijeku—Medicinski Fakultet Osijek, Josipa Huttlera 4, 31000 Osijek, Croatia
| | - Iva Andrašek
- Specijalna bolnica Radiochirurgia Zagreb, Ulica Dr. Franje Tuđmana 4, 10431 Sveta Nedelja, Croatia; (D.K.); (D.S.); (H.Š.); (A.Č.); (V.L.); (I.A.); (A.A.); (M.M.)
| | - Asmir Avdičević
- Specijalna bolnica Radiochirurgia Zagreb, Ulica Dr. Franje Tuđmana 4, 10431 Sveta Nedelja, Croatia; (D.K.); (D.S.); (H.Š.); (A.Č.); (V.L.); (I.A.); (A.A.); (M.M.)
| | - Mihaela Mlinarić
- Specijalna bolnica Radiochirurgia Zagreb, Ulica Dr. Franje Tuđmana 4, 10431 Sveta Nedelja, Croatia; (D.K.); (D.S.); (H.Š.); (A.Č.); (V.L.); (I.A.); (A.A.); (M.M.)
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20
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Koka K, Verma A, Dwarakanath BS, Papineni RVL. Technological Advancements in External Beam Radiation Therapy (EBRT): An Indispensable Tool for Cancer Treatment. Cancer Manag Res 2022; 14:1421-1429. [PMID: 35431581 PMCID: PMC9012312 DOI: 10.2147/cmar.s351744] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/26/2022] [Indexed: 12/14/2022] Open
Abstract
Recent technological advancements have increased the efficacy of radiotherapy, leading to effective management of cancer patients with enhanced patient survival and improved quality of life. Several important developments like multileaf collimator, integration of imaging techniques like positron emission tomography (PET) and computed tomography (CT), involvement of advanced dose calculation algorithms, and delivery techniques have increased tumor dose distribution and decreased normal tissue toxicity. Three-dimensional conformal radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT), stereotactic radiotherapy, image-guided radiotherapy (IGT), and particle therapy have facilitated the planning procedures, accurate tumor delineation, and dose estimation for effective personalized treatment. In this review, we present the technological advancements in various types of EBRT methods and discuss their clinical utility and associated limitations. We also reveal novel approaches of using biocompatible yttrium oxide scintillator-photosensitizer complex (YSM) that can generate X-ray induced cytotoxic reactive oxygen species, facilitating X-ray activated photodynamic therapy (XPDT (external beam) and/or iXPDT (internal X-ray source)) and azido-derivatives of 2-deoxy-D-glucose (2-DG) as agents for site-specific radiation-induced DNA damage.
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Affiliation(s)
| | | | - Bilikere S Dwarakanath
- Central Research Facility, Sri Ramachandra Institute of Higher Education and Research Porur, Chennai, India
| | - Rao V L Papineni
- PACT & Health LLC, Branford, CT, USA
- Department of Surgery, University of Kansas Medical Center, Kansas City, KS, USA
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21
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Czajkowski P, Piotrowski T. Evaluation of the accuracy of dose delivery in stereotactic radiotherapy using the Velocity commercial software. Phys Med 2022; 95:133-139. [DOI: 10.1016/j.ejmp.2022.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 01/31/2022] [Accepted: 02/04/2022] [Indexed: 12/18/2022] Open
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22
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Kiesel BF, Guo J, Parise RA, Venkataramanan R, Clump DA, Bakkenist CJ, Beumer JH. Dose-dependent bioavailability and tissue distribution of the ATR inhibitor AZD6738 (ceralasertib) in mice. Cancer Chemother Pharmacol 2022; 89:231-242. [PMID: 35066692 PMCID: PMC8829872 DOI: 10.1007/s00280-021-04388-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/14/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Ataxia telangiectasia and Rad3-related (ATR) initiates and regulates cellular responses to DNA damage, such as those caused by cancer treatments. Several ATR inhibitors (ATRi) are in clinical development including AZD6738. Therapeutic indices among ATRi may differ as a result of varying potencies and concentrations at both tumor and off-target sites. Additionally, AZD6738 contributes to anti-tumor immune responses necessitating evaluation of exposure at immunological sites. METHODS Using mouse models and a highly sensitive LC-MS/MS assay, the pharmacokinetics of AZD6738 were studied, including dose linearity, bioavailability, metabolism, and tissue distribution in tumor-bearing mice. RESULTS Initial studies identified dose-dependent bioavailability, with greater than proportional increases in exposure as dose increased resulting in a ~ twofold increase in bioavailability between the lowest and highest investigated doses. These behaviors were successfully captured with a compartmental PK model. Analysis of metabolite PK revealed decreasing metabolic ratios with increasing dose, indicative of saturable first-pass metabolism. Further analysis revealed that intestinal and gut metabolism contribute to metabolism and these saturable mechanisms. Studies of tumor and tissue distribution found rapid and extensive drug distribution to most tissues except brain and spinal cord. CONCLUSION The complex non-linear behavior of AZD6738 PK in mice was due to pre-systemic saturation and which appears to be recapitulated clinically at low doses. PK reported here will allow future correlation of tissue related toxicities with drug exposure as well as exposure with immunological responses. These results can also be compared with those from similar studies of other ATRi to contrast drug exposure with responses.
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Affiliation(s)
- Brian F Kiesel
- Cancer Therapeutics Drug Discovery Program, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jianxia Guo
- Cancer Therapeutics Drug Discovery Program, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Robert A Parise
- Cancer Therapeutics Drug Discovery Program, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Raman Venkataramanan
- Cancer Therapeutics Drug Discovery Program, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
- Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - David A Clump
- Department of Radiation Oncology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Christopher J Bakkenist
- Department of Radiation Oncology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Pharmacology and Chemical Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jan H Beumer
- Cancer Therapeutics Drug Discovery Program, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA.
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- UPMC Hillman Cancer Center, Room G27e, 5117 Centre Ave, Pittsburgh, PA, 15213, USA.
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23
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The Role of Ablative Radiotherapy to Liver Oligometastases from Colorectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2021. [DOI: 10.1007/s11888-021-00472-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Abstract
Purpose of Review
This review describes recent data supporting locoregional ablative radiation in the treatment of oligometastatic colorectal cancer liver metastases.
Recent Findings
Stereotactic body radiotherapy (SBRT) demonstrates high rates of local control in colorectal cancer liver metastases when a biologically equivalent dose of > 100 Gy is delivered. Future innovations to improve the efficacy of SBRT include MRI-guided radiotherapy (MRgRT) to enhance target accuracy, systemic immune activation to treat extrahepatic disease, and genomic customization. Selective internal radiotherapy (SIRT) with y-90 is an intra-arterial therapy that delivers high doses to liver metastases internally which has shown to increase liver disease control in phase 3 trials. Advancements in transarterial radioembolization (TARE) dosimetry could improve local control and decrease toxicity.
Summary
SBRT and SIRT are both promising options in treating unresectable metastatic colorectal cancer liver metastases. Identification of oligometastatic patients who receive long-term disease control from either therapy is essential. Future advancements focusing on improving radiation design and customization could further improve efficacy and toxicity.
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Farrugia B, Knight K, Wright C, Tacey M, Foroudi F, Chao M, Khor R. A prospective trial demonstrating the benefit of personalized selection of breath-hold technique for upper-abdominal radiotherapy using the Active Breathing Co-ordinator (ABC). Int J Radiat Oncol Biol Phys 2021; 111:1289-1297. [PMID: 34384855 DOI: 10.1016/j.ijrobp.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND For upper abdominal (UA) tumors, our institutional-standard motion reduction method is Expiration Breath Hold (EBH), using Active Breathing Coordinator (ABC)TM. However, an individual patient's breath-hold (BH) reproducibility (RBH) may be improved in Deep Inspiration or Inspiration Breath-Hold (DIBH or IBH). This trial compared the tumor position RBH, stability (SBH), and breath-hold time (TBH) of three BH methods, using ABC, to personalize the selection of technique, by employing a pre-planning screening assessment. METHODS Patients planned for UA radiotherapy (kidney, pancreas, liver, or adrenal gland), were invited to participate in this prospective trial. Active Breathing Coordinator (ABC)TM education was conducted, then participants attempted EBH, DIBH and IBH, in randomized order. During five consecutive BH's for each method, kV fluoroscopy images of the diaphragm were acquired. The BH technique selection was personalized according to a decision matrix. The EBH and the personalized technique cohort mean RBH and SBH of were analyzed. RESULTS Between May 2019 and March 2020, 19 participants were recruited. Median age of participants was 68 years (range 32-81). Tumor sites included kidney (n=1), adrenal gland (n=5) and liver (n=14). One participant was excluded due to poor BH compliance, leaving 270 images from 18 participants for analysis. Mean TBH was 22.1, 23.9 & 24.2 seconds for EBH, DIBH and IBH respectively. Screening selected EBH for 44% (n=8), IBH for 39% (n=7) and DIBH for 17% (n=3) of participants. The mean RBH was superior at 0.92mm (0.79mm SD) for the personalized technique, compared to EBH of 1.79mm (1.49mm SD) (p=0.016). Pre-planned subset analysis of participants whose personalized technique was not EBH showed improved mean RBH of 0.63mm (0.29mm SD) compared to their EBH RBH of 2.2mm (1.7mm SD) (p=0.011). CONCLUSIONS In 56% of participants, DIBH or IBH demonstrated superior RBH compared to EBH Personalized BH screening can inform selection of an ABC BH method which provides optimal RBH with improved TBH for an individual's planning and treatment course. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR): XXX (withheld - blinded manuscript).
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Affiliation(s)
- Briana Farrugia
- Radiation Oncology, Olivia Newton-John Cancer Wellness & Research Centre, Austin Health. PO Box 5555, Heidelberg, VIC, 3084, Australia.; Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, VIC, 3800, Australia
| | - Kellie Knight
- Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, VIC, 3800, Australia
| | - Caroline Wright
- Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, VIC, 3800, Australia
| | - Mark Tacey
- Radiation Oncology, Olivia Newton-John Cancer Wellness & Research Centre, Austin Health. PO Box 5555, Heidelberg, VIC, 3084, Australia.; Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, 3053, Australia.
| | - Farshad Foroudi
- Radiation Oncology, Olivia Newton-John Cancer Wellness & Research Centre, Austin Health. PO Box 5555, Heidelberg, VIC, 3084, Australia
| | - Michael Chao
- Radiation Oncology, Olivia Newton-John Cancer Wellness & Research Centre, Austin Health. PO Box 5555, Heidelberg, VIC, 3084, Australia
| | - Richard Khor
- Radiation Oncology, Olivia Newton-John Cancer Wellness & Research Centre, Austin Health. PO Box 5555, Heidelberg, VIC, 3084, Australia.; School of Molecular Sciences, La Trobe University, Melbourne, Australia; Olivia Newton John Cancer Research Institute, Melbourne, Australia.
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25
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Blažek T, Zděblová Čermáková Z, Knybel L, Hurník P, Štembírek J, Resová K, Paračková T, Formánek M, Cvek J, Soumarová R. Dose escalation in advanced floor of the mouth cancer: a pilot study using a combination of IMRT and stereotactic boost. Radiat Oncol 2021; 16:122. [PMID: 34187494 PMCID: PMC8243893 DOI: 10.1186/s13014-021-01842-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE We evaluated the efficiency and toxicity of stereotactic hypofractionated boost in combination with conventionally fractionated radiotherapy in the treatment of advanced floor of the mouth cancer. METHODS Thirty-seven patients with advanced stage of the floor of the mouth cancer, histologically confirmed squamous cell carcinoma (p16 negative) ineligible for surgical treatment, were indicated for radiochemotherapy or hyperfractionated accelerated radiotherapy (HART). The radiotherapy protocol combined external beam radiotherapy (EBRT) and a stereotactic hypofractionated boost to the primary tumor. The dose delivered from EBRT was 70-72.5 Gy in 35/50 fractions. The hypofractionated boost followed with 10 Gy in two fractions. For the variables-tumor volume, stage and grade a multivariate analysis was performed to find the relationship between overall survival, local progression and metastasis. Toxicity was evaluated according to CTCAE scale version 4. RESULTS After a median follow-up of 16 months, 23 patients (62%) achieved complete remission. The median time to local progression and metastasis was 7 months. Local control (LC) at 2 and 5-years was 70% and 62%, respectively. Progression-free survival (PFS) and overall survival (OS) were 57% and 49% at 2 years and 41% and 27% at 5 years, respectively. Statistical analysis revealed that larger tumors had worse overall survival and a greater chance of metastasis. Log-Rank GTV > 44 ccm (HR = 1.96; [95% CI (0.87; 4.38)]; p = 0.11). No boost-related severe acute toxicity was observed. Late osteonecrosis was observed in 3 patients (8%). CONCLUSION The combination of EBRT and stereotactic hypofractionated boost is safe and seems to be an effective option for dose escalation in patients with advanced floor of the mouth tumors who are ineligible for surgical treatment and require a non-invasive approach.
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Affiliation(s)
- Tomáš Blažek
- Department of Oncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,3Rd Faculty of Medicine, Charles University Prague, Prague, Czech Republic
| | - Zuzana Zděblová Čermáková
- Department of Oncology, University Hospital Ostrava, Ostrava, Czech Republic. .,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
| | - Lukáš Knybel
- Department of Oncology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Pavel Hurník
- Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Pathology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Jan Štembírek
- Department of Oral and Maxillofacial Surgery, University Hospital Ostrava, Ostrava, Czech Republic.,Institute of Animal Physiology and Genetics, Czech Academy of Sciences, Brno, Czech Republic
| | - Kamila Resová
- Department of Oncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, Palacký University Olomouc, Olomouc, Czech Republic
| | - Tereza Paračková
- Department of Oncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, Palacký University Olomouc, Olomouc, Czech Republic
| | - Martin Formánek
- Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.,Department of Otorhinolaryngology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Jakub Cvek
- Department of Oncology, University Hospital Ostrava, Ostrava, Czech Republic.,Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Renata Soumarová
- 3Rd Faculty of Medicine, Charles University Prague, Prague, Czech Republic.,Department of Oncology, University Hospital Královské Vinohrady Prague, Prague, Czech Republic
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Kapitanova I, Biswas S, Divekar S, Kemmerer EJ, Rostock RA, Forster KM, Grimm RJ, Scofield CJ, Grimm J, Emami B, Mahadevan A. Estimating the tolerance of brachial plexus to hypofractionated stereotactic body radiotherapy: a modelling-based approach from clinical experience. Radiat Oncol 2021; 16:98. [PMID: 34098991 PMCID: PMC8186142 DOI: 10.1186/s13014-021-01822-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 05/19/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Brachial plexopathy is a potentially serious complication from stereotactic body radiation therapy (SBRT) that has not been widely studied. Therefore, we compared datasets from two different institutions and generated a brachial plexus dose-response model, to quantify what dose constraints would be needed to minimize the effect on normal tissue while still enabling potent therapy for the tumor. METHODS Two published SBRT datasets were pooled and modeled from patients at Indiana University and the Richard L. Roudebush Veterans Administration Medical Center from 1998 to 2007, as well as the Karolinska Institute from 2008 to 2013. All patients in both studies were treated with SBRT for apically located lung tumors localized superior to the aortic arch. Toxicities were graded according to Common Terminology Criteria for Adverse Events, and a probit dose response model was created with maximum likelihood parameter fitting. RESULTS This analysis includes a total of 89 brachial plexus maximum point dose (Dmax) values from both institutions. Among the 14 patients who developed brachial plexopathy, the most common complications were grade 2, comprising 7 patients. The median follow-up was 30 months (range 6.1-72.2) in the Karolinska dataset, and the Indiana dataset had a median of 13 months (range 1-71). Both studies had a median range of 3 fractions, but in the Indiana dataset, 9 patients were treated in 4 fractions, and the paper did not differentiate between the two, so our analysis is considered to be in 3-4 fractions, one of the main limitations. The probit model showed that the risk of brachial plexopathy with Dmax of 26 Gy in 3-4 fractions is 10%, and 50% with Dmax of 70 Gy in 3-4 fractions. CONCLUSIONS This analysis is only a preliminary result because more details are needed as well as additional comprehensive datasets from a much broader cross-section of clinical practices. When more institutions join the QUANTEC and HyTEC methodology of reporting sufficient details to enable data pooling, our field will finally reach an improved understanding of human dose tolerance.
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Affiliation(s)
- Irina Kapitanova
- Department of Psychiatry, Mount Sinai St. Luke's Hospital, New York, NY, USA
| | - Sharmi Biswas
- Department of Pediatric Nephrology, Weill Cornell Medicine, New York, NY, USA
| | - Sabrina Divekar
- Sackler School of Medicine, Tel Aviv University, New York, NY, USA
| | - Eric J Kemmerer
- Department of Radiation Oncology, Geisinger Cancer Institute, 100 N Academy Ave, Danville, PA, 17822, USA
| | - Robert A Rostock
- Department of Radiation Oncology, Geisinger Cancer Institute, 100 N Academy Ave, Danville, PA, 17822, USA
| | - Kenneth M Forster
- Department of Radiation Oncology, Geisinger Cancer Institute, 100 N Academy Ave, Danville, PA, 17822, USA
| | - Rachel J Grimm
- Department of Radiation Oncology, Thomas Jefferson Hospital, Philadelphia, PA, USA
| | - Carla J Scofield
- Department of Radiation Oncology, Geisinger Cancer Institute, 100 N Academy Ave, Danville, PA, 17822, USA
| | - Jimm Grimm
- Department of Radiation Oncology, Geisinger Cancer Institute, 100 N Academy Ave, Danville, PA, 17822, USA.
- Department of Medical Imaging and Radiation Sciences, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Bahman Emami
- Department of Radiation Oncology, Loyola University Medical Center, Chicago, IL, USA
| | - Anand Mahadevan
- Department of Radiation Oncology, Geisinger Cancer Institute, 100 N Academy Ave, Danville, PA, 17822, USA
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Gago-Arias A, Neira S, Pombar M, Gómez-Caamaño A, Pardo-Montero J. Evaluation of indirect damage and damage saturation effects in dose-response curves of hypofractionated radiotherapy of early-stage NSCLC and brain metastases. Radiother Oncol 2021; 161:1-8. [PMID: 34015386 DOI: 10.1016/j.radonc.2021.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE To investigate the possible contribution of indirect damage and damage saturation to tumour control obtained with SBRT/SRS treatments for early-stage NSCLC and brain metastases. METHODS AND MATERIALS We have constructed a dataset of early-stage NSCLC and brain metastases dose-response. These data were fitted to models based on the linear-quadratic (LQ), the linear-quadratic-linear (LQL), and phenomenological modifications of the LQ-model to account for indirect cell damage. We use the Akaike-Information-Criterion formalism to compare performance, and studied the stability of the results with changes in fitting parameters and perturbations on dose/TCP values. RESULTS In NSCLC, a modified LQ-model with a beta-term increasing with dose yields the best-fits for α/β = 10 Gy. Only the inclusion of very fast accelerated proliferation or low α/β values can eliminate such superiority. In brain, the LQL model yields the best-fits, and the ranking is not affected by variations of fitting parameters or dose/TCP perturbations. CONCLUSIONS For α/β = 10 Gy, a modified LQ-model with a beta-term increasing with dose provides better fits to NSCLC dose-response curves. For brain metastases, the LQL provides the best fit. This might be interpreted as a hint of indirect damage in NSCLC, and damage saturation in brain metastases. The results for NSCLC are strongly dependent on the value of α/β and may require further investigation, while those for brain seem to be clearly significant. Our results can assist in the design of improved radiotherapy for NSCLC and brain metastases, aiming at avoiding over/under-treatment.
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Affiliation(s)
- Araceli Gago-Arias
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain; Department of Medical Physics, Complexo Hospitalario Universitario de Santiago de Compostela, Spain; Institute of Physics, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile.
| | - Sara Neira
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | - Miguel Pombar
- Department of Medical Physics, Complexo Hospitalario Universitario de Santiago de Compostela, Spain; Group of Molecular Imaging and Oncology, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | - Antonio Gómez-Caamaño
- Group of Molecular Imaging and Oncology, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain; Department of Radiotherapy, Complexo Hospitalario Universitario de Santiago de Compostela, Spain
| | - Juan Pardo-Montero
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain; Department of Medical Physics, Complexo Hospitalario Universitario de Santiago de Compostela, Spain.
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Lee YYD, Nguyen DT, Moodie T, O'Brien R, McMaster A, Hickey A, Pritchard N, Poulsen P, Tabaksblat EM, Weber B, Worm E, Pryor D, Chu J, Hardcastle N, Booth J, Gebski V, Wang T, Keall P. Study protocol of the LARK (TROG 17.03) clinical trial: a phase II trial investigating the dosimetric impact of Liver Ablative Radiotherapy using Kilovoltage intrafraction monitoring. BMC Cancer 2021; 21:494. [PMID: 33941111 PMCID: PMC8091536 DOI: 10.1186/s12885-021-08184-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/13/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Stereotactic Ablative Body Radiotherapy (SABR) is a non-invasive treatment which allows delivery of an ablative radiation dose with high accuracy and precision. SABR is an established treatment for both primary and secondary liver malignancies, and technological advances have improved its efficacy and safety. Respiratory motion management to reduce tumour motion and image guidance to achieve targeting accuracy are crucial elements of liver SABR. This phase II multi-institutional TROG 17.03 study, Liver Ablative Radiotherapy using Kilovoltage intrafraction monitoring (LARK), aims to investigate and assess the dosimetric impact of the KIM real-time image guidance technology. KIM utilises standard linear accelerator equipment and therefore has the potential to be a widely available real-time image guidance technology for liver SABR. METHODS Forty-six patients with either hepatocellular carcinoma or oligometastatic disease to the liver suitable for and treated with SABR using Kilovoltage Intrafraction Monitoring (KIM) guidance will be included in the study. The dosimetric impact will be assessed by quantifying accumulated patient dose distribution with or without the KIM intervention. The patient treatment outcomes of local control, toxicity and quality of life will be measured. DISCUSSION Liver SABR is a highly effective treatment, but precise dose delivery is challenging due to organ motion. Currently, there is a lack of widely available options for performing real-time tumour localisation to assist with accurate delivery of liver SABR. This study will provide an assessment of the impact of KIM as a potential solution for real-time image guidance in liver SABR. TRIAL REGISTRATION This trial was registered on December 7th 2016 on ClinicalTrials.gov under the trial-ID NCT02984566 .
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Affiliation(s)
- Yoo Young Dominique Lee
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, QLD, Australia.
- The University of Sydney, Sydney, NSW, Australia.
| | - Doan Trang Nguyen
- The University of Sydney, Sydney, NSW, Australia
- School of Biomedical Engineering, University of Technology Sydney, Sydney, NSW, Australia
- ACRF Image X Institute, Sydney, NSW, Australia
| | - Trevor Moodie
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Sydney, NSW, Australia
| | - Ricky O'Brien
- ACRF Image X Institute, Sydney, NSW, Australia
- Radiation Physics Laboratory, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Anne McMaster
- Department of Radiation Oncology, Liverpool-Macarthur Cancer Therapy Centre, Sydney, NSW, Australia
| | - Andrew Hickey
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Sydney, NSW, Australia
| | - Nicole Pritchard
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Sydney, NSW, Australia
- Gamma Gurus Pty Ltd, Sydney, NSW, Australia
| | - Per Poulsen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Britta Weber
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Esben Worm
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - David Pryor
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Julie Chu
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Nicholas Hardcastle
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Jeremy Booth
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Sydney, NSW, Australia
| | - Val Gebski
- University of Sydney NHMRC Clinical Trials Centre, Sydney, NSW, Australia
| | - Tim Wang
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Sydney, NSW, Australia
| | - Paul Keall
- ACRF Image X Institute, Sydney, NSW, Australia
- Radiation Physics Laboratory, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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Grimm J, Marks LB, Jackson A, Kavanagh BD, Xue J, Yorke E. High Dose per Fraction, Hypofractionated Treatment Effects in the Clinic (HyTEC): An Overview. Int J Radiat Oncol Biol Phys 2021; 110:1-10. [PMID: 33864823 PMCID: PMC9447432 DOI: 10.1016/j.ijrobp.2020.10.039] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/08/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Jimm Grimm
- Department of Radiation Oncology, Geisinger Cancer Institute, Danville, Pennsylvania; Department of Medical Imaging and Radiation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Lawrence B Marks
- Department of Radiation Oncology and Lineberger Cancer Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Andrew Jackson
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Brian D Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jinyu Xue
- Department of Radiation Oncology, NYU Langone Medical Center, New York, New York
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
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Henry EC, Strugari M, Mawko G, Brewer KD, Abraham R, Kappadath SC, Syme A. Post-administration dosimetry in yttrium-90 radioembolization through micro-CT imaging of radiopaque microspheres in a porcine renal model. Phys Med Biol 2021; 66. [PMID: 33784639 DOI: 10.1088/1361-6560/abf38a] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/30/2021] [Indexed: 12/27/2022]
Abstract
The purpose of this study is to perform post-administration dosimetry in yttrium-90 radioembolization through micro-CT imaging of radiopaque microsphere distributions in a porcine renal model and explore the impact of spatial resolution of an imaging system on the extraction of specific dose metrics. Following the administration of radiopaque microspheres to the kidney of a hybrid farm pig, the kidney was explanted and imaged with micro-CT. To produce an activity distribution, 400 MBq of yttrium-90 activity was distributed throughout segmented voxels of the embolized vasculature based on an established linear relationship between microsphere concentration and CT voxel value. This distribution was down-sampled to coarser isotropic grids ranging in voxel size from 2.5 to 15 mm to emulate nominal resolutions comparable to those found in yttrium-90 PET and Bremsstrahlung SPECT imaging. Dose distributions were calculated through the convolution of activity distributions with dose-voxel kernels generated using the GATE Monte Carlo toolkit. Contours were computed to represent normal tissue and target volumes. Dose-volume histograms, dose metrics, and dose profiles were compared to a ground truth dose distribution computed with GATE. The mean dose to the target for all studied voxel sizes was found to be within 5.7% of the ground truth mean dose.D70was shown to be strongly correlated with image voxel size of the dose distribution (r2 = 0.90).D70is cited in the literature as an important dose metric and its dependence on voxel size suggests higher resolution dose distributions may provide new perspectives on dose-response relationships in yttrium-90 radioembolization. This study demonstrates that dose distributions with large voxels incorrectly homogenize the dose by attributing escalated doses to normal tissues and reduced doses in high-dose target regions. High-resolution micro-CT imaging of radiopaque microsphere distributions can provide increased confidence in characterizing the absorbed dose heterogeneity in yttrium-90 radioembolization.
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Affiliation(s)
- E Courtney Henry
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada
| | - Matthew Strugari
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada.,Biomedical Translational Imaging Centre, Halifax, Canada
| | - George Mawko
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada.,Department of Diagnostic Radiology, Dalhousie University, Halifax, Canada.,Department of Medical Physics, Nova Scotia Health Authority, Halifax, Canada.,Department of Radiation Oncology, Dalhousie University, Halifax, Canada
| | - Kimberly D Brewer
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada.,Biomedical Translational Imaging Centre, Halifax, Canada.,Department of Diagnostic Radiology, Dalhousie University, Halifax, Canada.,Department of Biomedical Engineering, Dalhousie University, Halifax, Canada
| | - Robert Abraham
- Department of Diagnostic Radiology, Dalhousie University, Halifax, Canada.,ABK Biomedical Inc., Halifax, Canada
| | - S Cheenu Kappadath
- Department of Imaging Physics, University of Texas MD Anderson Cancer Centre, Houston, United States of America
| | - Alasdair Syme
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Canada.,Department of Medical Physics, Nova Scotia Health Authority, Halifax, Canada.,Department of Radiation Oncology, Dalhousie University, Halifax, Canada
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31
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Couñago F, de la Pinta C, Gonzalo S, Fernández C, Almendros P, Calvo P, Taboada B, Gómez-Caamaño A, Guerra JLL, Chust M, González Ferreira JA, Álvarez González A, Casas F. GOECP/SEOR radiotherapy guidelines for small-cell lung cancer. World J Clin Oncol 2021; 12:115-143. [PMID: 33767969 PMCID: PMC7968106 DOI: 10.5306/wjco.v12.i3.115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/25/2021] [Accepted: 02/12/2021] [Indexed: 02/06/2023] Open
Abstract
Small cell lung cancer (SCLC) accounts for approximately 20% of all lung cancers. The main treatment is chemotherapy (Ch). However, the addition of radiotherapy significantly improves overall survival (OS) in patients with non-metastatic SCLC and in those with metastatic SCLC who respond to Ch. Prophylactic cranial irradiation reduces the risk of brain metastases and improves OS in both metastatic and non-metastatic patients. The 5-year OS rate in patients with limited-stage disease (non-metastatic) is slightly higher than 30%, but less than 5% in patients with extensive-stage disease (metastatic). The present clinical guidelines were developed by Spanish radiation oncologists on behalf of the Oncologic Group for the Study of Lung Cancer/Spanish Society of Radiation Oncology to provide a current review of the diagnosis, planning, and treatment of SCLC. These guidelines emphasise treatment fields, radiation techniques, fractionation, concomitant treatment, and the optimal timing of Ch and radiotherapy. Finally, we discuss the main indications for reirradiation in local recurrence.
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Affiliation(s)
- Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Hospital La Luz, Universidad Europea de Madrid, Madrid 28223, Madrid, Spain
| | - Carolina de la Pinta
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - Susana Gonzalo
- Department of Radiation Oncology, Hospital Universitario La Princesa, Madrid 28006, Spain
| | - Castalia Fernández
- Department of Radiation Oncology, GenesisCare Madrid, Madrid 28043, Spain
| | - Piedad Almendros
- Department of Radiation Oncology, Hospital General Universitario, Valencia 46014, Spain
| | - Patricia Calvo
- Department of Radiation Oncology, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela 15706, Spain
| | - Begoña Taboada
- Department of Radiation Oncology, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela 15706, Spain
| | - Antonio Gómez-Caamaño
- Department of Radiation Oncology, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela 15706, Spain
| | - José Luis López Guerra
- Department of Radiation Oncology, Hospital Universitario Virgen del Rocío, Sevilla 41013, Spain
| | - Marisa Chust
- Department of Radiation Oncology, Fundación Instituto Valenciano de Oncología, Valencia 46009, Spain
| | | | | | - Francesc Casas
- Department of Radiation Oncology, Thoracic Unit, Hospital Clinic, Barcelona 08036, Spain
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Saha A, Beasley M, Hatton N, Dickinson P, Franks K, Clarke K, Jain P, Teo M, Murray P, Lilley J. Clinical and dosimetric predictors of radiation pneumonitis in early-stage lung cancer treated with Stereotactic Ablative radiotherapy (SABR) - An analysis of UK's largest cohort of lung SABR patients. Radiother Oncol 2021; 156:153-159. [PMID: 33333139 DOI: 10.1016/j.radonc.2020.12.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 08/17/2020] [Accepted: 12/07/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Stereotactic Ablative Radiotherapy (SABR) is the standard treatment for early-stage medically inoperable lung cancer. Predictors of radiation pneumonitis (RP) in patients treated with SABR are poorly defined. In this study, we investigate clinical and dosimetric parameters, which can predict symptomatic RP in early-stage lung cancer patients treated with SABR. MATERIALS AND METHODS Patients treated with lung SABR between May 2009 and August 2018, in a single United Kingdom (UK) radiotherapy center were included. The patient's baseline characteristics, treatment details, and toxicity were retrieved from the electronic medical record. Dosimetric data was extracted from Xio and Monaco treatment planning systems. Patients were treated according to the UK SABR consortium guidelines. RP was graded retrospectively using Common Terminology Criteria for Adverse Events (CTCAE) version 4.0, based on available clinical and imaging information. Univariate and multivariate binary logistic regression was performed to determine predictive factors for grade ≥ 2 radiation pneumonitis, using Statistical Package for the Social Sciences (SPSS) statistics version 21 software. The goodness of fit was assessed using the Hosmer and Lemeshow test. The optimal diagnostic threshold was tested using the Receiver operating characteristics (ROC) curve. The chi-square test was carried out to test the different risk factors against the likelihood of developing grade ≥ 2 pneumonitis. RESULTS A total of 1266 patients included in the analysis. The median age of patients was 75 years. Six hundred sixty-six patients (52.6%) were female. Median follow up was 56 months. Sixty-five percent of patients received 55 Gy in 5 fractions. Forty-three percent of patients had Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 2 and 16.2% had PS of 3. The Median Charlson comorbidity index was 6 (range 2-11). Median Standardized Uptake Value (SUV) max of the tumor was 6.5. Four hundred two patients (31.8%) had confirmed histological diagnosis; other patients were treated based on a radiological diagnosis. The median tumor size was 20 mm (range 4 mm-63 mm). Median Planning Target Volume (PTV) was 30.3 cc. Median values of R100, R50, and D2cm were 1.1, 5.6, 32.8 Gy. The median value of mean lung dose, V20, and V12.5 were 3.9 Gy, 5 %and 9.3% respectively. Eighty-five (6.7%) patients developed symptomatic RP (grade ≥ 2) with only 5(0.4%) developing grade 3 RP. Five percent of patients developed rib fractures but only 28% of these were symptomatic. On univariate analysis lower lobe tumor location, larger tumor size, PTV, mean lung dose, lung V20Gy, and V12.5 Gy were significantly associated with grade ≥ 2 RP. On multivariate analysis, only mean lung dose was associated with grade ≥ 2 pneumonitis. ROC curve analysis showed optimal diagnostic threshold for tumour size, PTV, mean lung dose, V20 and V12.5; are 22.5 mm ((Area Under Curve (AUC)-0.565)), 27.15 cc (AUC-0.58), 3.7 Gy (AUC-0.633), 4.6% (AUC-0.597), 9.5% (AUC-0.616). The incidence of ≥grade 2 RP was significantly high for values higher than the ROC threshold. CONCLUSION SABR treatment resulted in a very low rate of grade 3 pneumonitis. Lower lobe tumor location, larger tumor size, PTV, mean lung dose, V20, and V12.5 were found to be significant predictors of symptomatic radiation pneumonitis.
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Affiliation(s)
- Animesh Saha
- Department of Oncology, Apollo Gleneagles Cancer Hospital, Kolkata, India.
| | - Matthew Beasley
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Nathaniel Hatton
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Peter Dickinson
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Kevin Franks
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Katy Clarke
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Pooja Jain
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Mark Teo
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Patrick Murray
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - John Lilley
- Department of Medical Physics, St James's University Hospital, Leeds, UK
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Experimental verification of consistency of micro-silica glass bead thermoluminescent detectors for mixed gamma/neutron irradiation. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2020.109210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Imaizumi A, Araki T, Okada H, Sasaki Y, Komiyama T, Suzuki T, Takahashi H, Onishi H. Transarterial fiducial marker implantation for CyberKnife radiotherapy to treat pancreatic cancer: an experience with 14 cases. Jpn J Radiol 2021; 39:84-92. [PMID: 32918250 PMCID: PMC7813694 DOI: 10.1007/s11604-020-01040-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/26/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the safety and feasibility of transarterial fiducial marker implantation for CyberKnife radiotherapy to treat locally advanced pancreatic cancer. MATERIALS AND METHODS Fifteen pancreatic cancer patients were enrolled for transarterial marker implantation. Embolization platinum coils were implanted as a fiducial marker within 20 mm of the cancer edge, and preferably within 3 mm. The technical success of the implantation was defined as implantation of at least one fiducial marker within 20 mm of the target tumor. Irradiation was performed using the CyberKnife system. RESULTS For 14 of 15 patients, transarterial implantation was successfully performed, and for 13 of 14 patients, the tracking marker was implanted within 3 mm of the cancer. Tracking instability was observed in two patients, but irradiation was accomplished in all 14 patients. No major complications caused by the implantation procedure were observed. The median overall survival after irradiation was 13.8 months, and the 1- and 2-years survival rates were 62.9% and 32.3%, respectively. CONCLUSION Transarterial fiducial marker implantation for pancreatic cancer can be safely performed for tracking, and it will be a valuable alternative approach to percutaneous fiducial marker implantation.
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Affiliation(s)
- Akira Imaizumi
- Department of Radiology, Yamanashi University, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan.
| | - Takuji Araki
- Department of Radiology, Yamanashi University, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Hiroki Okada
- Department of Radiology, Yamanashi University, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Yu Sasaki
- Department of Radiology, Yamanashi University, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Takafumi Komiyama
- Department of Radiology, Yamanashi University, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Toshihiro Suzuki
- Kasugai CyberKnife Rehabilitation Hospital, 436 Kokufu, Kasugai-cho, Fuefuki, Yamanashi, 406-0014, Japan
| | - Hiroshi Takahashi
- Kasugai CyberKnife Rehabilitation Hospital, 436 Kokufu, Kasugai-cho, Fuefuki, Yamanashi, 406-0014, Japan
| | - Hiroshi Onishi
- Department of Radiology, Yamanashi University, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan
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Vempati P, Halthore AN, Teckie S, Rana Z, Gogineni E, Antone J, Zhang H, Marrero M, Beadle K, Frank DK, Aziz M, Paul D, Ghaly M. Phase I trial of dose-escalated stereotactic radiosurgery (SRS) boost for unfavorable locally advanced oropharyngeal cancer. Radiat Oncol 2020; 15:278. [PMID: 33308265 PMCID: PMC7731764 DOI: 10.1186/s13014-020-01718-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/13/2020] [Indexed: 12/28/2022] Open
Abstract
Background and purpose Patients with locally advanced oropharynx squamous cell carcinoma have suboptimal outcomes with standard chemoradiation. Here, we evaluated toxicity and oncologic outcomes of dose escalation using radiosurgical boost for patients with unfavorable oropharynx squamous cell carcinoma. Materials and methods Between 2010–2017, Thirty four patients with intermediate- or high-risk oropharynx squamous cell carcinoma were enrolled onto this prospective phase I trial. Each patient received concurrent cisplatin and fractionated radiotherapy totaling 60 Gy or 66 Gy followed by radiosurgery boost to areas of residual gross tumor: single fraction of 8 Gy or 10 Gy, or two fractions of 5 Gy each. Primary endpoint was treatment toxicity. Secondary endpoints were local, regional, and distant disease control. Results Eleven, sixteen and seven patients received radiosurgery boost with 8 Gy in 1 fraction, 10 Gy in 1 fraction, and 10 Gy in 2 fractions respectively. Acute toxicities include 4 patients with tumor necrosis causing grade 3 dysphagia, of which 3 developed grade 4 pharyngeal hemorrhage requiring surgical intervention. At 24 months after treatment, 7%, 9%, and 15% had grade 2 dysgeusia, xerostomia, and dysphagia, respectively, and two patients remained feeding tube dependent. No grade 5 toxicities occurred secondary to treatment. Local, regional, and distant control at a median follow up of 4.2 years were 85.3%, 85.3% and 88.2%, respectively. Five patients died resulting in overall survival of 85.3%. Conclusions This study is the first to report the use of radiosurgery boost dose escalation in patients with unfavorable oropharynx squamous cell carcinoma. Longer follow-up, larger cohorts, and further refinement of boost methodology are needed prior to implementation in routine clinical practice. Trial Registration: Northwell Health Protocol #09-309A (NCT02703493) (https://clinicaltrials.gov/ct2/show/NCT02703493)
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Affiliation(s)
- Prashant Vempati
- Department of Radiation Medicine, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 450 Lakeville Road, Lake Success, NY, 11040, USA.,Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Aditya N Halthore
- Department of Radiation Medicine, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 450 Lakeville Road, Lake Success, NY, 11040, USA.,Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Sewit Teckie
- Department of Radiation Medicine, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 450 Lakeville Road, Lake Success, NY, 11040, USA.,Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Zaker Rana
- Department of Radiation Medicine, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 450 Lakeville Road, Lake Success, NY, 11040, USA.,Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Emile Gogineni
- Department of Radiation Medicine, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 450 Lakeville Road, Lake Success, NY, 11040, USA.,Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Jeffrey Antone
- Department of Radiation Medicine, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 450 Lakeville Road, Lake Success, NY, 11040, USA
| | - Honglai Zhang
- Department of Radiation Medicine, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 450 Lakeville Road, Lake Success, NY, 11040, USA
| | - Mihaela Marrero
- Department of Radiation Medicine, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 450 Lakeville Road, Lake Success, NY, 11040, USA
| | - Kristin Beadle
- Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Douglas K Frank
- Hofstra Northwell School of Medicine, Hempstead, NY, USA.,Department of Otolaryngology, Northwell Health, Lake Success, NY, USA
| | - Mohamed Aziz
- Hofstra Northwell School of Medicine, Hempstead, NY, USA
| | - Doru Paul
- Hofstra Northwell School of Medicine, Hempstead, NY, USA.,Department of Hematology/Oncology, Northwell Health, Lake Success, NY, USA
| | - Maged Ghaly
- Department of Radiation Medicine, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, 450 Lakeville Road, Lake Success, NY, 11040, USA. .,Hofstra Northwell School of Medicine, Hempstead, NY, USA.
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Chiu MH, Mitchell LB, Ploquin N, Faruqi S, Kuriachan VP. Review of Stereotactic Arrhythmia Radioablation Therapy for Cardiac Tachydysrhythmias. CJC Open 2020; 3:236-247. [PMID: 33778440 PMCID: PMC7984992 DOI: 10.1016/j.cjco.2020.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/06/2020] [Indexed: 12/04/2022] Open
Abstract
Cardiac tachyarrhythmias are a major cause of morbidity and mortality. Treatments for these tachyarrhythmias include antiarrhythmic drugs, catheter ablation, surgical ablation, cardiac implantable electronic devices, and cardiac transplantation. Each of these treatment approaches is effective in some patients but there is considerable room for improvement, particularly with respect to the most common of the tachydysrhythmias, atrial fibrillation, and the most dangerous of the tachydysrhythmias, ventricular tachycardia (VT) or ventricular fibrillation. Noninvasive stereotactic ablative radiation therapy is emerging as an effective treatment for refractory tachyarrhythmias. Animal models have shown successful ablation of arrhythmogenic myocardial substrates with minimal short-term complications. Studies of stereotactic radioablation involving patients with refractory VT have shown a reduction in VT recurrence and promising early safety data. In this review, we provide the background for the application of stereotactic arrhythmia radioablation therapy along with promising results from early applications of the technology.
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Affiliation(s)
- Michael H Chiu
- Libin Cardiovascular Institute of Alberta, Department of Cardiac Sciences, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - L Brent Mitchell
- Libin Cardiovascular Institute of Alberta, Department of Cardiac Sciences, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Nicolas Ploquin
- Libin Cardiovascular Institute of Alberta, Department of Cardiac Sciences, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Salman Faruqi
- Libin Cardiovascular Institute of Alberta, Department of Cardiac Sciences, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Vikas P Kuriachan
- Libin Cardiovascular Institute of Alberta, Department of Cardiac Sciences, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
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Dalwadi S, Echeverria A, Jhaveri P, Bui T, Waheed N, Tran D, Bonnen M, Ludwig M. Non-invasive stereotactic ablative boost in patients with locally advanced cervical cancer. Int J Gynecol Cancer 2020; 30:1684-1688. [PMID: 32636273 DOI: 10.1136/ijgc-2019-001104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The current literature is insufficient to guide care for patients with cervical cancer ineligible for brachytherapy. Stereotactic ablative radiotherapy boost is a clinical necessity for these patients, but highly debated among radiation oncologists. OBJECTIVE To report toxicity and survival outcomes in a large cohort of patients with locally advanced cervical cancer treated with a non-invasive stereotactic ablative radiotherapy boost instead of brachytherapy METHODS: Patients with locally advanced cervical cancer were entered, between January 2008 and December 2018, who were recommended definitive intent external boost after pelvic radiotherapy to 45-50.4 Gy concurrent with weekly cisplatin and simultaneous/sequential nodal boost up to 55-66 Gy. Simulation CT was facilitated using radio-opaque fiducials, empty rectum, dedicated bladder filling, and whole body vaculoplastic immobilization. Kaplan-Meier survival estimates were used to report local/regional recurrences, distant metastases, cancer-specific survival, and overall survival. RESULTS A total of 25 patients were analyzed. Median follow-up was 25 months (range 6-54). Patients received stereotactic ablative radiotherapy due to refusal of brachytherapy (9/25, 36%), medical co-morbidities limiting implantation (9/25, 36%), or technical infeasibility (7/25, 28%). Typical fractionation was 24-30 Gy in 4-5 fractions (24/25, 96%). The most common long-term toxicity was grade 1-2 vaginal dryness, discomfort, stenosis, and/or dyspareunia (4/25, 16%). One patient had new post-treatment grade 4 fistula in an area of previous tumor erosion (1/25, 4%). Overall survival, cancer specific survival, loco-regional control, and distant control were 95.5%, 100%, 95.5%, and 89.1%, respectively, at 2 years. CONCLUSION Further study of stereotactic ablative radiotherapy boost for cervical cancer is needed; a brachytherapy-similar approach portends clinical success with 95.5% overall survival and loco-regional control at 2 years.
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Affiliation(s)
- Shraddha Dalwadi
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Alfredo Echeverria
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Pavan Jhaveri
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Tung Bui
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Nabila Waheed
- Department of Radiation Oncology, The Center for Cancer and Blood Disorders, Dallas, Texas, United States
| | - Danny Tran
- Department of Radiation Oncology, Remote Dosimetry Services, Houston, Texas, USA
| | - Mark Bonnen
- Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Michelle Ludwig
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas, USA
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Farrugia B, Khor R, Foroudi F, Chao M, Knight K, Wright C. Protocol of a study investigating breath-hold techniques for upper-abdominal radiation therapy (BURDIE): addressing the challenge of a moving target. Radiat Oncol 2020; 15:250. [PMID: 33126899 PMCID: PMC7602358 DOI: 10.1186/s13014-020-01688-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 10/20/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Radiation therapy to upper abdominal sites is technically challenging due to motion of tumors and surrounding organs resulting from normal respiration. Breath-hold, using an Active Breathing Coordinator is one strategy used to reduce motion in these tumor sites. Though widely used, no studies have prospectively compared the different breath-hold techniques (inspiration, deep-inspiration and expiration) using ABC in the same patient cohort. METHODS Patients planned for radiation therapy to upper abdominal tumors are invited to participate in this prospective study. Participants attempt three breath hold techniques: inspiration, deep-inspiration and expiration breath-hold, in random order. kV fluoroscopy images of the dome of diaphragm are taken of five consecutive breath-holds in each technique. Reproducibility and stability of tumour position are measured, and used to select the technique with which to proceed to planning and treatment. Reproducibility at planning and each treatment fraction is measured, along with breath hold time, treatment efficiency and patient experience. DISCUSSION The screening method was validated after the first three participants. This screening process may be able to select the best breath-hold technique for an individual, which may lead to improved reproducibility. The screening process is being piloted as a prospective clinical trial. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR): 12618001691235. Registered 12th October 2018. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376109&isReview=true .
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Affiliation(s)
- Briana Farrugia
- Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia. .,Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, VIC, 3800, Australia.
| | - Richard Khor
- Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia
| | - Farshad Foroudi
- Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia
| | - Michael Chao
- Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia
| | - Kellie Knight
- Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, VIC, 3800, Australia
| | - Caroline Wright
- Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, VIC, 3800, Australia
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Impact of a vacuum cushion on intrafraction motion during online adaptive MR-guided SBRT for pelvic and para-aortic lymph node oligometastases. Radiother Oncol 2020; 154:110-117. [PMID: 32950531 DOI: 10.1016/j.radonc.2020.09.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE Vacuum cushion immobilization is commonly used during stereotactic body radiotherapy (SBRT) to reduce intrafraction motion. We investigated target and bony anatomy intrafraction motion (translations and rotations) during online adaptive SBRT on an MR-linac for pelvic/para-aortic lymph node metastases with and without vacuum cushion. MATERIALS AND METHODS Thirty-nine patients underwent 5x7 Gy SBRT on a 1.5T MR-linac, 19 patients were treated with vacuum cushion, 19 without and 1 patient sequentially with and without. Intrafraction motion was calculated for target lymph nodes (GTVs) and nearby bony anatomy, for three time intervals (pre-position verification (PV), pre-post, PV-post, relating to the online MRI scans) per treatment fraction. RESULTS Vacuum cushion immobilization significantly reduced anterior-posterior translations for the pre-PV and pre-post intervals, for bony anatomy and pre-post interval for GTV (p < 0.05). Mean GTV intrafraction motion reduction in posterior direction was 0.7 mm (95% confidence interval 0.3-1.1 mm) for pre-post interval (mean time = 32 min). Shifts in other directions were not significantly reduced. More motion occurred in pre-PV interval than in PV-post interval (mean time = 16 min for both); vacuum cushion immobilization did not reduce intrafraction motion during the beam-on period. CONCLUSION A vacuum cushion reduces GTV and bony anatomy intrafraction motion in posterior direction during pelvic/para-aortic lymph node SBRT. This motion reduction was found for the first 16 min per session. For single targets this motion can be corrected for directly with an MR-linac. Intrafraction motion was not reduced during the second half of the session, the period of radiotherapy delivery on an MR-linac. Vacuum cushion immobilization may not be necessary for patients with single lymph node oligometastases undergoing SBRT on an MR-linac.
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40
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Yanagihara TK, Wang TJC. Commentary: Stagnant Venous Outflow Predicts Brain Arteriovenous Malformation Obliteration After Gamma Knife Radiosurgery Without Prior Intervention. Neurosurgery 2020; 87:E119-E120. [PMID: 31792535 DOI: 10.1093/neuros/nyz518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ted K Yanagihara
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Tony J C Wang
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York
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41
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Kjærgaard K, Weber B, Alstrup AKO, Petersen JBB, Hansen R, Hamilton-Dutoit SJ, Mortensen FV, Sørensen M. Hepatic regeneration following radiation-induced liver injury is associated with increased hepatobiliary secretion measured by PET in Göttingen minipigs. Sci Rep 2020; 10:10858. [PMID: 32616907 PMCID: PMC7331737 DOI: 10.1038/s41598-020-67609-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 05/26/2020] [Indexed: 12/11/2022] Open
Abstract
Normal liver tissue is highly vulnerable towards irradiation, which remains a challenge in radiotherapy of hepatic tumours. Here, we examined the effects of radiation-induced liver injury on two specific liver functions and hepatocellular regeneration in a minipig model. Five Göttingen minipigs were exposed to whole-liver stereotactic body radiation therapy (SBRT) in one fraction (14 Gy) and examined 4–5 weeks after; five pigs were used as controls. All pigs underwent in vivo positron emission tomography (PET) studies of the liver using the conjugated bile acid tracer [N-methyl-11C]cholylsarcosine ([11C]CSar) and the galactose-analogue tracer [18F]fluoro-2-deoxy-d-galactose ([18F]FDGal). Liver tissue samples were evaluated histopathologically and by immunohistochemical assessment of hepatocellular mitosis, proliferation and apoptosis. Compared with controls, both the rate constant for secretion of [11C]CSar from hepatocytes into intrahepatic bile ducts as well as back into blood were doubled in irradiated pigs, which resulted in reduced residence time of [11C]CSar inside the hepatocytes. Also, the hepatic systemic clearance of [18F]FDGal in irradiated pigs was slightly increased, and hepatocellular regeneration was increased by a threefold. In conclusion, parenchymal injury and increased regeneration after whole-liver irradiation was associated with enhanced hepatobiliary secretion of bile acids. Whole-liver SBRT in minipigs ultimately represents a potential large animal model of radiation-induced liver injury and for testing of normal tissue protection methods.
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Affiliation(s)
- Kristoffer Kjærgaard
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, 8200, Aarhus N, Denmark. .,Department of Hepatology and Gastroenterology, Aarhus University Hospital, 8200, Aarhus N, Denmark.
| | - Britta Weber
- Department of Oncology, Aarhus University Hospital, 8200, Aarhus N, Denmark
| | | | | | - Rune Hansen
- Department of Oncology, Aarhus University Hospital, 8200, Aarhus N, Denmark
| | | | | | - Michael Sørensen
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, 8200, Aarhus N, Denmark.,Department of Hepatology and Gastroenterology, Aarhus University Hospital, 8200, Aarhus N, Denmark
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Gough MJ, Sharon S, Crittenden MR, Young KH. Using Preclinical Data to Design Combination Clinical Trials of Radiation Therapy and Immunotherapy. Semin Radiat Oncol 2020; 30:158-172. [PMID: 32381295 PMCID: PMC7213059 DOI: 10.1016/j.semradonc.2019.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Immunotherapies are rapidly entering the clinic as approved treatments for diverse cancer pathologies. Radiation therapy is an integral partner in cancer therapy, commonly as part of complicated multimodality approaches that optimize patient outcomes. Preclinical studies have demonstrated that the success of radiation therapy in tumor control is due in part to immune mechanisms, and that outcomes following radiation therapy can be improved through combination with a range of immunotherapies. However, preclinical models of cancer are very different from patient tumors, and the way these preclinical tumors are treated is often very different from standard of care treatment of patients. This review examines the preclinical and clinical data for the role of the immune system in radiation therapy outcomes, and how to integrate preclinical findings into clinical trials, using ongoing studies as examples.
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Affiliation(s)
- Michael J Gough
- Earle A. Chiles Research Institute, Providence Cancer Institute, Providence Portland Medical Center, Portland, OR.
| | - Shay Sharon
- Department of Oral and Maxillofacial Surgery, Hadassah and Hebrew University Medical Center, Jerusalem, ISRAEL
| | - Marka R Crittenden
- Earle A. Chiles Research Institute, Providence Cancer Institute, Providence Portland Medical Center, Portland, OR; The Oregon Clinic, Portland, OR
| | - Kristina H Young
- Earle A. Chiles Research Institute, Providence Cancer Institute, Providence Portland Medical Center, Portland, OR; The Oregon Clinic, Portland, OR
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Antony R, Lonski P, Ungureanu E, Hardcastle N, Yeo A, Siva S, Kron T. Independent review of 4DCT scans used for SABR treatment planning. J Appl Clin Med Phys 2020; 21:62-67. [PMID: 32053280 PMCID: PMC7075381 DOI: 10.1002/acm2.12825] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 12/08/2019] [Accepted: 12/26/2019] [Indexed: 12/01/2022] Open
Abstract
Four-dimensional computerized tomography (4DCT) is required for stereotactic ablative body radiotherapy (SABR) of mobile targets to account for tumor motion during treatment planning and delivery. In this study, we report on the impact of an image review quality assurance process performed prior to treatment planning by medical physicists for 4DCT scans used for SABR treatment. Reviews were performed of 211 4DCT scans (193 patients) over a 3-yr period (October 2014 to October 2017). Treatment sites included lung (n = 168), kidney/adrenal/adrenal gland (n = 12), rib (n = 4), mediastinum (n = 10), liver (n = 2), T-spine (n = 1), and other abdominal sites (n = 14). It was found that in 23% (n = 49) of cases patient management was altered due to the review process. The most frequent intervention involved patient-specific contouring advice (n = 35 cases, 17%) including adjustment of internal target volume (ITV) margins. In 13 cases (6%) a rescan was requested due to extensive motion artifact rendering the scan inadequate for SABR treatment planning. 4DCT review by medical physicists was found to be an effective method to improve plan quality for SABR.
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Affiliation(s)
- Rachitha Antony
- Department of Physical SciencesPeter MacCallum Cancer CentreMelbourneVicAustralia
| | - Peta Lonski
- Department of Physical SciencesPeter MacCallum Cancer CentreMelbourneVicAustralia
| | - Elena Ungureanu
- Department of Physical SciencesPeter MacCallum Cancer CentreMelbourneVicAustralia
| | - Nicholas Hardcastle
- Department of Physical SciencesPeter MacCallum Cancer CentreMelbourneVicAustralia
- Centre for Medical Radiation PhysicsUniversity of WollongongWollongongNSWAustralia
| | - Adam Yeo
- Department of Physical SciencesPeter MacCallum Cancer CentreMelbourneVicAustralia
| | - Shankar Siva
- Department of Radiation OncologyPeter MacCallum Cancer CentreMelbourneVicAustralia
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVicAustralia
| | - Tomas Kron
- Department of Physical SciencesPeter MacCallum Cancer CentreMelbourneVicAustralia
- Sir Peter MacCallum Department of OncologyUniversity of MelbourneMelbourneVicAustralia
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A Novel Approach for Treatment of Uterine Fibroids: Stereotactic Radiosurgery as a Proposed Treatment Modality. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2020. [DOI: 10.1007/s13669-020-00277-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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45
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Rodríguez-Barbeito P, Díaz-Botana P, Gago-Arias A, Feijoo M, Neira S, Guiu-Souto J, López-Pouso Ó, Gómez-Caamaño A, Pardo-Montero J. A Model of Indirect Cell Death Caused by Tumor Vascular Damage after High-Dose Radiotherapy. Cancer Res 2019; 79:6044-6053. [PMID: 31641030 DOI: 10.1158/0008-5472.can-19-0181] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 07/02/2019] [Accepted: 10/16/2019] [Indexed: 11/16/2022]
Abstract
There is increasing evidence that high doses of radiotherapy, like those delivered in stereotactic body radiotherapy (SBRT), trigger indirect mechanisms of cell death. Such effect seems to be two-fold. High doses may trigger an immune response and may cause vascular damage, leading to cell starvation and death. Development of mathematical response models, including indirect death, may help clinicians to design SBRT optimal schedules. Despite increasing experimental literature on indirect tumor cell death caused by vascular damage, efforts on modeling this effect have been limited. In this work, we present a biomathematical model of this effect. In our model, tumor oxygenation is obtained by solving the reaction-diffusion equation; radiotherapy kills tumor cells according to the linear-quadratic model, and also endothelial cells (EC), which can trigger loss of functionality of capillaries. Capillary death will affect tumor oxygenation, driving nearby tumor cells into severe hypoxia. Capillaries can recover functionality due to EC proliferation. Tumor cells entering a predetermined severe hypoxia status die according to a hypoxia-death model. This model fits recently published experimental data showing the effect of vascular damage on surviving fractions. It fits surviving fraction curves and qualitatively reproduces experimental values of percentages of functional capillaries 48 hours postirradiation, and hypoxic cells pre- and 48 hours postirradiation. This model is useful for exploring aspects of tumor and EC response to radiotherapy and constitutes a stepping stone toward modeling indirect tumor cell death caused by vascular damage and accounting for this effect during SBRT planning. SIGNIFICANCE: A novel biomathematical model of indirect tumor cell death caused by vascular radiation damage could potentially help clinicians interpret experimental data and design better radiotherapy schedules.
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Affiliation(s)
- Pedro Rodríguez-Barbeito
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain.,Department of Applied Mathematics, Universidade de Santiago de Compostela, Spain
| | - Pablo Díaz-Botana
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain.,Galician Supercomputation Center (CESGA), Santiago de Compostela, Spain
| | - Araceli Gago-Arias
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain.,Institute of Physics, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Manuel Feijoo
- Department of Particle Physics, Universidade de Santiago de Compostela, Spain
| | - Sara Neira
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | - Jacobo Guiu-Souto
- Department of Medical Physics, Complexo Hospitalario Universitario de Santiago de Compostela, Spain.,Department of Medical Physics, Fundación Centro Oncolóxico de Galicia, A Coruña, Spain
| | - Óscar López-Pouso
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain.,Department of Applied Mathematics, Universidade de Santiago de Compostela, Spain
| | - Antonio Gómez-Caamaño
- Department of Radiotherapy, Complexo Hospitalario Universitario de Santiago de Compostela, Spain
| | - Juan Pardo-Montero
- Group of Medical Physics and Biomathematics, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain. .,Department of Medical Physics, Complexo Hospitalario Universitario de Santiago de Compostela, Spain
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Hoffman D, Dragojević I, Hoisak J, Hoopes D, Manger R. Lung Stereotactic Body Radiation Therapy (SBRT) dose gradient and PTV volume: a retrospective multi-center analysis. Radiat Oncol 2019; 14:162. [PMID: 31481089 PMCID: PMC6724320 DOI: 10.1186/s13014-019-1334-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 07/09/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The treatment of lung lesions with stereotactic body radiation therapy calls for highly conformal dose, which is evaluated by a number of metrics. Lung stereotactic body radiation therapy clinical trials constrain a plans gradient index. The purpose of this work is to describe the dependence of clinically achievable dose gradient on planning target volume. METHODS Three hundred seventy-four lung stereotactic body radiation therapy treatment plans were retrospectively reviewed and selected for this study. The relationship between R50% and planning target volume size was observed and compared against the RTOG 0915 and 0813 constraints noting minor and major deviations. Then a least squares regression was used to determine the coefficients for a power functional form of the dependence of gradient measure (GM) on planning target volume size. RESULTS Of the 317 peripheral lung SBRT plans, 142 exhibited no deviation, 135 exhibited a minor deviation, and 40 exhibited a major deviation according to the RTOG 0915 dosimetric. conformality and dose fall-off constraints. A plot of gradient measure versus planning target volume size for peripheral lesions, excluding RTOG 0915 major deviations, is fit with an power function of GM = 0.564 V0.215. CONCLUSIONS Using the PTV size and GM relationship we have characterized, treatment plans with PTV < 85 cm3 can be evaluated subjectively to our previously plans, and given a percentile GM. This relationship and evaluation is useful for volumetric modulated arc therapy lung stereotactic body radiation therapy treatment planning and quality control.
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Affiliation(s)
- David Hoffman
- UC San Diego Radiation Medicine and Applied Sciences, 3855 Health Sciences Dr. #0843, La Jolla, CA 92093-0843 USA
| | - Irena Dragojević
- UC San Diego Radiation Medicine and Applied Sciences, 3855 Health Sciences Dr. #0843, La Jolla, CA 92093-0843 USA
| | - Jeremy Hoisak
- UC San Diego Radiation Medicine and Applied Sciences, 3855 Health Sciences Dr. #0843, La Jolla, CA 92093-0843 USA
| | - David Hoopes
- UC San Diego Radiation Medicine and Applied Sciences, 3855 Health Sciences Dr. #0843, La Jolla, CA 92093-0843 USA
| | - Ryan Manger
- UC San Diego Radiation Medicine and Applied Sciences, 3855 Health Sciences Dr. #0843, La Jolla, CA 92093-0843 USA
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Henry EC, Mawko G, Tonkopi E, Frampton J, Kehoe S, Boyd D, Abraham R, Gregoire M, O’Connell K, Kappadath SC, Syme A. Quantification of the inherent radiopacity of glass microspheres for precision dosimetry in yttrium-90 radioembolization. Biomed Phys Eng Express 2019. [DOI: 10.1088/2057-1976/ab36c2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Taggart M, Charoupa A, Hubbard M, Jafari S, Lohstroh A, Stroud M. Suitability of a SiPM photodetector for implementation in an automated thermoluminescent dosimeter reader. Radiat Phys Chem Oxf Engl 1993 2019. [DOI: 10.1016/j.radphyschem.2019.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Improved respiratory motion tracking through a novel fiducial marker placement guidance system during electromagnetic navigational bronchoscopy (ENB). Radiat Oncol 2019; 14:124. [PMID: 31296231 PMCID: PMC6625013 DOI: 10.1186/s13014-019-1306-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/24/2019] [Indexed: 12/31/2022] Open
Abstract
Background Stereotactic ablative radiotherapy (SABR) is a treatment option for patients with early stage non-small cell lung cancer (NSCLC) and recurrent or oligometastatic disease who are not surgical candidates. Due to the continuous motion of tumors within the lungs, implementing a strategy to track the target lesion is crucial. One method is to place fiducial markers which the robotic SABR system is able to track during treatment. However, placing these markers in a manner that maximizes tracking efficacy can be challenging. Using a novel fiducial placement guidance system (FPGS) during fiducial deployment may offer a way to improve the quantity of fiducials tracked by the robotic SABR system. Method This was an institutional, retrospective review identifying all patients who received robotic SABR for lung tumors from May 2015 until January 2017. The FPGS was instituted in May 2016. The median number of fiducials tracked and the rate of complication was compared between patients whose fiducials were placed using FPGS versus those that were not. Results A total of 128 patients with 147 treated lung lesions were identified. Of the lesions that utilized FPGS (n = 44), 28 had 2 tracked fiducials (63.6%), 14 had 3 (31.8%) and 2 had 4 (4.6%). Of the lesions treated without FPGS (n = 103), 5 had 1 tracked fiducial (4.9%), 91 had 2 (88.4%), 6 had 3 (5.8%), and 2 had 4 (1.9%). A significant improvement in the median number of fiducials tracked per fraction was observed for the lesions with fiducials placed using FPGS on Wilcoxon rank sum test (p < 0.001). The rate of complication was low and not statistically different between cohorts (p = 0.44). Conclusions The FPGS can be used during the deployment of fiducial markers and may increase the number of fiducials tracked. Trial registration An exemption for this retrospective review was granted by the East Carolina University IRB under UMCIRB 15-001726.
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Chun M, Joon An H, Kwon O, Oh DH, Park JM, Kim JI. Impact of plan parameters and modulation indices on patient-specific QA results for standard and stereotactic VMAT. Phys Med 2019; 62:83-94. [PMID: 31153402 DOI: 10.1016/j.ejmp.2019.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 05/03/2019] [Accepted: 05/04/2019] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To demonstrate the impact of modulation indices and plan parameters on the gamma passing rates (GPR) of patient-specific quality assurance of standard and stereotactic volumetric modulated arc therapy (VMAT) plans. METHODS A total of 758 patients' QA plans were utilized, including standard VMAT plans with Trilogy (n = 87, group A) and TreuBeam STx (n = 332, group B), and 339 stereotactic VMAT plans with TrueBeam STx (group C). Modulation indices were obtained considering the speed and acceleration of the multileaf collimator (MLC) (MIs, MIa), and MLC, gantry speed, and dose rate changes (MIt). The mean aperture size (MA), monitor unit (MU), and amount of jaw tracking (%JT) were acquired. Gamma analysis was performed with 2 mm/2% and 1 mm/2% for the standard and stereotactic VMAT plans, respectively. Statistical analyses were performed to investigate the correlation between modulation index/plan parameters and GPR. RESULTS Spearman's rank correlation to GPRs with MIs, MIa, and MIt, were -0.44, -0.45, and -0.46 for group A; -0.39, -0.37, and -0.38 for group B; and -0.04, -0.11, and -0.10 for group C, respectively. While MU and MA showed significant correlations in all groups, %JT showed a significant correlation only with stereotactic VMAT plans. The most influential parameter combinations were MU-MA (rs = 0.50), MIs-%JT (rs = 0.43), and MU-%JT (rs = 0.38) for groups A, B, and C, respectively. CONCLUSIONS MLC modulation mostly affected the GPR in the delivery of standard VMAT plans, while MU and %JT showed more importance in stereotactic VMAT plans.
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Affiliation(s)
- Minsoo Chun
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Hyun Joon An
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ohyun Kwon
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Do Hoon Oh
- Department of Radiation Oncology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jong Min Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea; Center for Convergence Research on Robotics, Advanced Institutes of Convergence Technology, Suwon, Republic of Korea
| | - Jung-In Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.
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