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Chuong MD, Mittauer KE, Bassetti MF, Rojas C, Glide-Hurst C, Kalman NS, Tom MC, Rubens M, Crosby J, Burr A, Tolakanahalli R, Gutierrez AN, Bassiri N, Mehta MP, Kotecha R. Stereotactic Magnetic Resonance Guided Adaptive Radiation Therapy in One Fraction: A Multicenter, Single-Arm, Phase 2 Trial. Int J Radiat Oncol Biol Phys 2025:S0360-3016(25)00263-9. [PMID: 40158734 DOI: 10.1016/j.ijrobp.2025.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2025] [Revised: 03/10/2025] [Accepted: 03/15/2025] [Indexed: 04/02/2025]
Abstract
PURPOSE Stereotactic body radiation therapy (SBRT) is an advanced technique that enables precise delivery of radiation directly to a tumor, typically in ≤5 fractions. Single-fraction SBRT for visceral tumors is uncommon, likely related to concerns about risks of geographic tumor miss because of suboptimal cone beam computed tomography scan quality on conventional linear accelerators (linacs). Magnetic resonance (MR) guided linacs are a novel technology offering superior imaging that might facilitate the safe delivery of single-fraction SBRT. METHODS AND MATERIALS We conducted a multicenter phase 2 trial of single-fraction SBRT delivered on a 0.35 Tesla MR-linac for primary or metastatic lesions of the lung (30-34 Gy; biologically effective dose [BED10] = 120-149.6 Gy10), liver (35-40 Gy; BED10 = 157.5-200 Gy10), pancreas (25 Gy; BED10 = 87.5 Gy10), adrenal gland (25 Gy10), kidney (25 Gy10), and abdominal/pelvic lymph nodes (25 Gy10). Primary objectives included feasibility and safety. The trial is registered with ClinicalTrials.gov, NCT04939246. RESULTS The study accrued 30 patients with 32 lesions at 2 centers in the United States between June 2021 and June 2023. All patients had 1 lesion except for 2 with 2 lesions each. Target locations included lung (34.4%), adrenal gland (28.1%), lymph node (18.8%), liver (15.6%), and pancreas (3.1%). The primary objectives were met; total in-room time was <90 minutes for 87.1% of delivered plans and 1 acute grade 3 adverse event was possibly related to single-fraction SBRT. No late grade 3-to-5 adverse events were observed. One-year local control and overall survival were 96.2% (95% CI, 88.8%-100%) and 86.3% (95% CI, 73.8%-98.8%), respectively. CONCLUSIONS This is the first prospective study to demonstrate that MR guided single-fraction SBRT is feasible, safe, and effective for not only tumors in the peripheral lung, but also the abdomen and pelvis. Future studies should clarify patient selection for single- versus multifraction SBRT.
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Affiliation(s)
- Michael D Chuong
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida.
| | - Kathryn E Mittauer
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida
| | - Michael F Bassetti
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Carolina Rojas
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida
| | - Carri Glide-Hurst
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Noah S Kalman
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida
| | - Martin C Tom
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Muni Rubens
- Office of Clinical Research, Miami Cancer Institute, Miami, Florida
| | - Jennie Crosby
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Adam Burr
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Alonso N Gutierrez
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida
| | - Nema Bassiri
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida
| | - Minesh P Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida
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Herrera RA, Akdemir EY, Kotecha R, Mittauer KE, Hall MD, Kaiser A, Bassiri-Gharb N, Kalman NS, Weiss Y, Romaguera T, Alvarez D, Yarlagadda S, Tolakanahalli R, Gutierrez AN, Mehta MP, Chuong MD. Evolving Trends and Patterns of Utilization of Magnetic Resonance-Guided Radiotherapy at a Single Institution, 2018-2024. Cancers (Basel) 2025; 17:208. [PMID: 39857990 PMCID: PMC11763864 DOI: 10.3390/cancers17020208] [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: 11/30/2024] [Revised: 01/02/2025] [Accepted: 01/07/2025] [Indexed: 01/27/2025] Open
Abstract
Background/Objectives: Over the past decade, significant advances have been made in image-guided radiotherapy (RT) particularly with the introduction of magnetic resonance (MR)-guided radiotherapy (MRgRT). However, the optimal clinical applications of MRgRT are still evolving. The intent of this analysis was to describe our institutional MRgRT utilization patterns and evolution therein, specifically as an early adopter within a center endowed with multiple other technology platforms. Materials/Methods: We retrospectively evaluated patterns of MRgRT utilization for patients treated with a 0.35-Tesla MR-Linac at our institution from April 2018 to April 2024. We analyzed changes in utilization across six annualized periods: Period 1 (April 2018-April 2019) through Period 6 (April 2023-April 2024). We defined ultra-hypofractionation (UHfx) as 5 or fewer fractions with a minimum fractional dose of 5 Gy. Electronic health records were reviewed, and data were extracted related to patient, tumor, and treatment characteristics. Results: A total of 823 treatment courses were delivered to 712 patients treated for 854 lesions. The most commonly treated sites were the pancreas (242 [29.4%]), thorax (172; 20.9%), abdominopelvic lymph nodes (107; 13.0%), liver (72; 8.7%), and adrenal glands (68; 8.3%). The median total prescribed dose of 50 Gy in five fractions (fxs) was typically delivered in consecutive days with automatic beam gating in inspiration breath hold. The median biologically effective dose (α/β = 10, BED10) was 94.4 Gy with nearly half (404, 49.1%) of all courses at a prescribed BED10 ≥ 100 Gy, which is widely regarded as a highly effective ablative dose. Courses in Period 6 vs. Period 1 more often had a prescribed BED10 ≥ 100 Gy (60.2% vs. 41.6%; p = 0.004). Of the 6036 total delivered fxs, nearly half (2643, 43.8%) required at least one fx of on-table adaptive radiotherapy (oART), most commonly for pancreatic tumors (1081, 17.9%). UHfx was used in over three quarters of all courses (630, 76.5%) with 472 (57.4%) of these requiring oART for at least one fraction. The relative utilization of oART increased significantly from Period 1 to Period 6 (37.6% to 85.0%; p < 0.001); a similar increase in the use of UHfx (66.3% to 89.5%; p < 0.001) was also observed. The median total in-room time for oART decreased from 81 min in Period 1 to 45 min in Period 6, while for non-oART, it remained stable around 40 min across all periods. Conclusions: Our institution implemented MRgRT with a priority for targeting mobile extracranial tumors in challenging anatomic locations that are frequently treated with dose escalation, require enhanced soft-tissue visualization, and could benefit from an ablative radiotherapy approach. Over the period under evaluation, the use of high-dose ablative doses (BED10 ≥ 100 Gy), oART and UHfx (including single-fraction ablation) increased significantly, underscoring both a swift learning curve and ability to optimize processes to maximize throughput and efficiency.
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Affiliation(s)
- Robert A. Herrera
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; (E.Y.A.); (R.K.); (K.E.M.); (M.D.H.); (N.B.-G.); (N.S.K.); (Y.W.); (T.R.); (D.A.); (S.Y.); (R.T.); (A.N.G.); (M.P.M.)
| | - Eyub Y. Akdemir
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; (E.Y.A.); (R.K.); (K.E.M.); (M.D.H.); (N.B.-G.); (N.S.K.); (Y.W.); (T.R.); (D.A.); (S.Y.); (R.T.); (A.N.G.); (M.P.M.)
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; (E.Y.A.); (R.K.); (K.E.M.); (M.D.H.); (N.B.-G.); (N.S.K.); (Y.W.); (T.R.); (D.A.); (S.Y.); (R.T.); (A.N.G.); (M.P.M.)
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Kathryn E. Mittauer
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; (E.Y.A.); (R.K.); (K.E.M.); (M.D.H.); (N.B.-G.); (N.S.K.); (Y.W.); (T.R.); (D.A.); (S.Y.); (R.T.); (A.N.G.); (M.P.M.)
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Matthew D. Hall
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; (E.Y.A.); (R.K.); (K.E.M.); (M.D.H.); (N.B.-G.); (N.S.K.); (Y.W.); (T.R.); (D.A.); (S.Y.); (R.T.); (A.N.G.); (M.P.M.)
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Adeel Kaiser
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; (E.Y.A.); (R.K.); (K.E.M.); (M.D.H.); (N.B.-G.); (N.S.K.); (Y.W.); (T.R.); (D.A.); (S.Y.); (R.T.); (A.N.G.); (M.P.M.)
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Nema Bassiri-Gharb
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; (E.Y.A.); (R.K.); (K.E.M.); (M.D.H.); (N.B.-G.); (N.S.K.); (Y.W.); (T.R.); (D.A.); (S.Y.); (R.T.); (A.N.G.); (M.P.M.)
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Noah S. Kalman
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; (E.Y.A.); (R.K.); (K.E.M.); (M.D.H.); (N.B.-G.); (N.S.K.); (Y.W.); (T.R.); (D.A.); (S.Y.); (R.T.); (A.N.G.); (M.P.M.)
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Yonatan Weiss
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; (E.Y.A.); (R.K.); (K.E.M.); (M.D.H.); (N.B.-G.); (N.S.K.); (Y.W.); (T.R.); (D.A.); (S.Y.); (R.T.); (A.N.G.); (M.P.M.)
| | - Tino Romaguera
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; (E.Y.A.); (R.K.); (K.E.M.); (M.D.H.); (N.B.-G.); (N.S.K.); (Y.W.); (T.R.); (D.A.); (S.Y.); (R.T.); (A.N.G.); (M.P.M.)
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Diane Alvarez
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; (E.Y.A.); (R.K.); (K.E.M.); (M.D.H.); (N.B.-G.); (N.S.K.); (Y.W.); (T.R.); (D.A.); (S.Y.); (R.T.); (A.N.G.); (M.P.M.)
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Sreenija Yarlagadda
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; (E.Y.A.); (R.K.); (K.E.M.); (M.D.H.); (N.B.-G.); (N.S.K.); (Y.W.); (T.R.); (D.A.); (S.Y.); (R.T.); (A.N.G.); (M.P.M.)
| | - Ranjini Tolakanahalli
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; (E.Y.A.); (R.K.); (K.E.M.); (M.D.H.); (N.B.-G.); (N.S.K.); (Y.W.); (T.R.); (D.A.); (S.Y.); (R.T.); (A.N.G.); (M.P.M.)
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Alonso N. Gutierrez
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; (E.Y.A.); (R.K.); (K.E.M.); (M.D.H.); (N.B.-G.); (N.S.K.); (Y.W.); (T.R.); (D.A.); (S.Y.); (R.T.); (A.N.G.); (M.P.M.)
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Minesh P. Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; (E.Y.A.); (R.K.); (K.E.M.); (M.D.H.); (N.B.-G.); (N.S.K.); (Y.W.); (T.R.); (D.A.); (S.Y.); (R.T.); (A.N.G.); (M.P.M.)
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Michael D. Chuong
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; (E.Y.A.); (R.K.); (K.E.M.); (M.D.H.); (N.B.-G.); (N.S.K.); (Y.W.); (T.R.); (D.A.); (S.Y.); (R.T.); (A.N.G.); (M.P.M.)
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
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Buchberger DS, Khurana R, Bolen M, Videtic GMM. The Treatment of Patients with Early-Stage Non-Small Cell Lung Cancer Who Are Not Candidates or Decline Surgical Resection: The Role of Radiation and Image-Guided Thermal Ablation. J Clin Med 2024; 13:7777. [PMID: 39768701 PMCID: PMC11727850 DOI: 10.3390/jcm13247777] [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: 11/18/2024] [Revised: 12/10/2024] [Accepted: 12/16/2024] [Indexed: 01/16/2025] Open
Abstract
The standard of care for early-stage NSCLC has historically been surgical resection. Given the association of lung cancer with smoking, a large number of early-stage patients also have active smoking-related medical comorbidities such as COPD precluding surgery. The current approach for treating such inoperable patients is frequently considered to be stereotactic body radiation therapy (SBRT). SBRT (also known as stereotactic ablative radiation therapy or SABR) is a curative modality that precisely delivers very high dose radiation in few (typically <5) sessions. That said, because of their minimal invasiveness and repeatable nature, image-guided thermal ablation therapies such as radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation (CA) have also been used to treat early-stage lung tumors. For those patients deemed to have "high operative risk" (i.e., those who cannot tolerate lobectomy, but are candidates for sublobar resection), the appropriateness of potential alternatives [e.g., SBRT; ablation] to surgery is an active area of investigation. In the absence of completed randomized phase III trials, the approach to comparing outcomes between surgery, SBRT, or ablative therapies by their efficacy or equivalence is complex. An overview of the role of SBRT and other non-surgical modalities in the management of early-stage lung cancer is the subject of the present review.
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Affiliation(s)
- David S. Buchberger
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Rishabh Khurana
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH 44195, USA; (R.K.); (M.B.)
| | - Michael Bolen
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH 44195, USA; (R.K.); (M.B.)
| | - Gregory M. M. Videtic
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA;
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4
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Moore-Palhares D, Ng SSW, Louie AV. Alleviating retroperitoneal pain with celiac plexus radiosurgery. Lancet Oncol 2024; 25:952-953. [PMID: 39029484 DOI: 10.1016/s1470-2045(24)00285-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 05/15/2024] [Indexed: 07/21/2024]
Affiliation(s)
- Daniel Moore-Palhares
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Sylvia S W Ng
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada.
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Laeseke P, Ng C, Naghi A, Wright GWJ, Laxmanan B, Ghosh SK, Amos TB, Kalsekar I, Pritchett M. Response to letter: Microwave ablation for Early-Stage Non-Small cell Lung Cancer: Don't Put the Cart before the stereotactic Horse. Lung Cancer 2024; 189:107504. [PMID: 38368724 DOI: 10.1016/j.lungcan.2024.107504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/20/2024]
Affiliation(s)
- Paul Laeseke
- Radiology, University of Wisconsin, Madison, WI, United States.
| | - Calvin Ng
- Department of Surgery, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China
| | | | | | - Balaji Laxmanan
- Lung Cancer Initiative, Johnson & Johnson, New Brunswick, NJ, United States.
| | - Sudip K Ghosh
- Health Economics and Market Access, Johnson & Johnson, Cincinnati, OH, United States.
| | - Tony B Amos
- Interventional Oncology at Johnson & Johnson, New Brunswick, NJ, United States.
| | - Iftekhar Kalsekar
- Lung Cancer Initiative, Johnson & Johnson, New Brunswick, NJ, United States.
| | - Michael Pritchett
- Pulmonary and Critical Care Medicine, FirstHealth Moore Regional Hospital, and Pinehurst Medical Clinic, Pinehurst, NC, United States.
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Schrand TV, Iovoli AJ, Almeida ND, Yu H, Malik N, Farrugia M, Singh AK. Differences between Survival Rates and Patterns of Failure of Patients with Lung Adenocarcinoma and Squamous Cell Carcinoma Who Received Single-Fraction Stereotactic Body Radiotherapy. Cancers (Basel) 2024; 16:755. [PMID: 38398146 PMCID: PMC10886818 DOI: 10.3390/cancers16040755] [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: 01/16/2024] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
We investigated the survival and patterns of failure in adenocarcinoma (ADC) and squamous cell carcinoma (SCC) in early stage non-small cell lung cancer (NSCLC) treated with single-fraction stereotactic body radiation therapy (SF-SBRT) of 27-34 Gray. A single-institution retrospective review of patients with biopsy-proven early stage ADC or SCC undergoing definitive SF-SBRT between September 2008 and February 2023 was performed. The primary outcomes were overall survival (OS) and disease-free survival (DFS). The secondary outcomes included local failure (LF), nodal failure (NF), and distant failure (DF). Of 292 eligible patients 174 had adenocarcinoma and 118 had squamous cell carcinoma. There was no significant change in any outcome except distant failure. Patients with ADC were significantly more likely to experience distant failure than patients with SCC (p = 0.0081). In conclusion, while SF-SBRT produced similar LF, NF, DFS, and OS, the higher rate of distant failure in ADC patients suggests that ongoing trials of SBRT and systemic therapy combinations should report their outcomes by histology.
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Affiliation(s)
- Tyler V. Schrand
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (T.V.S.); (A.J.I.); (N.D.A.); (N.M.); (M.F.)
- Department of Chemistry, Bowling Green State University, Bowling Green, OH 43403, USA
| | - Austin J. Iovoli
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (T.V.S.); (A.J.I.); (N.D.A.); (N.M.); (M.F.)
| | - Neil D. Almeida
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (T.V.S.); (A.J.I.); (N.D.A.); (N.M.); (M.F.)
| | - Han Yu
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Nadia Malik
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (T.V.S.); (A.J.I.); (N.D.A.); (N.M.); (M.F.)
| | - Mark Farrugia
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (T.V.S.); (A.J.I.); (N.D.A.); (N.M.); (M.F.)
| | - Anurag K. Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (T.V.S.); (A.J.I.); (N.D.A.); (N.M.); (M.F.)
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Iovoli AJ, Prasad S, Ma SJ, Fekrmandi F, Malik NK, Fung-Kee-Fung S, Farrugia MK, Singh AK. Long-Term Survival and Failure Outcomes of Single-Fraction Stereotactic Body Radiation Therapy in Early Stage NSCLC. JTO Clin Res Rep 2023; 4:100598. [PMID: 38124792 PMCID: PMC10730364 DOI: 10.1016/j.jtocrr.2023.100598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/12/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION This study aims to report our 13-year institutional experience with single-fraction stereotactic body radiation therapy (SF-SBRT) for early stage NSCLC. METHODS A single-institutional retrospective review of patients with biopsy-proven peripheral cT1-2N0M0 NSCLC undergoing definitive SF-SBRT between September 2008 and May 2022 was performed. All patients were treated to 27 Gy with heterogeneity corrections or 30 Gy without. Primary outcomes were overall survival and progression-free survival. Secondary outcomes included local failure, nodal failure, distant failure, and second primary lung cancer. RESULTS Among 263 eligible patients, the median age was 76 years (interquartile range [IQR]: 70-81 y) and median follow-up time was 27.2 months (IQR: 14.25-44.9 mo). Median tumor size was 1.9 cm (IQR: 1.4-2.6 cm), and 224 (85%) tumors were T1. There were 92 patients (35%) alive at the time of analysis with a median follow-up of 34.0 months (IQR: 16.6-50.0 mo). Two- and five-year overall survival was 65% and 26%, respectively. A total of 74 patients (28%) developed disease progression. Rates of five-year local failure, nodal failure, distant failure, and second primary lung cancer were 12.7%, 14.7%, 23.5%, and 12.0%, respectively. CONCLUSIONS Consistent with multiple prospective randomized trials, in a large real-world retrospective cohort, SF-SBRT for peripheral early stage NSCLC was an effective treatment approach.
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Affiliation(s)
- Austin J. Iovoli
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Sharan Prasad
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Fatemeh Fekrmandi
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Nadia K. Malik
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Simon Fung-Kee-Fung
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Mark K. Farrugia
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Anurag K. Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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Penrod D, Hirsch B. Nursing Care for Metastatic Bone Cancer: Trends for the Future. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6483. [PMID: 37569024 PMCID: PMC10418383 DOI: 10.3390/ijerph20156483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/20/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023]
Abstract
To effectively treat patients and minimize viral exposure, oncology nurses and radiology departments during COVID-19 had to re-examine the ability to offer palliative radiation treatments to people with metastatic bone cancer. Decreasing potential exposure to the virus resulted in extra measures to keep patients and personnel safe. Limiting radiotherapy treatments, social distancing, and limiting caregivers were a few of the ways that oncology patients were impacted by the pandemic. Hypofractionated radiation therapy (HFRT), or the delivery of fewer higher-dose treatments, was a method of providing care but also limiting exposure to infection for immunocompromised patients as well as healthcare staff. As oncology radiation centers measure the impact of patient care during the pandemic, a trend toward HFRT may occur in treating the painful symptoms of bone cancer. In anticipation that HFRT may be increasingly used in patient treatment plans, oncology nurses should consider patient perspectives and outcomes from the pandemic to further determine how to manage future trends in giving personalized care, and supportive care.
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Affiliation(s)
- Debra Penrod
- Nursing, School of Health Sciences, Southern Illinois University, Carbondale, IL 62901, USA
| | - Brandon Hirsch
- Radiological Sciences, School of Health Sciences, Southern Illinois University, Carbondale, IL 62920, USA;
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Siva S, Sakyanun P, Mai T, Wong W, Lim A, Ludbrook J, Bettington C, Rezo A, Pryor D, Hardcastle N, Kron T, Higgs B, Le H, Skala M, Gill S, Eade T, Awad R, Sasso G, Vinod S, Montgomery R, Ball D, Bressel M. Long-Term Outcomes of TROG 13.01 SAFRON II Randomized Trial of Single- Versus Multifraction Stereotactic Ablative Body Radiotherapy for Pulmonary Oligometastases. J Clin Oncol 2023:JCO2300150. [PMID: 37179526 DOI: 10.1200/jco.23.00150] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.In a randomized phase II clinical trial, the Trans Tasman Radiation Oncology Group compared single- versus multifraction stereotactic ablative body radiotherapy (SABR) in 90 patients with 133 oligometastases to the lung. The study found no differences in safety, efficacy, systemic immunogenicity, or survival between arms, with single-fraction SABR picked as the winner on the basis of cost-effectiveness. In this article, we report the final updated survival outcome analysis. The protocol mandated no concurrent or post-therapy systemic therapy until progression. Modified disease-free survival (mDFS) was defined as any progression not addressable by local therapy, or death. At a median follow-up of 5.4 years, the 3- and 5-year estimates for overall survival (OS) were 70% (95% CI, 59 to 78) and 51% (95% CI, 39 to 61). There were no significant differences between the multi- and single-fraction arms for OS (hazard ratio [HR], 1.1 [95% CI, 0.6 to 2.0]; P = .81). The 3- and 5-year estimates for disease-free survival were 24% (95% CI, 16 to 33) and 20% (95% CI, 13 to 29), with no differences between arms (HR, 1.0 [95% CI, 0.6 to 1.6]; P = .92). The 3- and 5-year estimates for mDFS were 39% (95% CI, 29 to 49) and 34% (95% CI, 24 to 44), with no differences between arms (HR, 1.0 [95% CI, 0.6 to 1.8]; P = .90). In this patient population, where patients receive SABR in lieu of systemic therapy, one-in-three patients are alive without disease in the long term. There were no differences in outcomes by fractionation schedule.
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Affiliation(s)
- Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
| | - Pitchaya Sakyanun
- Department of Radiation Oncology, Phramongkutklao Hospital, Bangkok, Thailand
| | - Tao Mai
- Princess Alexandra Hospital, Radiation Oncology Centre, Brisbane, Australia
| | - Wenchang Wong
- Department of Radiation Oncology, Prince of Wales Hospital, Sydney, Australia
| | - Adeline Lim
- Department of Radiation Oncology, Austin Health, Melbourne, Australia
| | - Joanna Ludbrook
- Department of Radiation Oncology, Calvary Mater Newcastle, Newcastle, Australia
| | - Catherine Bettington
- Department of Radiation Oncology, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Angela Rezo
- Radiation Oncology Department, Canberra Hospital, Canberra, Australia
| | - David Pryor
- Princess Alexandra Hospital, Radiation Oncology Centre, Brisbane, Australia
| | - Nicholas Hardcastle
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Tomas Kron
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Braden Higgs
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia
| | - Marketa Skala
- Radiation Oncology, Royal Hobart Hospital, Hobart, Australia
| | - Suki Gill
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Thomas Eade
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Raef Awad
- Radiation Oncology, Royal Hobart Hospital, Hobart, Australia
| | - Giuseppe Sasso
- Radiation Oncology Department, Auckland City Hospital, Auckland, New Zealand
| | - Shalini Vinod
- Liverpool Hospital, Cancer Therapy Centre, Sydney, Australia
| | | | - David Ball
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
| | - Mathias Bressel
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
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10
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Buchberger DS, Videtic GMM. Stereotactic Body Radiotherapy for the Management of Early-Stage Non-Small-Cell Lung Cancer: A Clinical Overview. JCO Oncol Pract 2023; 19:239-249. [PMID: 36800644 DOI: 10.1200/op.22.00475] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Affiliation(s)
- David S Buchberger
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Gregory M M Videtic
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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11
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Terlizzi M, Limkin E, Sellami N, Louvel G, Blanchard P. Is single fraction the future of stereotactic body radiation therapy (SBRT)? A critical appraisal of the current literature. Clin Transl Radiat Oncol 2023; 39:100584. [PMID: 36816840 PMCID: PMC9931895 DOI: 10.1016/j.ctro.2023.100584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/15/2023] [Accepted: 01/15/2023] [Indexed: 01/26/2023] Open
Abstract
Stereotactic Body Radiation Therapy (SBRT) is a standard of care for many localizations but the question of the optimal fractionation remains a matter of concern. If single fraction sessions are routinely used for intracranial targets, their utilization for mobile extracranial lesions is a source of debate and apprehension. Single session treatments improve patient comfort, provide a medico-economic benefit, and have proven useful in the context of the SARS-CoV 2 pandemic. However, both technical and radiobiological uncertainties remain. Experience from intracranial radiosurgery has shown that the size of the target, its proximity to organs at risk, tumor histology, and the volume of normal tissue irradiated are all determining factors in the choice of fractionation. The literature on the use of single fraction for extracranial sites is still scarce. Only primary and secondary pulmonary tumors have been evaluated in prospective randomized trials, allowing the integration of these fractionation schemes in daily practice, for highly selected cases and in trained teams. The level of evidence for the other organs is mainly based on dose escalation or retrospective trials and calls for caution, with further studies being needed before routine use in clinical practice.
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12
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Videtic GMM, Reddy CA, Woody NM, Stephans KL. Local Control With Single-Fraction Lung Stereotactic Body Radiotherapy is not influenced by Non-Small Cell Lung Cancer Histologic Subtype. Clin Lung Cancer 2022; 23:e428-e434. [PMID: 35750570 DOI: 10.1016/j.cllc.2022.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/26/2022] [Accepted: 05/28/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION/BACKGROUND For early stage medically inoperable lung cancer treated with fractionated stereotactic body radiotherapy (SBRT), higher local failure is associated with squamous carcinoma (SqC) compared to adenocarcinoma (AC). This study explored whether histology influences single-fraction SBRT local control. MATERIALS AND METHODS We surveyed our prospective data registry from 12/2009 to 12/2019 for SF-SBRT cases with biopsy-proven AC or SqC only. Outcomes of interest included local (LF), nodal (NF), distant (DF) failure rates and overall survival (OS), as well as treatment-related toxicity. RESULTS For the 10-year interval surveyed, 113 patients met study criteria. There was no association between histology and dose received (34 Gy or 30 Gy). Median follow up was 22.9 months. Patient characteristics were balanced between histologic cohorts. Median tumor size was 1.9 cm. Comparing total AC vs. SqC cohorts, 2-year LF rates (%) were 7.3 vs. 9.6, respectively (P = .9805). In %, 2-year LF, NF, DF and OS rates for AC for 30 Gy and 34 Gy, respectively, were 10.8 vs. 6.4; 10.5 vs. 16.2; 15.8 vs. 13.0; 77.9 vs.71.2 (all P = non-significant). In %, 2-year LF, NF, DF, and OS rates for SqC for 30 Gy and 34 Gy, respectively, were 11.8 vs. 8.1; 5.9 vs. 18.0; 23.5 vs. 9.7; 70.6 vs. 77.1 (all P = non-significant). When considering toxicities, there were no grade 4/5 toxicities and no significant differences in any other toxicity rate by histology or dose. CONCLUSION SF-SBRT local control was not associated with histology, unlike fractionated schedules. This novel finding adds to the evolving understanding of this treatment schedule.
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Affiliation(s)
- Gregory M M Videtic
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH.
| | - Chandana A Reddy
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Neil M Woody
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Kevin L Stephans
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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13
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Devine A, O'Donovan T. Impact of the COVID-19 pandemic on Radiation Therapy Practice: A Catalyst for Research. Radiography (Lond) 2022; 28 Suppl 1:S13-S15. [PMID: 36202470 PMCID: PMC9527504 DOI: 10.1016/j.radi.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- A. Devine
- Corresponding author. UG 13 ASSERT, Brookfield Health Sciences, T12 AK54, Ireland
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14
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Li Z, Hu Y, Zeng M, Hu Q, Ye F, Liu R, Cai H, Li Q, Wang X. The role transition of radiotherapy for the treatment of liver cancer in the COVID-19 era. Front Oncol 2022; 12:976143. [PMID: 36185295 PMCID: PMC9516283 DOI: 10.3389/fonc.2022.976143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
The uncontrollable COVID-19 crises in the SARS-CoV-2 high-prevalence areas have greatly disrupted the routine treatment of liver cancer and triggered a role transformation of radiotherapy for liver cancer. The weight of radiotherapy in the treatment algorithm for liver cancer has been enlarged by the COVID-19 pandemic, which is helpful for the optimal risk-benefit profile.
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Affiliation(s)
- Zheng Li
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China
- Lanzhou Heavy Ion Hospital, Lanzhou, China
| | - Yue Hu
- Chengdu Women’s and Children’s Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Ming Zeng
- Department of Radiation Oncology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, United States
| | - Qinyong Hu
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Fei Ye
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China
| | - Ruifeng Liu
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China
- Lanzhou Heavy Ion Hospital, Lanzhou, China
| | - Hongyi Cai
- Department of Radiotherapy, Gansu Provincial Hospital, Lanzhou, China
| | - Qiang Li
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China
- Lanzhou Heavy Ion Hospital, Lanzhou, China
| | - Xiaohu Wang
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, China
- Lanzhou Heavy Ion Hospital, Lanzhou, China
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15
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Gaudreault M, Yeo A, Kron T, Hanna GG, Siva S, Hardcastle N. Treatment Time Optimization in Single Fraction Stereotactic Ablative Radiation Therapy: A 10-Year Institutional Experience. Adv Radiat Oncol 2022; 7:100829. [PMID: 36148377 PMCID: PMC9486429 DOI: 10.1016/j.adro.2021.100829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 09/30/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose Stereotactic ablative radiation therapy (SABR) delivered in a single fraction (SF) can be considered to have higher uncertainty given that the error probability is concentrated in a single session. This study aims to report the variation in technology and technique used and its effect on intrafraction motion based on a 10 years of experience in SF SABR. Methods and Materials Records of patients receiving SF SABR delivered at our instruction between 2010 and 2019 were included. Treatment parameters were extracted from the patient management database by using an in-house script. Treatment time was defined as the time difference between the first image acquisition to the last beam off of a single session. The intrafraction variation was measured from the 3-dimensional couch displacement measured after the first cone beam computed tomography (CBCT) acquired during a treatment. Results The number of SF SABR increased continuously from 2010 to 2019 and were mainly lung treatments. Treatment time was minimized by using volumetric modulated arc therapy, flattening filter-free dose rate, and coplanar field (24 ± 9 min). Treatment time increased as the number of CBCTs per session increased. The most common scenario involved both 2 and 3 CBCTs per session. On the average, a CBCT acquisition added 6 minutes to the treatment time. All treatments considered, the average intrafraction variation was 1.7 ± 1.6 mm. Conclusions SF SABR usage increased with time in our institution. The intrafraction motion was acceptable and therefore a single fraction is an efficacious treatment option when considering SABR.
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16
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Sarudis S, Karlsson A, Nyman J, Bäck A. Dosimetric effects of respiratory motion during stereotactic body radiation therapy of lung tumors. Acta Oncol 2022; 61:1004-1011. [PMID: 35905048 DOI: 10.1080/0284186x.2022.2092420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Respiratory-induced lung tumor motion may affect the delivered dose in stereotactic body radiation therapy (SBRT). Previous studies are often based on phantom studies for one specific treatment technique. In this study, the dosimetric effect of tumor motion was quantified in real patient geometries for different modulated treatments and tumor motion amplitudes for lung-SBRT. MATERIAL AND METHODS A simulation method using deformable image registrations and 4-dimensional computed tomographies (4DCT) was developed to assess the dosimetric effects of tumor motion. The method was evaluated with ionization chamber and Gafchromic film measurements in a thorax phantom and used to simulate the effect for 15 patients with lung tumors moving 7.3-27.4 mm. Four treatment plans with different complexities were created for each patient and the motion-induced dosimetric effect to the gross tumor volume (GTV) was simulated. The difference between the planned dose to the static tumor and the simulated delivered dose to the moving tumor was quantified for the near minimum (D98%), near maximum (D2%) and mean dose (Dmean) to the GTV as well as the largest observed local difference within the GTV (Maxdiff). RESULTS No correlation was found between the dose differences and the tumor motion amplitude or plan complexity. However, the largest deviations were observed for tumors moving >15.0 mm. The simulated delivered dose was within 2.5% from the planned dose for D98% (tumors moving <15 mm) and within 3.3% (tumors moving >15 mm). The corresponding values were 1.7% vs. 6.4% (D2%); 1.7% vs. 2.4% (Dmean) and 8.9% vs. 35.2% (Maxdiff). Using less complex treatment techniques minimized Maxdiff for tumors moving >15.0 mm. CONCLUSION The dosimetric effects of respiratory-induced motion during lung SBRT are patient and plan specific. The magnitude of the dosimetric effect cannot be assessed solely based upon tumor motion amplitude or plan complexity.
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Affiliation(s)
- Sebastian Sarudis
- Department of Medical Radiation Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medical Physics, County Hospital Ryhov, Jönköping, Sweden
| | - Anna Karlsson
- Department of Medical Radiation Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jan Nyman
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Bäck
- Department of Medical Radiation Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden
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17
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Piras A, Venuti V, D’Aviero A, Cusumano D, Pergolizzi S, Daidone A, Boldrini L. Covid-19 and radiotherapy: a systematic review after 2 years of pandemic. Clin Transl Imaging 2022; 10:611-630. [PMID: 35910079 PMCID: PMC9308500 DOI: 10.1007/s40336-022-00513-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/12/2022] [Indexed: 02/08/2023]
Abstract
Introduction Following the Covid-19 pandemic spread, changes in clinical practice were necessary to limit the pandemic diffusion. Also, oncological practice has undergone changes with radiotherapy (RT) treatments playing a key role.Although several experiences have been published, the aim of this review is to summarize the current evidence after 2 years of pandemic to provide useful conclusions for clinicians. Methods A Pubmed/MEDLINE and Embase systematic review was conducted. The search strategy was "Covid AND Radiotherapy" and only original articles in the English language were considered. Results A total of 2.733 papers were obtained using the mentioned search strategy. After the complete selection process, a total of 281 papers were considered eligible for the analysis of the results. Discussion RT has played a key role in Covid-19 pandemic as it has proved more resilient than surgery and chemotherapy. The impact of the accelerated use of hypofractionated RT and telemedicine will make these strategies central also in the post-pandemic period.
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Affiliation(s)
- Antonio Piras
- Radioterapia Oncologica, Villa Santa Teresa, Palermo, Italy
| | - Valeria Venuti
- Radioterapia Oncologica, Università degli Studi di Palermo, Palermo, Italy
| | - Andrea D’Aviero
- Radiation Oncology, Mater Olbia Hospital, Olbia, Sassari Italy
| | | | - Stefano Pergolizzi
- Radiation Oncology Unit, Department of Biomedical, Dental Science and Morphological and Functional Images, University of Messina, Messina, Italy
| | | | - Luca Boldrini
- Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, UOC Radioterapia Oncologica - Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
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18
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Zeng H, De Ruysscher DK, Hu X, Zheng D, Yang L, Ricardi U, Kong FMS, Hendriks LE. Radiotherapy for small cell lung cancer in current clinical practice guidelines. JOURNAL OF THE NATIONAL CANCER CENTER 2022; 2:113-125. [PMID: 39034955 PMCID: PMC11256623 DOI: 10.1016/j.jncc.2022.02.003] [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: 11/29/2021] [Revised: 02/13/2022] [Accepted: 02/22/2022] [Indexed: 11/17/2022] Open
Abstract
Several guidelines including radiotherapy recommendations exist worldwide for the treatment of small cell lung cancer (SCLC). To evaluate the differences in radiotherapy recommendations we conducted a systematic review. PubMed and the sites of medical societies were searched for SCLC guidelines published in either English, Chinese, or Dutch. This was limited to January 2018 till February 2021 to only include up-to-date recommendations. Data was extracted and compared regarding the guideline's development method and radiotherapy recommendations. Eleven guidelines were identified (PubMed n=4, societies n=7) from Spain (n=1), Canada (n=1), America (n=3), United Kingdom (n=1), the Netherlands (n=1), and China (n=3), respectively. Nine guidelines assessed the strength of evidence (SOE) and specified the strength of recommendation (SOR), although methods were different. The major radiotherapy recommendations are similar although differences exist in thoracic radiotherapy (TRT) dose, time, and volume. Controversial areas are TRT in resected stage I-IIA (pN1), prophylactic cranial irradiation (PCI) in resected as well as unresected stage I-IIA, stereotactic body radiation therapy (SBRT) in unresected stage I-IIA, PCI time, and PCI versus magnetic resonance imaging (MRI) surveillance in stage IV. The existence of several overlapping guidelines for SCLC treatment indicates that guideline development is (unnecessarily) repeated by different organizations or societies. Improvement could be made by better international collaboration to avoid duplicating unnecessary work, which would spare a lot of time and resources. Efforts should be made to work together on controversial or unknown fields.
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Affiliation(s)
- Haiyan Zeng
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Dirk K.M. De Ruysscher
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Xiao Hu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Danyang Zheng
- Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Li Yang
- Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | | | - Feng-Ming Spring Kong
- Department of Clinical Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Lizza E.L. Hendriks
- Department of Pulmonary Diseases, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
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19
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Tjong MC, Louie AV, Singh AK, Videtic G, Stephans K, Plumridge N, Harden S, Slotman BJ, Alongi F, Guckenberger M, Siva S. Single-Fraction Stereotactic Ablative Body Radiotherapy to the Lung - The Knockout Punch. Clin Oncol (R Coll Radiol) 2022; 34:e183-e194. [PMID: 35221140 DOI: 10.1016/j.clon.2022.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/19/2022] [Accepted: 02/07/2022] [Indexed: 12/12/2022]
Abstract
This overview summarises the current evidence on efficacy and safety of single-fraction stereotactic ablative body radiotherapy (SABR) for primary lung cancers and lung metastases, in comparison with the more widely adapted multi-fraction SABR regimens. A literature search using the Medline database through PubMed was carried out using the following key words: ('stereotactic' or 'sabr' or 'sbrt'), ('radiotherapy' or 'radiation therapy'), ('lung' or 'thorax' or 'thoracic' or 'chest'), ('cancer' or 'metasta-' or 'oligometasta-'), alongside: (i) ('single-fraction' or 'single-dose') to identify trials and cohort studies with single-fraction SABR to lung malignant tumours and (ii) ('fraction' or 'schedule') limiting the search to 'clinical trial' and 'randomized controlled trial' to ensure thorough capture of lung SABR trials comparing different fractionations. The review discusses the radiobiological, technical and organ at risk considerations of single-fraction SABR to the lung.
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Affiliation(s)
- M C Tjong
- Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - A V Louie
- Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - A K Singh
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - G Videtic
- The Cleveland Clinic, Cleveland, OH, USA
| | - K Stephans
- The Cleveland Clinic, Cleveland, OH, USA
| | - N Plumridge
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - S Harden
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - B J Slotman
- Amsterdam University Medical Centers/VUMC, Amsterdam, the Netherlands
| | - F Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore-Don Calabria Hospital, Negrar-Verona, Italy; University of Brescia, Brescia, Italy
| | - M Guckenberger
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - S Siva
- Peter MacCallum Cancer Centre, Melbourne, Australia.
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20
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Fernández C, Navarro-Martin A, Bobo A, Cabrera-Rodriguez J, Calvo P, Chicas-Sett R, Luna J, Rodríguez de Dios N, Couñago F. Single-fraction stereotactic ablative body radiation therapy for primary and metastasic lung tumor: A new paradigm? World J Clin Oncol 2022; 13:101-115. [PMID: 35316929 PMCID: PMC8894272 DOI: 10.5306/wjco.v13.i2.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/07/2021] [Accepted: 01/24/2022] [Indexed: 02/06/2023] Open
Abstract
Stereotactic ablative body radiotherapy (SABR) is an effective technique comparable to surgery in terms of local control and efficacy in early stages of non-small cell lung cancer (NSCLC) and pulmonary metastasis. Several fractionation schemes have proven to be safe and effective, including the single fraction (SF) scheme. SF is an option cost-effectiveness, more convenience and comfortable for the patient and flexible in terms of its management combined with systemic treatments. The outbreak of the severe acute respiratory syndrome coronavirus 2 pandemic has driven this not new but underutilized paradigm, recommending this option to minimize patients' visits to hospital. SF SABR already has a long experience, strong evidence and sufficient maturity to reliably evaluate outcomes in peripheral primary NSCLC and there are promising outcomes in pulmonary metastases, making it a valid treatment option; although its use in central locations, synchronous and recurrencies tumors requires more prospective safety and efficacy studies. The SABR radiobiology study, together with the combination with systemic therapies, (targeted therapies and immunotherapy) is a direction of research in both advanced disease and early stages whose future includes SF.
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Affiliation(s)
- Castalia Fernández
- Department of Radiation Oncology, GenesisCare Madrid, Madrid 28043, Spain
| | - Arturo Navarro-Martin
- Department of Radiation Oncology, Institut Catalá d’Oncologia, L’Hospitalet de Llobregat, Barcelona 08908, Spain
| | - Andrea Bobo
- Department of Radiation Oncology, Hospital Ruber Internacional, Madrid 28034, Spain
| | | | - Patricia Calvo
- Department of Radiation Oncology, Hospitalario Clínico Universitario de Santiago de Compostela, Santiago de Compostela 15706, Spain
| | - Rodolfo Chicas-Sett
- Department of Radiation Oncology, ASCIRES Grupo Biomédico, Valencia 46004, Spain
| | - Javier Luna
- Department of Radiation Oncology, Hospital Fundación Jiménez Díaz, Madrid 28040, Spain
| | | | - Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Madrid 28223, Spain
- Department of Radiation Oncology, Hospital La Luz, Madrid 28223, Spain
- Department of Medicine, School of Biomedical Sciences, Universidad Europea, Madrid 28223, Spain
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21
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Bartl AJ, Mahoney M, Hennon MW, Yendamuri S, Videtic GMM, Stephans KL, Siva S, Farrugia MK, Ma SJ, Singh AK. Systematic Review of Single-Fraction Stereotactic Body Radiation Therapy for Early Stage Non-Small-Cell Lung Cancer and Lung Oligometastases: How to Stop Worrying and Love One and Done. Cancers (Basel) 2022; 14:790. [PMID: 35159057 PMCID: PMC8834253 DOI: 10.3390/cancers14030790] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/26/2022] [Accepted: 02/01/2022] [Indexed: 02/06/2023] Open
Abstract
Adoption of single-fraction lung stereotactic body radiation therapy (SBRT) for patients with medically inoperable early stage non-small-cell lung cancer (NSCLC) or oligometastatic lung disease, even during the coronavirus disease 2019 (COVID-19) pandemic, was limited despite encouraging phase II trial results. Barriers to using single-fraction SBRT may include lack of familiarity with the regimen and lack of clarity about the expected toxicity. To address these concerns, we performed a systematic review of prospective literature on single-fraction SBRT for definitive treatment of early stage and oligometastatic lung cancer. A PubMed search of prospective studies in English on single-fraction lung SBRT was conducted. A systematic review was performed of the studies that reported clinical outcomes of single-fraction SBRT in the treatment of early stage non-small-cell lung cancer and lung oligometastases. The current prospective literature including nine trials supports the use of single-fraction SBRT in the definitive treatment of early stage peripheral NSCLC and lung oligometastases. Most studies cite local control rates of >90%, mild toxicity profiles, and favorable survival outcomes. Most toxicities reported were grade 1-2, with grade ≥3 toxicity in 0-17% of patients. Prospective trial results suggest potential consideration of utilizing single-fraction SBRT beyond the COVID-19 pandemic.
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Affiliation(s)
- Austin J. Bartl
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY 14203, USA;
| | - Mary Mahoney
- College of Medicine, State University of New York Upstate Medical University, Syracuse, NY 13210, USA;
| | - Mark W. Hennon
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.W.H.); (S.Y.)
| | - Sai Yendamuri
- Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.W.H.); (S.Y.)
| | - Gregory M. M. Videtic
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH 44195, USA; (G.M.M.V.); (K.L.S.)
| | - Kevin L. Stephans
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH 44195, USA; (G.M.M.V.); (K.L.S.)
| | - Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia;
| | - Mark K. Farrugia
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.K.F.); (S.J.M.)
| | - Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.K.F.); (S.J.M.)
| | - Anurag K. Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.K.F.); (S.J.M.)
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22
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Li Z, Li Q, Wang X, Li S, Chen W, Jin X, Liu X, Dai Z, Liu X, Zheng X, Li P, Zhang H, Zhang Q, Luo H, Liu R. Carbon Ion Radiotherapy Acts as the Optimal Treatment Strategy for Unresectable Liver Cancer During the Coronavirus Disease 2019 Crisis. Front Public Health 2021; 9:767617. [PMID: 34957022 PMCID: PMC8695803 DOI: 10.3389/fpubh.2021.767617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/05/2021] [Indexed: 12/30/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has greatly disrupted the normal treatment of patients with liver cancer and increased their risk of death. The weight of therapeutic safety was significantly amplified for decision-making to minimize the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Herein, the safety and effectiveness of carbon ion radiotherapy (CIRT) for unresectable liver cancer (ULC) were evaluated, and Chinese experiences were shared to solve the predicament of ULC treatment caused by SARS-CoV-2. Worldwide studies were collected to evaluate CIRT for ULC as the world has become a community due to the COVID-19 pandemic. We not only searched five international databases including the Cochrane Library, Web of Science, PubMed, Embase, and Scopus but also performed supplementary retrieval with other sources. Chinese experiences of fighting against COVID-19 were introduced based on the advancements of CIRT in China and a prospective clinical trial of CIRT for treating ULC. A total of 19 studies involving 813 patients with ULC were included in the systematic review. The qualitative synthetic evaluation showed that compared with transarterial chemoembolization (TACE), CIRT could achieve superior overall survival, local control, and relative hepatic protection. The systematic results indicated that non-invasive CIRT could significantly minimize harms to patients with ULC and concurrently obtain superior anti-cancer effectiveness. According to the Chinese experience, CIRT allows telemedicine within the hospital (TMIH) to keep a sufficient person-to-person physical distance in the whole process of treatment for ULC, which is significant for cutting off the transmission route of SARS-CoV-2. Additionally, CIRT could maximize the utilization rate of hospitalization and outpatient care (UHO). Collectively, CIRT for ULC patients not only allows TMIH and the maximized UHO but also has the compatible advantages of safety and effectiveness. Therefore, CIRT should be identified as the optimal strategy for treating appropriate ULC when we need to minimize the risk of SARS-CoV-2 infection and to improve the capacity of medical service in the context of the unprecedented COVID-19 crisis.
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Affiliation(s)
- Zheng Li
- Institute of Modern Physics, Chinese Academy of Sciences (CAS), Lanzhou, China.,Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou, China.,Gansu Provincial Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Lanzhou, China.,Lanzhou Heavy Ion Hospital, Lanzhou, China
| | - Qiang Li
- Institute of Modern Physics, Chinese Academy of Sciences (CAS), Lanzhou, China.,Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou, China.,Gansu Provincial Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Lanzhou, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Xiaohu Wang
- Institute of Modern Physics, Chinese Academy of Sciences (CAS), Lanzhou, China.,Lanzhou Heavy Ion Hospital, Lanzhou, China
| | - Sha Li
- The 940th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army, Lanzhou, China
| | - Weiqiang Chen
- Institute of Modern Physics, Chinese Academy of Sciences (CAS), Lanzhou, China.,Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou, China.,Gansu Provincial Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Lanzhou, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Xiaodong Jin
- Institute of Modern Physics, Chinese Academy of Sciences (CAS), Lanzhou, China.,Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou, China.,Gansu Provincial Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Lanzhou, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Xinguo Liu
- Institute of Modern Physics, Chinese Academy of Sciences (CAS), Lanzhou, China.,Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou, China.,Gansu Provincial Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Lanzhou, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Zhongying Dai
- Institute of Modern Physics, Chinese Academy of Sciences (CAS), Lanzhou, China.,Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou, China.,Gansu Provincial Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Lanzhou, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Xiongxiong Liu
- Institute of Modern Physics, Chinese Academy of Sciences (CAS), Lanzhou, China.,Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou, China.,Gansu Provincial Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Lanzhou, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Xiaogang Zheng
- Institute of Modern Physics, Chinese Academy of Sciences (CAS), Lanzhou, China.,Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou, China.,Gansu Provincial Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Lanzhou, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Ping Li
- Institute of Modern Physics, Chinese Academy of Sciences (CAS), Lanzhou, China.,Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou, China.,Gansu Provincial Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Lanzhou, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Hui Zhang
- Institute of Modern Physics, Chinese Academy of Sciences (CAS), Lanzhou, China.,Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou, China.,Gansu Provincial Key Laboratory of Basic Research on Heavy Ion Radiation Application in Medicine, Lanzhou, China.,University of Chinese Academy of Sciences, Beijing, China
| | - Qiuning Zhang
- Institute of Modern Physics, Chinese Academy of Sciences (CAS), Lanzhou, China.,Lanzhou Heavy Ion Hospital, Lanzhou, China
| | - Hongtao Luo
- Institute of Modern Physics, Chinese Academy of Sciences (CAS), Lanzhou, China.,Lanzhou Heavy Ion Hospital, Lanzhou, China
| | - Ruifeng Liu
- Institute of Modern Physics, Chinese Academy of Sciences (CAS), Lanzhou, China.,Lanzhou Heavy Ion Hospital, Lanzhou, China
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23
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Li Z, Li Q, Wang X, Chen W, Jin X, Liu X, Ye F, Dai Z, Zheng X, Li P, Sun C, Liu X, Zhang Q, Luo H, Liu R. Hyperthermia ablation combined with transarterial chemoembolization versus monotherapy for hepatocellular carcinoma: A systematic review and meta-analysis. Cancer Med 2021; 10:8432-8450. [PMID: 34655179 PMCID: PMC8633247 DOI: 10.1002/cam4.4350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/15/2021] [Accepted: 10/03/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND AIMS The existing evidence has indicated that hyperthermia ablation (HA) and HA combined with transarterial chemoembolization (HATACE) are the optimal alternative to surgical resection for patients with hepatocellular carcinoma (HCC) in the COVID-19 crisis. However, the evidence for decision-making is lacking in terms of comparison between HA and HATACE. Herein, a comprehensive evaluation was performed to compare the efficacy and safety of HATACE with monotherapy. MATERIALS AND METHODS Worldwide studies were collected to evaluate the HATACE regimen for HCC due to the practical need for global extrapolation of applicative population. Meta-analyses were performed using the RevMan 5.3 software (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). RESULTS Thirty-six studies involving a large sample of 5036 patients were included finally. Compared with HA alone, HATACE produced the advantage of 5-year overall survival (OS) rate (OR:1.90; 95%CI:1.46,2.46; p < 0.05) without increasing toxicity (p ≥ 0.05). Compared with TACE alone, HATACE was associated with superior 5-year OS rate (OR:3.54; 95%CI:1.96,6.37; p < 0.05) and significantly reduced the incidences of severe liver damage (OR:0.32; 95%CI:0.11,0.96; p < 0.05) and ascites (OR:0.42; 95%CI:0.20,0.88; p < 0.05). Subgroup analysis results of small (≤3 cm) HCC revealed that there were no significant differences between the HATACE group and HA monotherapy group in regard to the OS rates (p ≥ 0.05). CONCLUSIONS Compared with TACE alone, HATACE was more effective and safe for HCC. Compared with HA alone, HATACE was more effective for non-small-sized (>3 cm) HCC with comparable safety. However, the survival benefit of adjuvant TACE in HATACE regimen was not found for the patients with small (≤3 cm) HCC.
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24
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Videtic GMM, Reddy CA, Woody NM, Stephans KL. Ten-Year Experience in Implementing Single-Fraction Lung SBRT for Medically Inoperable Early-Stage Lung Cancer. Int J Radiat Oncol Biol Phys 2021; 111:436-442. [PMID: 34048817 DOI: 10.1016/j.ijrobp.2021.05.116] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE To review 10 years of using single-fraction lung stereotactic body radiation therapy (SF-SBRT) for medically inoperable peripheral early-stage lung cancer. METHODS AND MATERIALS An institutional review board-approved prospective lung SBRT data registry was surveyed until the end of December 2019 for all patients receiving SF-SBRT with minimum 6-month follow-up. Doses used were either 34 Gy or 30 Gy. Outcomes of interest included rates of local failure and overall survival (OS), as well as treatment-related toxicity graded per Common Terminology Criteria for Adverse Events version 3.0. RESULTS A total of 229 patients met the study criteria. Patient characteristics included female sex (55%); median age, 74.6 years (range, 47-94); and median Karnofsky Performance Status 80 (range, 50-100). Tumor characteristics included median diameter, 1.6 cm (range, 0.7-4.1); median positron emission tomography standardized uptake value maximum 6.1 (range, 0.8-24.3); and 63.6% of patients biopsied. SF-SBRT dose was 34 Gy in 72.1% cases and 30 Gy in 27.9%, with patient and tumor characteristics balanced between cohorts. Overall median follow-up times for 30 Gy and 34 Gy were 36.7 and 17.2 months, respectively (P < .0001). At analysis, 55.9% patients were alive. Two (0.9%) patients developed grade 3 toxicities, and none had grade 4/5 toxicities. Grades 1 to 2 pneumonitis and chest wall toxicity were seen in 7% and 12.7% patients, respectively. Median overall survival was 44.1 months. Rates of 2-year local, nodal, and distant failure were 7.3%, 9.4%, and 12.2%, respectively. There were no significant differences in outcomes by dose. CONCLUSIONS This is the largest institutional series to date reporting on SF-SBRT outcomes for medically inoperable peripheral early-stage lung cancer and the first to report on a decade's experience in implementing this schedule. Outcomes from this analysis are comparable to published results from 2 randomized trials and validate the use of this schedule in routine practice. In the absence of phase 3 trials, this study should encourage increased use of SF-SBRT for inoperable tumors.
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Affiliation(s)
- Gregory M M Videtic
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Chandana A Reddy
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Neil M Woody
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kevin L Stephans
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
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25
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Galofaro E, Malizia C, Ammendolia I, Galuppi A, Guido A, Ntreta M, Siepe G, Tolento G, Veraldi A, Scirocco E, Arcelli A, Buwenge M, Ferioli M, Zamagni A, Strigari L, Cammelli S, Morganti AG. COVID-19 Pandemic-Adapted Radiotherapy Guidelines: Are They Really Followed? Curr Oncol 2021; 28:3323-3330. [PMID: 34590595 PMCID: PMC8482258 DOI: 10.3390/curroncol28050288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In our department, we provided guidelines to the radiation oncologists (ROs) regarding the omission, delay, or shortening of radiotherapy (RT). The purpose was to reduce the patients' exposure to the hospital environment and to minimize the departmental overcrowding. The aim was to evaluate the ROs' compliance to these guidelines. METHODS ROs were asked to fill out a data collection form during patients' first visits in May and June 2020. The collected data included the ROs' age and gender, patient age and residence, RT purpose, treated tumor, the dose and fractionation that would have been prescribed, and RT changes. The chi-square test and binomial logistic regression were used to analyze the correlation between the treatment prescription and the collected parameters. RESULTS One hundred and twenty-six out of 205 prescribed treatments were included in this analysis. Treatment was modified in 61.1% of cases. More specifically, the treatment was omitted, delayed, or shortened in 7.9, 15.9, and 37.3% of patients, respectively. The number of delivered fractions was reduced by 27.9%. A statistically significant correlation (p = 0.028) between younger patients' age and lower treatment modifications rate was recorded. CONCLUSION Our analysis showed a reasonably high compliance of ROs to the pandemic-adapted guidelines. The adopted strategy was effective in reducing the number of admissions to our department.
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Affiliation(s)
- Elena Galofaro
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic, and Specialty Medicine—DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
- Correspondence: ; Tel.: +39-3409328999
| | - Claudio Malizia
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Ilario Ammendolia
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
| | - Andrea Galuppi
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
| | - Alessandra Guido
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
| | - Maria Ntreta
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
| | - Giambattista Siepe
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
| | - Giorgio Tolento
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
| | - Antonio Veraldi
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
| | - Erica Scirocco
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic, and Specialty Medicine—DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
| | - Alessandra Arcelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic, and Specialty Medicine—DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
| | - Milly Buwenge
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic, and Specialty Medicine—DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
| | - Martina Ferioli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic, and Specialty Medicine—DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
| | - Alice Zamagni
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic, and Specialty Medicine—DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
| | - Lidia Strigari
- Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Silvia Cammelli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic, and Specialty Medicine—DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.A.); (A.G.); (A.G.); (M.N.); (G.S.); (G.T.); (A.V.); (E.S.); (A.A.); (M.B.); (M.F.); (A.Z.); (S.C.); (A.G.M.)
- Department of Experimental, Diagnostic, and Specialty Medicine—DIMES, Alma Mater Studiorum Bologna University, 40138 Bologna, Italy
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26
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Greco C, Fuks Z. Single-Dose Radiotherapy for Prostate Cancer-Lessons Learned From Single-Fraction High-Dose-Rate Brachytherapy-Reply. JAMA Oncol 2021; 7:1573. [PMID: 34351361 DOI: 10.1001/jamaoncol.2021.2694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Carlo Greco
- Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Zvi Fuks
- Champalimaud Centre for the Unknown, Lisbon, Portugal.,Memorial Sloan Kettering Cancer Center, New York, New York
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27
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Siavashpour Z, Goharpey N, Mobasheri M. Radiotherapy based management during Covid-19 pandemic - A systematic review of presented consensus and guidelines. Crit Rev Oncol Hematol 2021; 164:103402. [PMID: 34214608 PMCID: PMC8242203 DOI: 10.1016/j.critrevonc.2021.103402] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/17/2021] [Accepted: 06/18/2021] [Indexed: 01/18/2023] Open
Abstract
Treatment management of cancer patients in the radiation oncology departments during the current COVID-19 pandemic is challenging. A systematic review of published consensus/guidelines on the role of radiotherapy prioritization, suggested treatment protocols, and set up management was undertaken based on the PRISMA protocol and through PubMed/PMC, Scopus, Google Scholar, Web of Science databases until 01/20/2021. One hundred and sixty-eight publications or regional consensus were included. Summary of recommendations contained: (1) using hypo-fractionated (Hypo-F) regimens for therapeutic/palliative indications, (2) delaying radiotherapy for several weeks or until pandemic over, (3) omitting radiotherapy by replacement of alternative therapies or active surveillance, (4) applying safer patients' setup and preparation protocols, (5) developing telemedicine/telehealth service. To conclude, it is essential to carefully weigh the risk of exposure to COVID-19 infection and the benefit of treating cancer patients during the pandemic. Trying to have a global guideline facing this or any other probable crisis is crucial for health care service.
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Affiliation(s)
- Zahra Siavashpour
- Radiotherapy Oncology Department, Shohada-e Tajrish Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Neda Goharpey
- Radiotherapy Oncology Department, Shohada-e Tajrish Educational Hospital, Tehran, Iran.
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28
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Cuccia F, Rigo M, Gurrera D, Nicosia L, Mazzola R, Figlia V, Giaj-Levra N, Ricchetti F, Attinà G, Pastorello E, De Simone A, Naccarato S, Sicignano G, Ruggieri R, Alongi F. Mitigation on bowel loops daily variations by 1.5-T MR-guided daily-adaptive SBRT for abdomino-pelvic lymph-nodal oligometastases. J Cancer Res Clin Oncol 2021; 147:3269-3277. [PMID: 34268583 DOI: 10.1007/s00432-021-03739-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/30/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE We report preliminary dosimetric data concerning the use of 1.5-T MR-guided daily-adaptive radiotherapy for abdomino-pelvic lymph-nodal oligometastases. We aimed to assess the impact of this technology on mitigating daily variations for both target coverage and organs-at-risk (OARs) sparing. METHODS A total of 150 sessions for 30 oligometastases in 23 patients were analyzed. All patients were treated with MR-guided stereotactic body radiotherapy (SBRT) for a total dose of 35 Gy in five fractions. For each fraction, a quantitative analysis was performed for PTV volume, V35Gy and Dmean. Similarly, for OARs, we assessed daily variations of volume, Dmean, Dmax. Any potential statistically significant change between baseline planning and daily-adaptive sessions was assessed using the Wilcoxon signed-rank test, assuming a p value < 0.05 as significant. RESULTS Average baseline PTV, bowel, bladder, and single intestinal loop volumes were respectively 8.9 cc (range 0.7-41.2 cc), 1176 cc (119-3654 cc), 95 cc (39.7-202.9 cc), 18.3 cc (9.1-37.7 cc). No significant volume variations were detected for PTV (p = 0.21) bowel (p = 0.36), bladder (p = 0.47), except for single intestinal loops, which resulted smaller (p = 0.026). Average baseline V35Gy and Dmean for PTV were respectively 85.6% (72-98.8%) and 35.6 Gy (34.6-36.1 Gy). We recorded a slightly positive trend in favor of daily-adaptive strategy vs baseline planning for improved target coverage, although not reaching statistical significance (p = 0.11 and p = 0.18 for PTV-V35Gy and PTV-Dmean). Concerning OARs, a significant difference was observed in favor of daily-adapted treatments in terms of single intestinal loop Dmax [23.05 Gy (13.2-26.9 Gy) at baseline vs 20.5 Gy (12.1-24 Gy); p value = 0.0377] and Dmean [14.4 Gy (6.5-18 Gy) at baseline vs 13.0 Gy (6.7-17.6 Gy); p value = 0.0003]. Specifically for bladder, the average Dmax was 18.6 Gy (0.4-34.3 Gy) at baseline vs 18.3 Gy (0.7-34.3 Gy) for a p value = 0.28; the average Dmean was 7.0 Gy (0.2-16.6 Gy) at baseline vs 6.98 Gy (0.2-16.4 Gy) for a p value = 0.66. Concerning the bowel, no differences in terms of Dmean [4.78 Gy (1.3-10.9 Gy) vs 5.6 Gy (1.4-10.5 Gy); p value = 0.23] were observed between after daily-adapted sessions. A statistically significant difference was observed for bowel Dmax [26.4 Gy (7.7-34 Gy) vs 25.8 Gy (7.8-33.1 Gy); p value = 0.0086]. CONCLUSIONS Daily-adaptive MR-guided SBRT reported a significantly improved single intestinal loop sparing for lymph-nodal oligometastases. Also, bowel Dmax was significantly reduced with daily-adaptive strategy. A minor advantage was also reported in terms of PTV coverage, although not statistically significant.
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Affiliation(s)
- Francesco Cuccia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Michele Rigo
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Davide Gurrera
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Luca Nicosia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy.
| | - Rosario Mazzola
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Vanessa Figlia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Niccolò Giaj-Levra
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Francesco Ricchetti
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Giorgio Attinà
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Edoardo Pastorello
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Antonio De Simone
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Stefania Naccarato
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Gianluisa Sicignano
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Ruggero Ruggieri
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, VR, Italy.,University of Brescia, Brescia, Italy
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Alongi F, Nicosia L, Figlia V, De Sanctis V, Mazzola R, Giaj-Levra N, Reverberi C, Valeriani M, Osti MF. A multi-institutional analysis of fractionated versus single-fraction stereotactic body radiotherapy (SBRT) in the treatment of primary lung tumors: a comparison between two antipodal fractionations. Clin Transl Oncol 2021; 23:2133-2140. [PMID: 33840047 DOI: 10.1007/s12094-021-02619-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/01/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Stereotactic body radiotherapy (SBRT) is a consolidate treatment for inoperable early-stage lung tumors, usually delivered in single or multi-fraction regimens. We aimed to compare these two approaches in terms of local effectiveness, safety and survival. MATERIALS AND METHODS Patients affected by medically inoperable early-stage lung tumor were treated at two Institutions with two different schedules: 70 Gy in ten fractions (TF) (BED10: 119 Gy) or 30 Gy in single fraction (SF) (BED10: 120 Gy). RESULTS 73 patients were treated with SBRT delivered with two biological equivalent schedules: SF (44) and TF (29). The median follow-up was 34 months (range 3-81 months). Three-year Overall survival (OS) was 57.9%, 3-year cancer-specific survival (CSS) was 77.2%, with no difference between treatment groups. Three-year progression-free survival (LPFS) was 88.9% and did not differs between SF and TF. Overall, four cases (5.4%) of acute grade ≥ 3 pneumonitis occurred. No differences in acute and late toxicity between the two groups were detected. CONCLUSION SF and TF seems to be equally safe and effective in the treatment of primary inoperable lung tumors especially for smaller lesion. The SF may be preferentially offered to reduce patient access to hospital with no negative impact on tumor control and survival.
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Affiliation(s)
- F Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Verona, Negrar, Italy
- University of Brescia, Brescia, Italy
| | - L Nicosia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Verona, Negrar, Italy.
| | - V Figlia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Verona, Negrar, Italy
| | - V De Sanctis
- Department of Radiation Oncology, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - R Mazzola
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Verona, Negrar, Italy
| | - N Giaj-Levra
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, via Don Sempreboni 5, 37034, Verona, Negrar, Italy
| | - C Reverberi
- Department of Radiation Oncology, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - M Valeriani
- Department of Radiation Oncology, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - M F Osti
- Department of Radiation Oncology, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
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Chuong MD, Kotecha R, Mehta MP, Adamson S, Romaguera T, Hall MD, Alvarez D, Gutierrez AN, Mishra V, De Zarraga F, Mittauer KE. Case report of visual biofeedback-driven, magnetic resonance-guided single-fraction SABR in breath hold for early stage non-small-cell lung cancer. Med Dosim 2021; 46:247-252. [PMID: 33648822 DOI: 10.1016/j.meddos.2021.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/14/2021] [Accepted: 01/31/2021] [Indexed: 10/22/2022]
Abstract
Stereotactic ablative body radiation therapy (SABR) is a well-established alternative to surgery for early stage non-small-cell lung cancer (NSCLC). While SABR is typically delivered in 3 to 5 fractions, randomized trials have shown single-fraction SABR to be a reasonable alternative. We present the case of a 66-year-old male with history of cholangiocarcinoma who was subsequently diagnosed with peripheral early stage NSCLC and treated in mid-inspiration breath hold (BH) to 34 Gy in 1 fraction on a magnetic resonance (MR)-guided linear accelerator, with treatment delivery completed in 17 minutes. Visual biofeedback was utilized to maximize patient compliance with appropriate depth of inspiration BH and improve overall treatment delivery time efficiency. The benefits of single- vs multifraction SABR and unique advantages of MR guidance that are particularly well-suited for single-fraction SABR are reviewed.
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Affiliation(s)
- Michael D Chuong
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Minesh P Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Sonia Adamson
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA
| | - Tino Romaguera
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Matthew D Hall
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Diane Alvarez
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Alonso N Gutierrez
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Vivek Mishra
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Fernando De Zarraga
- Department of Medical Oncology, Miami Cancer Institute, Miami, FL 33176, USA
| | - Kathryn E Mittauer
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
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31
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Lee S, Yadav P, van der Kogel AJ, Bayouth J, Bassetti MF. In Silico Single-Fraction Stereotactic Ablative Radiation Therapy for the Treatment of Thoracic and Abdominal Oligometastatic Disease With Online Adaptive Magnetic Resonance Guidance. Adv Radiat Oncol 2021; 6:100652. [PMID: 34195490 PMCID: PMC8233469 DOI: 10.1016/j.adro.2021.100652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/16/2020] [Accepted: 01/11/2021] [Indexed: 02/06/2023] Open
Abstract
Purpose Although SABR can improve oncologic outcomes for patients with oligometastatic disease, treatment of metastases near critical organs remains challenging. The purpose of this study is to determine the dosimetric feasibility of delivering magnetic resonance imaging (MRI)-guided adaptive SABR in a single fraction for abdominal and thoracic metastases. Methods and Materials Previously delivered MRI-guided radiation therapy plans for 20 patients with oligometastatic disease in the thorax or abdomen, with 70% (14/20) of the lesions within 8 mm from dose-limiting organs at risk (OARs), were used to simulate the delivery of 24 Gy in a single fraction. Planning objectives included planning target volume (PTV) V95% >90%, optimized PTV (PTVopt) V95% >90%, and PTVopt D99% >20 Gy with no OAR dose violations, where PTVopt removed overlap with nearby planning organ at risk volume (PRV). Single-fraction plans were simulated on the first 5 daily setup breath-hold MRI scans, and the plans were reoptimized to consider variations in setup position and anatomy. Results The mean PTV V95% for single-fraction SABR plans was lower compared with multifraction plans (mean 85.4% vs 92.6%, P = .02), but mean PTVopt V95% was not different (95.3% vs 98.2%, P = .62). After reoptimization of the single-fraction plan to the treatment day MRI, there was an increase in mean PTV V95% (85.0% vs 88.1%, P = .05), increase in mean PTVopt V95% (92.7% vs 96.3%, P = .02), increase in mean PTVopt D99% (19.7 Gy vs 23.8 Gy, P < .01), increase in mean frequency of meeting PTV D99% >20 Gy (52% vs 87%, P < .01), and increase in mean gross tumor volume minimum dose (17.5 Gy vs 19.3 Gy, P < .01). Reoptimization decreased mean frequency of OAR dose constraint violation (48% vs 0%, P < .01). Conclusions Single-fraction MRI-guided SABR is a dosimetrically feasible treatment for oligometastases that allows for on-table adaptation to avoid OAR dose constraint violations, but this method requires clinical validation.
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Affiliation(s)
- Sangjune Lee
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.,Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Poonam Yadav
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Albert J van der Kogel
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - John Bayouth
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Michael F Bassetti
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
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