Radiosurgery for liver metastases. A single institution experience

AimTo report our initial results on the use of radiosurgery for treatment of liver metastases.BackgroundIn recent years there has been increasing interest in the use of stereotactic body radiation therapy to treat metastatic disease to the liver as an alternative to interventional procedures.Materials and methodsBetween November 2008 and June 2015 a total of 36 LINAC-based radiosurgeries using VMAT were performed in 27 patients with liver metastases from 10 different primary sites. Doses ranged from 21[[ce:hsp sp="0.25"/]]Gy to 60[[ce:hsp sp="0.25"/]]Gy in 1 to 5 fractions. In all patients the volume of liver receiving less than 15[[ce:hsp sp="0.25"/]]Gy was more than 700[[ce:hsp sp="0.25"/]]cc. The volume treated with the prescription dose ranged from 1[[ce:hsp sp="0.25"/]]cc to 407[[ce:hsp sp="0.25"/]]cc with a median of 58[[ce:hsp sp="0.25"/]]cc. All patients but one received systemic treatment.ResultsOverall median survival for the entire group is 9 months (ranging from 1 to 67 months). Local recurrence free survival ranged from 4 to 67 months with a median of 14 months.Twenty patients (80%) survived more than six months. Three patients treated for oligometastases were alive after 3 years. Grade 0 toxicity was encountered in 22/27 patients, Grade 1 toxicity in 5/27 and only 1/27 patient experienced Grade 2 toxicity. No patient experienced grade 3–4 toxicity.ConclusionBased on these initial results we conclude that SBRT for treating liver metastases with radiosurgery is safe and effective for treating one or multiple lesions as long as normal tissue constraints for liver are respected

Local failure after primary radiotherapy in lung cancer: Is there a role for SBRT?

AimOur purpose is to construe the role of stereotactic body radiation therapy (SBRT) in the management of lung cancer from our early experience with SBRT for salvage treatment in patients with recurrent lung cancer after initial radiation therapy.BackgroundLocoregional recurrences are a frequent challenge in patients treated with radio-chemotherapy for locally advanced NSCLC. Conventional external beam radiation therapy (EBRT) is rarely given as salvage treatment because of the risk of toxicity. There is a paucity of published studies evaluating the role of SBRT in this clinical setting.Materials and methodsBetween 2008 and present, 10 patients with biopsy proven non-small cell lung cancer (NSCLC) underwent 14 radiosurgical procedures for salvage therapy after failing initial radiation treatment. Patients’ age ranged from 54 to 88 years with a median of 74 years in 6 males and 4 females. Intervals from initial radiation treatment to salvage SBRT were 3–33 months with a median of 13 months. SBRT treatments were delivered using Intensity Modulated Volumetric Arc Therapy (VMAT). All patients received concomitant chemotherapy.ResultsOverall survival after salvage radiosurgery ranged from 6 to 41 months (mean 20 months, median 18 months). Four of the ten patients are alive with disease locally controlled. Of the remaining 6 patients, 4 had distant progression of disease with brain metastases and one had both brain and lung metastases. The other patient had a regional failure. Toxicities were found in three of the ten (30%) patients with grade I pneumonitis.ConclusionIn our early experience, salvage SBRT is an effective modality of treating patients who failed after conventional irradiation, achieving excellent results in terms of local control with acceptable toxicity. Further prospective studies are needed to determine optimal fractionation schemes

Volumetric-modulated arc therapy with RapidArc: An evaluation of treatment delivery efficiency

Aim/backgroundTo evaluate how the use of volumetric-modulated arc therapy (VMAT) with RapidArc® can improve treatment delivery efficiency based on the analysis of the beam-on times and monitor units (MU) needed to deliver therapy for multiple clinical applications in a large patient population.Materials and methodsA total of 898 treatment courses were delivered in 745 patients treated from October 2008 to March 2013 using RapidArc® treatment plans generated in Eclipse™ TPS. All patients were treated with curative or palliative intent using different techniques including conventional fractionation (83%) and radiosurgery or SBRT (17%), depending on the clinical indications. Treatment delivery was evaluated based on measured beam-on time and recorded MU values delivered on a Varian Trilogy™ linear accelerator.ResultsFor conventional fractionation treatments using RapidArc®, the delivery times ranged from 38[[ce:hsp sp="0.25"/]]s to 4[[ce:hsp sp="0.25"/]]min and 40[[ce:hsp sp="0.25"/]]s (average 2[[ce:hsp sp="0.25"/]]min and 6[[ce:hsp sp="0.25"/]]s). For radiosurgical treatments the delivery times ranged from 1[[ce:hsp sp="0.25"/]]min and 42[[ce:hsp sp="0.25"/]]s to 9[[ce:hsp sp="0.25"/]]min and 22[[ce:hsp sp="0.25"/]]s (average 4[[ce:hsp sp="0.25"/]]min and 4[[ce:hsp sp="0.25"/]]s). The average number of MU per Gy was 301 for the entire group, with 285 for the conventional group and 317 for the radiosurgical group.ConclusionsIn this study with a large heterogeneous population, treatments using RapidArc® were delivered with substantially less beam-on time and fewer MUs than conventional fractionation. This was highly advantageous, increasing flexibility of the scheduling allowing treatment of radiosurgery patients during the regular daily work schedule. Additionally, reduction of leakage radiation dose was achieved

Improved outcome of treating locally advanced lung cancer with the use of Lattice Radiotherapy (LRT): A case report

The Lattice Radiotherapy (LRT) technique is mainly based on the GRID technology with the improved feature of the 3D treatment delivery. A 72 year old male presented with left shoulder pain due to a 6 cm pulmonary mass in the left upper lobe (LUL) histologically proven Non-Small Cell Lung Cancer (NSCLC) stage IIIA. In July 2011 he was treated in our center with LRT followed by conventional fractionated Volumetric Modulated Arc Therapy (VMAT) combined with chemotherapy. Clinical and imaging follow up of 6 years demonstrated continued improvement and the patient is currently with no evidence of disease (NED). This outstanding result obtained in our first lung cancer patient treated with this approach corroborates its potential in the treatment of locally advanced lung cancer. In a period of 7 years we have treated more than 30 patients with LRT for different diagnosis and sites; 12 of them NSCLC patients, with markedly improved local control and minimal toxicity

An International Consensus on the Design of Prospective Clinical–Translational Trials in Spatially Fractionated Radiation Therapy for Advanced Gynecologic Cancer

Despite the unexpectedly high tumor responses and limited treatment-related toxicities observed with SFRT, prospective multi-institutional clinical trials of SFRT are still lacking. High variability of SFRT technologies and methods, unfamiliar complex dose and prescription concepts for heterogeneous dose and uncertainty regarding systemic therapies present major obstacles towards clinical trial development. To address these challenges, the consensus guideline reported here aimed at facilitating trial development and feasibility through a priori harmonization of treatment approach and the full range of clinical trial design parameters for SFRT trials in gynecologic cancer. Gynecologic cancers were evaluated for the status of SFRT pilot experience. A multi-disciplinary SFRT expert panel for gynecologic cancer was established to develop the consensus through formal panel review/discussions, appropriateness rank voting and public comment solicitation/review. The trial design parameters included eligibility/exclusions, endpoints, SFRT technology/technique, dose/dosimetric parameters, systemic therapies, patient evaluations, and embedded translational science. Cervical cancer was determined as the most suitable gynecologic tumor for an SFRT trial. Consensus emphasized standardization of SFRT dosimetry/physics parameters, biologic dose modeling, and specimen collection for translational/biological endpoints, which may be uniquely feasible in cervical cancer. Incorporation of brachytherapy into the SFRT regimen requires additional pre-trial pilot investigations. Specific consensus recommendations are presented and discussed