To determine the chest wall movement of each patient during deep inspiratory breath hold (DIBH) and expiratory breath hold (EBH) in postoperative breast cancer patients. Postoperative breast cancer patients who underwent CT simulation for 3D radiotherapy treatment planning during December 2012 to November 2013 were included. Before scanning the radio-opaque wire was placed on the surface for breast and chest wall visualization on CT images, then the patient underwent three phases of CT scanning (free breathing, DIBH, and EBH, respectively). The distances of chest wall motion at five reference points were calculated using the treatment planning system. 38 breast cancer patients who underwent surgery were included. Median age was 48.5 (28–85) years. Median BMI was 23.4 (16.6–38.3) kg/m2. Median lung volume was 3160.5 (1830.8–4754.0) cm3. Median Haller index was 2.43 (1.92–3.56). Median chest wall movement was wider in anteroposterior (A–P, 4.2–5.4 mm) than superoinferior (S–I, 2.5–2.6 mm) and mediolateral (M–L, 0.6–1.1 mm) dimension in all five measured points. There was no significant effect of the type of surgery, BMI, lung volume, and the Haller index on the distances of chest wall movement. Additional margins of 7, 5, and 2 mm to the A–P, S–I, and M–L dimension should adequately cover the extreme chest wall movement in 95 % of the patients. This study showed that the maximal movement of the chest wall during DIBH and EBH was greatest in the A–P axis followed by the S–I axis, while the M–L axis was minimally affected by respiration.

Recent publications have reported stereotactic radiosurgery as an effective and safe treatment for intracranial hemangioblastomas. However, because of the low incidence of these particular tumors, reports on large patient number studies have not yet been available. The objective of this study was to analyze the clinical results of 14 patients with 56 intracranial hemangioblastomas treated with linear accelerator (linac)-based stereotactic radiosurgery (SRS) and radiotherapy (SRT) in the same institute. The median age of patients was 41 years (range, 28–73 years). Nine of the patients (64%) had von Hippel-Lindau disease. A total of 39 lesions (70%) were treated with CyberKnife (CK), and 17 lesions (30%) were treated with X-Knife. The median pretreatment volume was 0.26 cm3 (range, 0.026–20.4 cm3). The median marginal dose was 20 Gy (range, 10–32 Gy) in 1 fraction (range, 1–10 fractions). The median follow-up time was 24 months (range, 11–89 months). At the last follow-up, 47 tumors (84%) were stable, 7 (13%) decreased and 2 (4%) increased. The 1-, 2- and 6-year local control rates were 98%, 88% and 73%, respectively. No radiation complications were observed in this study. There was a trend toward local failure only in cystic tumors, but this trend was not found to be statistically significant. SRS/SRT achieved a high local control rate in intracranial hemangioblastomas without radiation-induced complications.

Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (SRT) have been recognized as an alternative to surgery for small to medium sized vestibular schwannoma (VS). This study analysed and compared the outcomes of VS treated with the first Thailand installation of a dedicated Linac-based stereotactic radiation machine using single-fraction radiosurgery (SRS), hypofraction stereotactic radiotherapy (HSRT) and conventional fraction stereotactic radiotherapy (CSRT). From 1997 to 2010, a total of 139 consecutive patients with 146 lesions of VS were treated with X-Knife at Ramathibodi hospital, Bangkok, Thailand. SRS was selected for 39 lesions (in patients with small tumors ≤3 cm and non-serviceable hearing function), whereas HSRT (79 lesions) and CSRT (28 lesions) were given for the remaining lesions that were not suitable for SRS. With a median follow-up time of 61 months (range, 12–143), the 5-year local control rate was 95, 100 and 95% in the SRS, HSRT and CSRT groups, respectively. Hearing preservation was observed after SRS in 75%, after HSRT in 87% and after CSRT in 63% of the patients. Cranial nerve complications were low in all groups. There were no statistically significant differences in local control, hearing preservation or complication between the treatment schedules. In view of our results, it may be preferable to use HSRT over CSRT for patients with serviceable hearing because of the shorter duration of treatment.