Comparison of Single-fraction and Multi-fraction Stereotactic Radiotherapy for Patients with 18F-fluorodeoxyglucose Positron Emission Tomography-staged Pulmonary Oligometastases

Siva, Shankar; Kirby, Kevin G.; Caine, H.; Pham, Daniel; Kron, Tomas; Marvelde, Luc te; Whalley, Deborah; Stevens, Michael G.; Foroudi, Farshad; MacManus, Michael; Ball, David; Eade, Thomas

doi:10.1016/j.clon.2015.01.004

Cited by 34 publications

(41 citation statements)

References 24 publications

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“…Standard quality assurance measures for SABR treatment were utilised including secondary monitor units check and fluence delivery [25]. Further quality measures, based on Failure Mode and Effects Analysis [26] and broad discussion with international thought leaders on MLC tracking safety, were implemented.…”

Section: Quality Assurance (Qa) Regimementioning

confidence: 99%

The first patient treatment of electromagnetic-guided real time adaptive radiotherapy using MLC tracking for lung SABR

Booth

Caillet

Hardcastle

et al. 2016

Radiotherapy and Oncology

103

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Section: Quality Assurance (Qa) Regimementioning

confidence: 99%

The first patient treatment of electromagnetic-guided real time adaptive radiotherapy using MLC tracking for lung SABR

Booth

Caillet

Hardcastle

et al. 2016

Radiotherapy and Oncology

103

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“…The use of single‐fraction lung SBRT treatments has been previously studied . For instance, Siva et al reported comparable local control rates, overall survival and toxicity profiles between single dose of 26 Gy for peripheral tumors and 18 Gy for centrally located tumors compared to 48 Gy in 4 fractions for peripheral tumors and 50 Gy in 5 fractions for the central tumors for patients with FDG‐PET staged pulmonary oligometastases. Recently, the results of a randomized phase‐II trial of 30 Gy in 1 fraction versus 60 Gy in 3 fractions for medically inoperable early stage lung cancer patients showed similar toxicity and effectiveness between the two arms .…”

Section: Discussionmentioning

confidence: 99%

Flattening filter free VMAT for a stereotactic, single‐dose of 30 Gy to lung lesion in a 15‐min treatment slot

Pokhrel

Sanford

Dhanireddy

et al. 2020

J Applied Clin Med Phys

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Cone-beam CT-guided single dose of lung stereotactic body radiotherapy (SBRT) treatment with a flattening filter free (FFF) beam and volumetric modulated arc therapy (VMAT) is a safe and highly effective treatment modality for selective small lung lesions. Four-dimensional (4D) CT-based treatment plans were generated using advanced AcurosXB algorithm for heterogeneity corrections. 6X-FFF beam produced highly conformal radiosurgical dose distribution to the target and reduced lung SBRT fraction duration to less than 10 min for a single dose of 30 Gy, significantly improving patient comfort and clinic workflow. Early follow-up CT imaging results (mean, 8 months) show high local control rates (100%) with no acute lung or rib toxicity.Longer clinical follow-up in a larger patient cohort managed in this fashion is underway to further validate this treatment approach. K E Y W O R D S beam-on time, FFF-beam, outcomes, single dose, stereotactic lung treatment, VMAT This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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“…[1][2][3][4][5] For the selected peripherally located NSCLC patients; single-dose of SBRT has become a curative treatment option as shown by the randomized trials. [6][7][8][9][10][11][12][13] For instance, Videtic and colleagues 7 compared 2 single-fraction SBRT dosing schemes of 30 and 34 Gy for 80 medically inoperable early stage-I NSCLC patients. Both treatment schedules provided similar tumor local-control and overall survival rates with minimal pulmonary toxicity.…”

Section: Introductionmentioning

confidence: 99%

A simple, yet novel hybrid‐dynamic conformal arc therapy planning via flattening filter‐free beam for lung stereotactic body radiotherapy

Pokhrel

Halfman

Sanford

2020

J Applied Clin Med Phys

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Due to multiple beamlets in the delivery of highly modulated volumetric arc therapy (VMAT) plans, dose delivery uncertainties associated with small-field dosimetry and interplay effects can be concerns in the treatment of mobile lung lesions using a single-dose of stereotactic body radiotherapy (SBRT). Herein, we describe and compare a simple, yet clinically useful, hybrid 3D-dynamic conformal arc (h-DCA) planning technique using flattening filter-free (FFF) beams to minimize these effects. Materials and Methods: Fifteen consecutive solitary early-stage I-II non-small-cell lung cancer (NSCLC) patients who underwent a single-dose of 30 Gy using 3-6 non-coplanar VMAT arcs with 6X-FFF beams in our clinic. These patients' plans were re-planned using a non-coplanar hybrid technique with 2-3 differentiallyweighted partial dynamic conformal arcs (DCA) plus 4-6 static beams. About 60-70% of the total beam weight was given to the DCA and the rest was distributed among the static beams to maximize the tumor coverage and spare the organs-atrisk (OAR). The clinical VMAT and h-DCA plans were compared via RTOG-0915 protocol for conformity and dose to OAR. Additionally, delivery efficiency, accuracy, and overall h-DCA planning time were recorded. Results: All plans met RTOG-0915 requirements. Comparison with clinical VMAT plans h-DAC gave better target coverage with a higher dose to the tumor and exhibited statistically insignificance differences in gradient index, D 2cm , gradient distance and OAR doses with the exception of maximal dose to skin (P = 0.015). For h-DCA plans, higher values of tumor heterogeneity and tumor maximum, minimum and mean doses were observed and were 10%, 2.8, 1.0, and 2.0 Gy, on average, respectively, compared to the clinical VMAT plans. Average beam on time was reduced by a factor of 1.51. Overall treatment planning time for h-DCA was about an hour. Conclusion: Due to no beam modulation through the target, h-DCA plans avoid small-field dosimetry and MLC interplay effects and resulting in enhanced target coverage by improving tumor dose (characteristic of FFF-beam). The h-DCA simplifies treatment planning and beam on time significantly compared to clinical VMAT plans. Additionally, h-DCA allows for the real time target verification and eliminates patient-specific VMAT quality assurance; potentially offering cost-effective, same or

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Comparison of Single-fraction and Multi-fraction Stereotactic Radiotherapy for Patients with 18F-fluorodeoxyglucose Positron Emission Tomography-staged Pulmonary Oligometastases

Cited by 34 publications

References 24 publications

The first patient treatment of electromagnetic-guided real time adaptive radiotherapy using MLC tracking for lung SABR

The first patient treatment of electromagnetic-guided real time adaptive radiotherapy using MLC tracking for lung SABR

Flattening filter free VMAT for a stereotactic, single‐dose of 30 Gy to lung lesion in a 15‐min treatment slot

A simple, yet novel hybrid‐dynamic conformal arc therapy planning via flattening filter‐free beam for lung stereotactic body radiotherapy

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