Historical Development of Stereotactic Ablative Radiotherapy

Solberg, T.D.; Siddon, Robert L.; Kavanagh, Brian D.

doi:10.1007/174_2012_540

Cited by 16 publications

(16 citation statements)

References 164 publications

(158 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Stereotactic radiosurgery (SRS) was first conceptualized by Lars Leksell 1,2 in 1950 as a single-fraction ablative radiotherapy for intracranial tumors. Years later, in 1991, an extension of this concept was applied to extracranial tumors by Blomgren and Lax, 1,2 called stereotactic body radiation therapy (SBRT), which has recently been renamed stereotactic ablative body radiotherapy (SABR).…”

Section: Introductionmentioning

confidence: 99%

The effect of stereotactic body radiotherapy (SBRT) using flattening filter‐free beams on cardiac implantable electronic devices (CIEDs) in clinical situations

Aslian

Kron

Watts

et al. 2020

J Applied Clin Med Phys

View full text Add to dashboard Cite

Purpose: This study focused on determining risks from stereotactic radiotherapy using flattening filter-free (FFF) beams for patients with cardiac implantable electronic device (CIEDs). Two strategies were employed: a) a retrospective analysis of patients with CIEDs who underwent stereotactic radiosurgery (SRS)/SBRT at the Peter MacCallum Cancer Centre between 2014 and 2018 and b) an experimental study on the impact of FFF beams on CIEDs.Methods: A retrospective review was performed. Subsequently, a phantom study was performed using 30 fully functional explanted CIEDs from two different manufacturers. Irradiation was carried out in a slab phantom with 6-MV and 10-MV FFF beams. First, a repetition-rate test (RRT) with a range of beam pulse frequencies was conducted. Then, multifraction SBRT (48 Gy/4 Fx) and single-fraction SBRT (28 Gy/1 Fx) treatment plans were used for lung tumors delivered to the phantom.Results: Between 2014 and 2018, 13 cases were treated with an FFF beam (6 MV, 1400 MU/min or 10 MV, 2400 MU/min), and 15 cases were treated with a flattening filter (FF) beam (6 MV, 600 MU/min). All the devices were positioned outside the treatment field at a distance of more than 5 cm, except for one case, and no failures were reported due to SBRT/SRS. In the phantom rep-rate tests, inappropriate sensing occurred, starting at a rep-rate of 1200 MU/min. Cardiac implantable electronic device anomalies during and after delivering VMAT-SBRT with a 10-MV FFF beam were observed. Conclusions:The study showed that caution should be paid to managing CIED patients when they undergo SBRT using FFF beams, as it is recommended by AAPM TG-203. Correspondingly, it was found that for FFF beams although there is small risk from dose-rate effects, delivering high dose of radiation with beam energy greater than 6 MV and high-dose rate to CIEDs positioned in close vicinity of the PTV may present issues.---

show abstract

Section: Introductionmentioning

confidence: 99%

The effect of stereotactic body radiotherapy (SBRT) using flattening filter‐free beams on cardiac implantable electronic devices (CIEDs) in clinical situations

Aslian

Kron

Watts

et al. 2020

J Applied Clin Med Phys

View full text Add to dashboard Cite

show abstract

“…In 1951, Lars Leksell pioneered SRS ultimately leading to the development of the first Gamma Knife device . In the 1960s and 1970s, SRS was becoming a routine procedure using Gamma Knife but external beam linear accelerators (linacs) of that era lacked the required accuracy for localization and delivery . The first SRS treatments using linacs were delivered in the 1980s using a specialized chair or a frame‐based system for patient positioning, recognizing the localization limitations of the couch.…”

Section: Introductionmentioning

confidence: 99%

“…Significant technological improvements in immobilization, imaging, localization, and delivery have led to the current state of frame‐based and frameless linac‐based SRS delivery. The advancements in localization for linac SRS delivery rely on modern image guidance techniques that include CBCT, kV and MV radiographs, and optical surface monitoring . Innovations on linac delivery are based on dynamic techniques that require the use of several intensity‐modulated static beams or arcs to focus and shape radiation at the target.…”

Section: Introductionmentioning

confidence: 99%

“…4,5 In the 1960s and 1970s, SRS was becoming a routine procedure using Gamma Knife but external beam linear accelerators (linacs) of that era lacked the required accuracy for localization and delivery. 6 The first SRS treatments using linacs were delivered in the 1980s using a specialized chair 7 or a frame-based system 8 for patient positioning, recognizing the localization limitations of the couch. Significant technological improvements in immobilization, imaging, localization, and delivery have led to the current state of frame-based and frameless linac-based SRS delivery.…”

Section: Introductionmentioning

confidence: 99%

“…The advancements in localization for linac SRS delivery rely on modern image guidance techniques that include CBCT, kV and MV radiographs, and optical surface monitoring. 6,9 Innovations on linac delivery are based on dynamic techniques that require the use of several intensitymodulated static beams or arcs to focus and shape radiation at the target. The degree of dose conformality is heavily dependent on the available beam entrance angles on the 4p space, and therefore SRS plans typically consist of a large number of gantry and couch angles.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Lateral head flexion as a noncoplanar solution for ring gantry stereotactic radiosurgery

et al. 2019

View full text Add to dashboard Cite

Purpose Ring gantry radiotherapy devices are often limited to deliver beams in the axial plane, severely limiting beam entrance angles and rendering noncoplanar beam delivery impossible. However, a ring gantry geometry greatly simplifies delivery machines and increases the efficiency of treatment with the potential to decrease the overall costs of radiotherapy. This study explores the use of lateral head flexion in order to increase beam entrance angles and extend the available solid angle space for a ring gantry stereotactic radiosurgery (SRS) application. Materials and methods A 1.5 T magnetic resonance imaging scanner was used to scan seven healthy volunteers at three different head positions: a neutral position, a left lateral flexion position and a right lateral flexion position. The lateral flexion scans were co‐registered to the neutral head position scan using rigid registration and extracting the rotational transformation. The head pitch, roll, and yaw were computed for each registration to evaluate the natural range of motion for all volunteers. A ring gantry plan geometry was used to generate two sets of single fraction SRS plans (21 Gy): one coplanar set for head neutral scans, and a three‐arc plan set using the head neutral and lateral head flexion scans. The conformity index (CI), intermediate dose fall‐off (R50), low dose spillage (R10), and gradient measure (GM) were used to evaluate both sets of plans. The treatment plans were generated for a ring‐gantry linear accelerator (linac) (Varian Halcyon 2.0) as well as radiosurgery linac (Varian Edge) for comparison. Results The average pitch, yaw, and roll for the lateral head flexion scans were 4.1° ± 4.7°, 16.9° ± 3.7°, and 2.5° ± 4.9° for the right flexion and 4.9° ± 4.3°, 14.0° ± 3.7° and 2.8° ± 5.4° for left flexion. When comparing the head flexion technique with a fully coplanar geometry, the ring gantry plans showed an average improvement in CI of 7.3% (1.46 ± 0.25 vs 1.36 ± 0.28), a decrease of 13% in R50 (5.46 ± 1.14 vs 4.78 ± 1.12), a decrease of 32% in R10 (85.7 ± 20.3 vs 58.2 ± 15.1), and a decrease of 7.8% in GM (0.53 ± 0.05 vs 0.49 ± 0.04). The Edge plans showed an average improvement in CI of 3.0% (1.49 ± 0.26 vs 1.45 ± 0.25), a decrease of 6.8% in R50 (5.19 ± 1.03 vs 4.82 ± 0.83), a decrease of 29% in R10 (84.1 ± 16.3 vs 59.9 ± 12.5), and a decrease of 5.0% in GM (0.50 ± 0.04 vs 0.47 ± 0.03). Conclusion Lateral head flexion was shown to increase beam entrance angles considerably improving plan conformity and normal tissue sparing in this pilot study of seven sets of plans. Rigid registrations demonstrated each lateral flexion to be analogous to a 15° couch kick. The head flexion technique outlined here was shown to be a feasible solution for SRS treatments being delivered on ring gantry devices.

show abstract

Linac‐based stereotactic radiosurgery (SRS) in the treatment of refractory trigeminal neuralgia: Detailed description of SRS procedure and reported clinical outcomes

Pokhrel

Sood

McClinton

et al. 2017

J Applied Clin Med Phys

View full text Add to dashboard Cite

Purpose/ObjectivesTo present our linac‐based SRS procedural technique for medically and/or surgically refractory trigeminal neuralgia (TN) treatment and simultaneously report our clinical outcomes.Materials and MethodsTwenty‐seven refractory TN patients who were treated with a single fraction of 80 Gy to TN. Treatment delivery was performed with a 4 mm cone size using 7‐arc arrangement with differential‐weighting for Novalis‐TX with six MV‐SRS (1000 MU/min) beam and minimized dose to the brainstem. Before each treatment, Winston–Lutz quality assurance (QA) with submillimeter accuracy was performed. Clinical treatment response was evaluated using Barrow Neurological Institute (BNI) pain intensity score, rated from I to V.ResultsOut of 27 patients, 22 (81%) and 5 (19%) suffered from typical and atypical TN, respectively, and had median follow‐up interval of 12.5 months (ranged: 1–53 months). For 80 Gy prescriptions, delivered total average MU was 19440 ± 611. Average beam‐on‐time was 19.4 ± 0.6 min. Maximum dose and dose to 0.5 cc of brainstem were 13.4 ± 2.1 Gy (ranged: 8.4–15.9 Gy) and 3.6 ± 0.4 Gy (ranged: 3.0–4.9 Gy), respectively. With a median follow‐up of 12.5 months (ranged: 1–45 months) in typical TN patients, the proportion of patients achieving overall pain relief was 82%, of which half achieved a complete pain relief with BNI score of I‐II and half demonstrated partial pain reduction with BNI score of IIIA‐IIIB. Four typical TN patients (18%) had no response to radiosurgery treatment. Of the patients who responded to treatment, actuarial pain recurrence free survival rates were approximately 100%, 75%, and 50% at 12 months, 15 months, and 24 months, respectively. Five atypical TN patients were included, who did not respond to treatment (BNI score: IV–V). However, no radiation‐induced cranial‐toxicity was observed in all patients treated.ConclusionLinac‐based SRS for medically and/or surgically refractory TN is a fast, effective, and safe treatment option for patients with typical TN who had excellent response rates. Patients, who achieve response to treatment, often have durable response rates with moderate actuarial pain recurrence free survival. Longer follow‐up interval is anticipated to confirm our clinical observations.

show abstract

Historical Development of Stereotactic Ablative Radiotherapy

Cited by 16 publications

References 164 publications

The effect of stereotactic body radiotherapy (SBRT) using flattening filter‐free beams on cardiac implantable electronic devices (CIEDs) in clinical situations

The effect of stereotactic body radiotherapy (SBRT) using flattening filter‐free beams on cardiac implantable electronic devices (CIEDs) in clinical situations

Lateral head flexion as a noncoplanar solution for ring gantry stereotactic radiosurgery

Linac‐based stereotactic radiosurgery (SRS) in the treatment of refractory trigeminal neuralgia: Detailed description of SRS procedure and reported clinical outcomes

Contact Info

Product

Resources

About