Low toxicity for lung tumors near the mediastinum treated with stereotactic body radiation therapy

Srivastava, Roma; Asbell, Sucha O.; LaCouture, Tamara; Krämer, Nils; Pahlajani, N; Xue, Jiangyu; Ahmad, Nazish; Chen, Yan; Croce, R; Grimm, Jimm

doi:10.1016/j.prro.2012.04.007

Cited by 12 publications

(11 citation statements)

References 15 publications

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“…From these analytical dose response curves, the table in Fig. 3 shows the estimated risk level corresponding to the dose tolerance limits found in the literature review (1) as part of a DVH Risk Map (10). Instead of creating yet another set of dose tolerance limits, whenever possible we used the clinical data to validate limits from existing publications, only adding new limits where they were missing from the high risk and low risk partitions, as may be seen from Appendix e1 and from the DVH Risk Map in Fig.…”

Section: Dose Tolerance Resultsmentioning

confidence: 99%

“…Dose response modeling was performed using the probit model for of each of the three parameters, D 1cc , D 0.1cc and D max , separately for the de novo and re-treatment cases, as described below. For de novo cases, a sufficient number of published treatment planning constraints exist (1) to construct a DVH Risk Map, which is a comparative graph of dose tolerance, as previously described in Srivastava et al (10). The estimated risk level of each dose tolerance limit was computed from the dose response model Eq.…”

Section: First 100 Spine Sbrt Cases From Stanfordmentioning

confidence: 99%

“…From these and other studies, several treatment planning constraints for the spinal cord have emerged (1). Using a DVH Risk Map (10) these spinal cord planning constraints can be organized into a unified format of high-risk and low-risk limits, based on the assumption that higher doses have relatively higher risk than the more conservative limits. With the addition of dose-response modeling, the DVH Risk Map can be enhanced to include statistically estimated risk levels of each dose tolerance limit based on clinical outcomes data.…”

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confidence: 99%

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Estimated Risk Level of Unified Stereotactic Body Radiation Therapy Dose Tolerance Limits for Spinal Cord

Grimm

Sahgal

Soltys

et al. 2016

Seminars in Radiation Oncology

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A literature review of more than 200 SBRT spine articles from the past 20 years found only a single manuscript that provided dose-volume data and outcomes for each spinal cord of a clinical dataset: the Gibbs 2007 article (2), which essentially contains the first 100 SBRT spine treatments from Stanford University Medical Center. The dataset is modeled and compared in detail to the rest of the literature review, which found 59 dose tolerance limits for the spinal cord in 1–5 fractions. We partitioned these limits into a unified format of high-risk and low-risk dose tolerance limits. To estimate the corresponding risk level of each limit we used the Gibbs 2007 clinical spinal cord dose-volume data for 102 spinal metastases in 74 patients treated by spinal radiosurgery. Fifty of the patients were previously irradiated to a median dose of 40 Gy in 2–3 Gy fractions and 3 patients developed treatment-related myelopathy. These dose-volume data were digitized into the DVH Evaluator software tool where parameters of the probit dose response model were fitted using the maximum likelihood approach (3). Based on this limited dataset, for de novo cases the unified low-risk dose tolerance limits yielded an estimated risk of spinal cord injury of ≤1% in 1–5 fractions, and the high-risk limits yielded an estimated risk of ≤3%. The QUANTEC Dmax limits of 13 Gy in a single fraction and 20 Gy in 3 fractions had less than 1% risk estimated from this dataset, so we consider these among the low-risk limits. In the previously irradiated cohort, the estimated risk levels for 10 Gy and 14 Gy maximum cord dose limits in 5 fractions are 0.4% and 0.6%, respectively. Longer follow-up and more patients are required to improve the risk estimates and provide more complete validation.

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Section: Dose Tolerance Resultsmentioning

confidence: 99%

Section: First 100 Spine Sbrt Cases From Stanfordmentioning

confidence: 99%

mentioning

confidence: 99%

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Estimated Risk Level of Unified Stereotactic Body Radiation Therapy Dose Tolerance Limits for Spinal Cord

Grimm

Sahgal

Soltys

et al. 2016

Seminars in Radiation Oncology

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“…Prior to dose-response modeling for each critical structure, all Dx values were converted to a common fractionation using the linear quadratic (LQ) model ( 18 ). Logistic ( 19 ) or probit ( 20 ) dose-response models were fitted to the data using the maximum-likelihood technique ( 21 ) and confidence intervals were based on the profile-likelihood method ( 22 ) in the DVH Evaluator (DiversiLabs, LLC, Huntingdon Valley, PA) ( 16 , 17 ). The endpoint of grade 3 or higher complications, according to the Common Terminology Criteria for Adverse Events (CTCAE) ( 23 ), version 3 for chestwall and duodenum, and version 4 for aorta/major vessels and small bowel was chosen for clinical relevance.…”

Section: Methodsmentioning

confidence: 99%

“…Phase III clinical studies would be the ideal solution but usually such trials are designed to evaluate new cancer drugs or treatment modalities instead of toxicity dose response models. Now, after 25 years of clinical experience, and with the recent arrival of automated clinical tools for quantifying dose-response outcomes ( 16 , 17 ) in terms of normal tissue complication probability (NTCP) models, it might be possible to finally quantify the late-effect complications from radiosurgery, and thereby better define the risk/benefit ratio of this important therapy.…”

Section: Introductionmentioning

confidence: 99%

Potential Clinical Significance of Overall Targeting Accuracy and Motion Management in the Treatment of Tumors That Move With Respiration: Lessons Learnt From a Quarter Century of Stereotactic Body Radiotherapy From Dose Response Models

et al. 2021

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ObjectiveTo determine the long-term normal tissue complication probability with stereotactic body radiation therapy (SBRT) treatments for targets that move with respiration and its relation with the type of respiratory motion management (tracking vs. compression or gating).MethodsA PubMed search was performed for identifying literature regarding dose, volume, fractionation, and toxicity (grade 3 or higher) for SBRT treatments for tumors which move with respiration. From the identified papers logistic or probit dose-response models were fitted to the data using the maximum-likelihood technique and confidence intervals were based on the profile-likelihood method in the dose-volume histogram (DVH) Evaluator.ResultsPooled logistic and probit models for grade 3 or higher toxicity for aorta, chest wall, duodenum, and small bowel suggest a significant difference when live motion tracking was used for targeting tumors with move with respiration which was on the average 10 times lower, in the high dose range.ConclusionLive respiratory motion management appears to have a better toxicity outcome when treating targets which move with respiration with very steep peripheral dose gradients. This analysis is however limited by sparsity of rigorous data due to poor reporting in the literature.

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Radiation Oncology

LaRue¹,

Gordon²

2020

Withrow and MacEwen's Small Animal Clinical Oncology

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Low toxicity for lung tumors near the mediastinum treated with stereotactic body radiation therapy

Cited by 12 publications

References 15 publications

Estimated Risk Level of Unified Stereotactic Body Radiation Therapy Dose Tolerance Limits for Spinal Cord

Estimated Risk Level of Unified Stereotactic Body Radiation Therapy Dose Tolerance Limits for Spinal Cord

Potential Clinical Significance of Overall Targeting Accuracy and Motion Management in the Treatment of Tumors That Move With Respiration: Lessons Learnt From a Quarter Century of Stereotactic Body Radiotherapy From Dose Response Models

Radiation Oncology

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