On-line rapid palliation using helical tomotherapy: A prospective feasibility study

MacPherson, M; Montgomery, Lynn; Fox, Greg; Carty, K.; Gerig, L; MacRae, Rob; Grimard, Lával; Clark, Brenda; Samant, Rajiv

doi:10.1016/j.radonc.2008.01.017

Cited by 25 publications

(23 citation statements)

References 17 publications

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“…However, a number of studies have begun to explore the use of high-technology palliative radiotherapy in situations like this, in an attempt to improve on some of the deficiencies of conventional treatment. Samant et al [16] have recently described their use of image-guided IMRT employing a TomoTherapy unit for online rapid palliative radiotherapy planning and treatment delivery in small numbers of patients, most of whom complained of painful bone metastases in the spine or pelvis [17]. They report that it is possible to scan patients using megavoltage CT acquisition, delineate target volumes, plan IMRT treatment, verify treatment and deliver the first radiotherapy fraction within a 1 h appointment [17].…”

Section: Discussionmentioning

confidence: 99%

“…Samant et al [16] have recently described their use of image-guided IMRT employing a TomoTherapy unit for online rapid palliative radiotherapy planning and treatment delivery in small numbers of patients, most of whom complained of painful bone metastases in the spine or pelvis [17]. They report that it is possible to scan patients using megavoltage CT acquisition, delineate target volumes, plan IMRT treatment, verify treatment and deliver the first radiotherapy fraction within a 1 h appointment [17]. They compare this to 3 h and 3.5 h experiences for patients undergoing conventional simulation and CT simulation, respectively.…”

Section: Discussionmentioning

confidence: 99%

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The developing role for intensity-modulated radiation therapy (IMRT) in the non-surgical treatment of brain metastases

Edwards

Keggin²,

Plowman³

2010

BJR

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ABSTRACT. Whole brain radiotherapy (WBRT) is the standard non-surgical treatment for brain metastatic disease, but rarely eradicates bulky metastases from most common cancers. Recent literature has demonstrated the safety and efficacy of delivering very high focal doses of radiation (by radiosurgical techniques) to the gross tumour volume of bulky brain metastases, thereby obtaining more certain local control than is achieved by WBRT. In this paper we report a study of 11 patients with bulky brain metastases in whom an intensity-modulated radiation therapy (IMRT) facility has been used to concomitantly boost the gross tumour volume of bulky brain metastatic disease (to 40 Gy) during a standard 30 Gy in 10 fractions WBRT schedule. No acute or subacute morbidity was encountered, and good early control data were noted. We discuss the perceived advantages of such a technique. Many patients who develop brain metastases will eventually die of progressive intracranial disease. Among selected patients with good performance status, controlled extracranial disease, favourable prognostic features and with a solitary brain metastasis, there are data from randomised clinical studies demonstrating that surgical excision followed by whole brain radiotherapy (WBRT) offers prolonged survival [5,6]. Stereotactic radiosurgery (SRS), using technologies such as Gamma Knife (Elekta, Linkoping, Sweden), may be able to replace surgery in certain circumstancesdelivering obliteratively high single doses to discrete (single) metastases. SRS is well suited to treating small numbers of brain metastases and achieves good local control of intracranial metastases [7,8]. The doses that can be delivered to individual metastases by Gamma Knife SRS (up to 25 Gy on the margin of MRI-mapped lesions) offer a greater degree of certainty of local control than those from routine WBRT dose prescription. The Radiation Therapy Oncology Group (RTOG) 9508 trial randomised 333 patients with one to three cerebral metastases to standard WBRT either with or without a stereotactic radiation boost and demonstrated an improved quality and quantity of life in those receiving the stereotactic boost [9]. This level 1 evidence thereby demonstrated that packing a higher radiation dose into bulky cerebral metastases is beneficial in addition to standard WBRT.Many patients are initially deemed unsuitable for neurosurgery or, later, SRS boost, owing to poor performance status, active extracranial disease or multiple brain metastases. In these patients, corticosteroids and WBRT are standard treatment. However, there is a subset of these patients receiving WBRT who have better prognostic factors from the systemic disease viewpoint, and who survive long enough to later die from uncontrolled brain metastatic disease. Benefit from brain radiation therapy was greater for the recursive partitioning analysis (RPA) Class I patients (age ,65 years, Karnofsky performance status 70% or higher, with a controlled primary tumour and no extracranial metastases) in the RTOG database [10]. ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The developing role for intensity-modulated radiation therapy (IMRT) in the non-surgical treatment of brain metastases

Edwards

Keggin²,

Plowman³

2010

BJR

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“…This approach will require dosimetrists to work in real time to generate a treatment plan quickly, which will require a good understanding of the expected dosimetry from the STAT RT software by both the dosimetrist and physicians. MacPherson et al 22 investigated the feasibility of using this technology to scan, plan, and deliver a RT treatment in a single patient visit. This study illustrated that patients can be treated within a 1-hour appointment for the first fraction.…”

Section: Introductionmentioning

confidence: 99%

Helical Tomotherapy-Based STAT RT: Dosimetric Evaluation for Clinical Implementation of a Rapid Radiation Palliation Program

McIntosh¹,

Sheng²,

Geezey³

et al. 2010

Medical Dosimetry

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“…Many respondents endorsed shorter or single-fraction treatments that can reduce the number of patient visits, especially when simulation and treatment can be expedited and performed on the same day. 26,27 Formative Factors that Shape Providers' Opinions About RT near the EoL EoL decisions can be very personal. Although some clinical practice guidelines were cited, only 23% of radiation oncologists felt that guidelines are very or extremely important in shaping their opinions about RT near the EoL.…”

Section: Complexities In Eol Carementioning

confidence: 99%

Academic and Resident Radiation Oncologists’ Attitudes and Intentions Regarding Radiation Therapy near the End of Life

Lloyd

Dosoretz²,

Yu³

et al. 2016

American Journal of Clinical Oncology

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On-line rapid palliation using helical tomotherapy: A prospective feasibility study

Cited by 25 publications

References 17 publications

The developing role for intensity-modulated radiation therapy (IMRT) in the non-surgical treatment of brain metastases

The developing role for intensity-modulated radiation therapy (IMRT) in the non-surgical treatment of brain metastases

Helical Tomotherapy-Based STAT RT: Dosimetric Evaluation for Clinical Implementation of a Rapid Radiation Palliation Program

Academic and Resident Radiation Oncologists’ Attitudes and Intentions Regarding Radiation Therapy near the End of Life

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