Pulmonary injury and tumor response after stereotactic body radiotherapy (SBRT): Results of a serial follow-up CT study

Gückenberger, Matthias; Heilman, Katrin; Wulf, Joern; Mueller, Gerd; Beckmann, Gabriele; Flentje, Michael

doi:10.1016/j.radonc.2007.10.044

Cited by 118 publications

(89 citation statements)

References 47 publications

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“…36,37 In addition, due to its retrospective nature and the relatively short FU, it cannot be excluded that some findings are biased with patient selection and that some structural changes may theoretically occur later, since the fibrotic evolution after high-dose irradiation is a dynamic process that might continue for many years. 38,39 A further limitation is that the scoring of CT changes after lung HHT adopted herein 23,24 is qualitative and may be subjective. Alternative methods, such as the use of CT density changes, may represent an objective measure of lung damage because density changes strongly correlate with histological findings of inflammation, 40 thus allowing for a more robust dose-response relationship based on quantitative data.…”

Section: Discussionmentioning

confidence: 99%

Treatment outcomes and patterns of radiologic appearance after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) for lung tumours

Arcangeli

Falcinelli²,

Bracci

et al. 2017

The British Journal of Radiology

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Cite this article as: Arcangeli S, Falcinelli L, Bracci S, Greco A, Monaco A, Dognini J, et al. Treatment outcomes and patterns of radiologic appearance after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) for lung tumours. Objective: To evaluate treatment outcomes and patterns of CT lung injury after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) in a series of inoperable lung lesions. Methods: 68 patients who were medically inoperable (69 lesions) without evidence of viable extrathoracic disease were included. Dose prescription was driven by tumour location (hilar/pericentral vs peripheral) and/or target volume.

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Section: Discussionmentioning

confidence: 99%

Treatment outcomes and patterns of radiologic appearance after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) for lung tumours

Arcangeli

Falcinelli²,

Bracci

et al. 2017

The British Journal of Radiology

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“…Although toxicities from lung SBRT are considered minimal, reported rates of radiation pneumonitis requiring clinical intervention range from 0% to 29% (7,(26)(27)(28). A large Japanese survey (7) of 2390 patients treated with SBRT reported (33).…”

Section: Toxicities and Pulmonary Fibrosismentioning

confidence: 99%

Excellent Cancer Outcomes Following Patient-adapted Robotic Lung SBRT But a Case for Caution in Idiopathic Pulmonary Fibrosis

Bahig

Filion

et al. 2014

Technol Cancer Res Treat

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The aim of this study is to report outcomes and prognostic factors for early stage non-small cell lung cancer treated with patient-adapted Cyberknife stereotactic body radiotherapy. A retrospective analysis of 150 patients with T1-2N0 non-small cell lung cancer treated with stereotactic body radiotherapy was conducted. An algorithm based on tumor and patient's characteristics was used to orient patients towards soft tissue (Xsight Lung), fiducials or adjacent bone (Xsight Spine) tracking. Median biological effective dose without correction for tissue inhomogeneities was 180 Gy 10 for peripheral tumors and 113 Gy 10 for central tumors. Median follow-up was 22 months. Actuarial 2 years local control, overall survival and disease-specific survival were respectively 96%, 87% and 95%. Every 1 cm increase in tumor diameter was associated with a relative risk for regional or distant relapse of 2 (95%CI 5 1.2-3.6, p 5 0.009). With doses 132 Gy 10 and 132 Gy 10 , local control was 98% vs. 82% (p 5 0.07), disease-specific survival 97% vs. 78% (p 5 0.02) and overall survival 93% vs. 76% (p 5 0.01), respectively. Better disease-specific survival and a trend for better overall survival was observed for peripheral vs. central tumors (96% vs. 79%, p 5 0.05 and 92% vs. 74%, p 5 0.08, respectively). A higher Charlson comordibity score (4) predicted lower overall survival (79% vs. 98%, p 5 0.01). Toxicities included 3 patients with idiopathic pulmonary fibrosis who developed grade 5 pneumonitis and 2 patients with grade 3 pneumonitis.We therefore report excellent local control and disease-specific survival following patientadapted Cyberknife lung stereotactic body radiotherapy. Although toxicities were in general minimal, patients with pulmonary fibrosis might be at greater risk of severe complications.Small size, peripheral location, dose  132 Gy 10 and a low Charlson co-morbidity score seem to be associated with better outcomes.

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“…3,5,[11][12][13] It has been reported that radiation can lead to electron density changes in the lung and liver, as observed from CT images. [14][15][16][17][18] The CT number (CTN) changes were found to be associated with radiation injuries.…”

Section: Introductionmentioning

confidence: 99%

Radiation-induced CT number changes in GTV and parotid glands during the course of radiation therapy for nasopharyngeal cancer

Yang

et al. 2016

BJR

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Objective: To investigate the changes in CT number (CTN) in gross tumour volume (GTV) and organs at risk (OARs) during the course of radiation therapy (RT) for nasopharyngeal cancer (NPC). Methods: Daily megavoltage CT (MVCT) data collected from 30 patients with NPC treated with a prescription dose of 70 Gy in 30-33 fractions using helical tomotherapy were retrospectively analyzed. The contours of GTV and OARs on daily MVCTs were obtained by populating the planning contours from planning CT to daily MVCTs with manual editing, if necessary. The changes of GTV and OAR volumes and the histograms of CTN in the GTV and OARs during the course of RT delivery were analyzed. Results: Volumes of GTV and parotid glands were reduced during the course of radiation treatment, with an average shrinkage rate of 0.23% per day (range, 0.02-0.8%) and 1.2% per day (range, 0.2-2.3%), respectively. The mean CTN changes in GTV and ipsilateral and contralateral parotid glands were reduced by 52 6 35 HU, 18 6 20 HU and 17 6 22 HU, respectively. For GTV, the CTN and GTV volume decreases were found to be correlated with each other (p , 0.0001). No noticeable CTN change was found in the spinal cord and non-specified tissue irradiated with low doses. Conclusion: The CTN changes in GTV and parotids are measurable during the delivery of fractionated radiotherapy for NPC, were associated with the doses received (the number of fractions delivered) and were patient specific. Advances in knowledge: The CTN change during radiotherapy is dose dependent and is measurable for NPC.

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Pulmonary injury and tumor response after stereotactic body radiotherapy (SBRT): Results of a serial follow-up CT study

Cited by 118 publications

References 47 publications

Treatment outcomes and patterns of radiologic appearance after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) for lung tumours

Treatment outcomes and patterns of radiologic appearance after hypofractionated image-guided radiotherapy delivered with helical tomotherapy (HHT) for lung tumours

Excellent Cancer Outcomes Following Patient-adapted Robotic Lung SBRT But a Case for Caution in Idiopathic Pulmonary Fibrosis

Radiation-induced CT number changes in GTV and parotid glands during the course of radiation therapy for nasopharyngeal cancer

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