Stereotactic Body Radiation Therapy (SBRT) for Lung Malignancies: Preliminary Toxicity Results Using a Flattening Filter-free Linear Accelerator Operating at 2400 Monitor Units per Minute

Prendergast, B.M.; Dobelbower, M.C.; Spencer, Sharon A.; Popple, Richard A.; Minnich, Douglas J.; Bonner, James A.; Fiveash, John B.

doi:10.1016/j.ijrobp.2012.07.1486

Cited by 4 publications

(4 citation statements)

References 18 publications

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“…It seems to be partly because the number of the subjects of this study was small, the stage and tumor diameters had a wide range, and the observation period was short. Prendergast et al reported that there was no significant difference between the two treatments, and Rieber et al pointed out the same cause as us (40,41).…”

Section: Discussionmentioning

confidence: 74%

Flattening filter-free technique in volumetric modulated arc therapy for lung stereotactic body radiotherapy: A clinical comparison with the flattening filter technique

et al. 2018

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Abstract. The present study sought to evaluate the impact of the flattening filter-free (FFF) technique in volumetric modulated arc therapy for lung stereotactic body radiotherapy. Its clinical safety and availability were compared with the flattening filter (FF) method. The cases of 65 patients who underwent lung volumetric modulated arc therapy-stereotactic body radiotherapy (VMAT-SBRT) using FF or FFF techniques were reviewed. A total of 55 Gy/4 fractions (fr) was prescribed for peripheral lesions or 56 Gy/7 fr for central lesions. The total monitor units (MU), treatment time, dose to tumors, dose to organs at risk, tumor control (local control rate, overall survival, progression-free survival) and adverse events between cases treated with FF and cases treated with the FFF technique were compared. A total of 35 patients were treated with conventional FF techniques prior to November 2014 and 30 patients were treated with FFF techniques after this date. It was revealed that the beam-on time was significantly shortened by the FFF technique (P<0.01). Other factors were similar for FFF and FF plans in respect to conformity (P=0.95), homogeneity (P=0.20) and other dosimetric values, including total MU and planning target volume/internal target volume coverage. The median follow-up period was 18 months (range, 2-35). One-year local control rates were 97.1 and 90.0% in the FF group and FFF groups, respectively (P=0.33). Grade 3 pneumonitis was observed in 5.8% of FF patients and 3.4% of FFF patients (P=1.00). No other adverse events ≥grade 3 were observed. The results of the study suggest that VMAT-SBRT using the FFF technique shortens the treatment time for lung SBRT while maintaining a high local control rate with low toxicity.

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Section: Discussionmentioning

confidence: 74%

Flattening filter-free technique in volumetric modulated arc therapy for lung stereotactic body radiotherapy: A clinical comparison with the flattening filter technique

et al. 2018

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“…Furthermore, the database lacks data regarding toxicity and quality of life. However, SBRT is generally well tolerated, with extremely low rates of clinically significant adverse effects, even within the elderly population . There were also relatively small numbers of patients who received SBRT compared with observation, likely because SBRT was in the early stages of adoption during the period of this study.…”

Section: Discussionmentioning

confidence: 96%

Stereotactic body radiation therapy versus no treatment for early stage non–small cell lung cancer in medically inoperable elderly patients: A National Cancer Data Base analysis

Nanda

Liu

Gillespie

et al. 2015

Cancer

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BACKGROUND Stereotactic body radiation therapy (SBRT) has demonstrated high rates of local control with low morbidity and has now emerged as the standard of care for medically inoperable, early stage non–small cell lung cancer (NSCLC). However, the impact of lung SBRT on survival in the elderly population is less clear given competing comorbid conditions. An analysis of the National Cancer Data Base (NCDB) was undertaken to determine whether definitive SBRT improves survival relative to observation alone patients ages 70 years and older. METHODS The NCDB, a retrospective national database that captures approximately 70% of all patients treated for cancer, was queried for patients aged 70 years or older with early stage (T1‐T3N0M0) NSCLC from 2003 to 2006. Overall survival was compared between patients who received stereotactic body radiotherapy alone and those who received no treatment. An extended Cox proportional hazards model was applied to estimate the treatment effect of SBRT. RESULTS In total, 3147 patients met the selection criteria for this analysis. SBRT was delivered to 258 patients (8.2%), and 2889 patients (91.8%) received no treatment. There was no significant difference in the distribution of Charlson/Deyo comorbidity index scores between the 2 groups (P = .076). Multivariable analysis revealed improved overall survival with SBRT compared with observation for the entire cohort (hazard ratio, 0.64; P < .001). CONCLUSIONS SBRT is associated with improved survival in elderly patients with early stage NSCLC who have concurrent comorbid conditions compared with observation alone. The current data support the use of SBRT for the treatment of elderly patients with early stage NSCLC who have limiting comorbid conditions. Cancer 2015;121:4222–4230. © 2015 American Cancer Society.

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“…Helical tomotherapy (HT) may improve OAR sparing for those in very close proximity to the PTV, as is the case with central lung tumors [ 119 ]. Additionally, flattening filter-free (FFF) linear accelerators, capable of delivering dose rates up to four times that of conventional linear accelerators, may allow for shorter treatment delivery times and thus reduce the opportunity for intrafraction motion [ 120 ] and exposure of normal tissue to scattered dose outside the field [ 121 ]. Volume-adapted dosing strategies hold promise for decreased radiotherapy intensity for smaller tumors with similar tumor control, and consequently, reduced dose to OARs [ 122 ].…”

Section: Ways To Avoid Complicationsmentioning

confidence: 99%

Complications from Stereotactic Body Radiotherapy for Lung Cancer

Kang¹,

Okoye²,

Patel³

et al. 2015

Cancers

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Stereotactic body radiotherapy (SBRT) has become a standard treatment option for early stage, node negative non-small cell lung cancer (NSCLC) in patients who are either medically inoperable or refuse surgical resection. SBRT has high local control rates and a favorable toxicity profile relative to other surgical and non-surgical approaches. Given the excellent tumor control rates and increasing utilization of SBRT, recent efforts have focused on limiting toxicity while expanding treatment to increasingly complex patients. We review toxicities from SBRT for lung cancer, including central airway, esophageal, vascular (e.g., aorta), lung parenchyma (e.g., radiation pneumonitis), and chest wall toxicities, as well as radiation-induced neuropathies (e.g., brachial plexus, vagus nerve and recurrent laryngeal nerve). We summarize patient-related, tumor-related, dosimetric characteristics of these toxicities, review published dose constraints, and propose strategies to reduce such complications.

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Stereotactic Body Radiation Therapy (SBRT) for Lung Malignancies: Preliminary Toxicity Results Using a Flattening Filter-free Linear Accelerator Operating at 2400 Monitor Units per Minute

Cited by 4 publications

References 18 publications

Flattening filter-free technique in volumetric modulated arc therapy for lung stereotactic body radiotherapy: A clinical comparison with the flattening filter technique

Flattening filter-free technique in volumetric modulated arc therapy for lung stereotactic body radiotherapy: A clinical comparison with the flattening filter technique

Stereotactic body radiation therapy versus no treatment for early stage non–small cell lung cancer in medically inoperable elderly patients: A National Cancer Data Base analysis

Complications from Stereotactic Body Radiotherapy for Lung Cancer

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