Stereotactic Single-Dose Radiation Therapy of Liver Tumors: Results of a Phase I/II Trial

Herfarth, Klaus; Debus, Jürgen; Lohr, Frank; Bahner, M. L.; Rhein, B.; Fritz, Péter; Höss, Angelika; Schlegel, Wolfgang; Wannenmacher, M.

doi:10.1200/jco.2001.19.1.164

Cited by 487 publications

(279 citation statements)

References 22 publications

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“…The investigators from Heidelberg observed that local control was more favorable after 26 Gy than after 14 Gy delivered in 1 fraction. 23 The team from Wurzburg found a 2-year local control of 82 vs. 58% after delivering 36-37.5 Gy in 3 fractions or 26 Gy in 1 fraction vs. 30 Gy in 3 fractions. 7 Later on, in the North American multiinstitutional phase I/II study, the dose was escalated from 36 to 60 Gy with reported 2 years local control rate of 92%.…”

Section: Discussionmentioning

confidence: 99%

Institutional experience in the treatment of colorectal liver metastases with stereotactic body radiation therapy

Romero

Keskin-Cambay

et al. 2017

Reports of Practical Oncology & Radiotherapy

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Metastases LiverStereotactic body radiation therapy a b s t r a c t Aim: To investigate whether the impact of dose escalation in our patient population represented an improvement in local control without increasing treatment related toxicity. Materials and methods:A cohort of consecutive patients with colorectal liver metastases treated with stereotactic body radiation therapy (SBRT) between December 2002 and December 2013 were eligible for this study. Inclusion criteria were a Karnofsky performance status ≥80% and, according to the multidisciplinary tumor board, ineligibility for surgery or radiofrequency ablation. Exclusion criteria were a lesion size >6 cm, more than 3 metastases, and treatment delivered with other fractionation scheme than 3 times 12.5 Gy or 16.75 Gy prescribed at the 65-67% isodose. To analyze local control, CT or MRI scans were acquired during follow-up. Toxicity was scored using the Common Toxicity Criteria Adverse Events v4.0.Results: A total of 40 patients with 55 colorectal liver metastases were included in this study.We delivered 37.5 Gy to 32 lesions, and 50.25 Gy to 23 lesions. Median follow-up was 26 and 25 months for these two groups. Local control at 2 and 3 years was 74 and 66% in the low dose group while 90 and 81% was reached in the high dose group. No significant difference in local control between the two dose fractionation schemes could be found. Grade 3 toxicity was limited and was not increased in the high dose group.Conclusions: SBRT for colorectal liver metastases offers a high chance of local control at long term. High irradiation doses may contribute to enhance this effect without increasing toxicity.

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Section: Discussionmentioning

confidence: 99%

Institutional experience in the treatment of colorectal liver metastases with stereotactic body radiation therapy

Romero

Keskin-Cambay

et al. 2017

Reports of Practical Oncology & Radiotherapy

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“…58,59 In conclusion, a prudent approach, is to use dosevolume constraints for organs at risk summarized in updated guidelines 2,54 or determined in high-quality phase I trials. 16 …”

Section: Dose-volume Constraints For Organs At Riskmentioning

confidence: 99%

Radiobiology of stereotactic body radiation therapy (SBRT)

Garau

2017

Reports of Practical Oncology & Radiotherapy

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a b s t r a c tRecent advances in the technology of radiotherapy have enabled the development of new therapeutic modalities that deliver radiation with very high accuracy, reduced margins and high dose conformation, allowing the reduction of healthy tissue irradiated and therefore minimizing the risk of toxicity. The next step was to increase the total tumor dose using conventional fractionation (which remains the best way to relatively radioprotect healthy tissues when large volumes are treated) or to use new fractionation schemes with greater biological effectiveness. Based on the experience gained in radiosurgery, the latter way was chosen for small and well-defined tumors in the body. Stereotactic body radiotherapy delivers high doses of radiation to small and well-defined targets in an extreme hypofractionated (and accelerated) scheme with a very high biological effectiveness obtaining very good initial clinical results in terms of local tumor control and acceptable rate of late complications.In fact, we realize a posteriori that it was not feasible to administer such biologically equivalent dose in a conventional fractionation because the treatment could last several months.So far, these new therapeutic modalities have been developed due to technologic advances in image guidance and treatment delivery but without a solid biological basis. It is the role of traditional radiobiology (and molecular radiobiology) to explain the effects of high doses of ionizing radiation on tumor and normal tissues. Only through a better understanding of how high doses of ionizing radiation act, clinicians will know exactly what we do, allowing us in the future to refine our treatments. This article attempts to describe through simple and understandable concepts the known aspects of the biological action of high doses of radiation on tumor and normal tissues, but it is clear that we need much more basic research to better understand the biology of high doses of radiation.

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“…13,18 This illustrates the positive impact that international protocols and recommendations have in our setting. [20][21][22][23][24] An USA national survey from 510 radiation oncologists in 2010 reported that lung followed by spine and liver were the most common sites of SBRT treatment and three fractions were the most common fractionation used. They also reported a fast increase on SBRT application (from less than 10% in 2000 to 65% in 2010) and most of the centers are planning to increase the SBRT applications.…”

Section: Resultsmentioning

confidence: 99%

Emerging radiotherapy technology in a developing country: A single Brazilian institution assessment of stereotactic body radiotherapy application

Moraes

Bonifacio

Neves-Junior

et al. 2016

Rev. Assoc. Med. Bras.

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Objective: To provide a quantitative profile of the indications and use of stereotactic body radiotherapy (SBRT) in a developing country oncology-based institution. In addition, to describe the patients' and treatment characteristics, and to provide a temporal analysis. Method: SBRT patients treated from 2007 to 2015 were retrospectively evaluated by two independently investigators. Data were stratified and compared in two periods: first experience (FE) (May 2007 to April 2011), and following experience (FollowE) (May 2011 to April 2015). The following parameters were compared between the groups: total number of treated patients and lesions, treatment site, additional image fusion used, formal protocol adoption, and SBRT planning technique. Results: One hundred and seventy-six (176) patients with 191 lesions were treated: 34 (18%) lesions in the FE and 157 (82%) lesions in FollowE. The majority of lesions were metastases (60.3%), and lung (60.2%) was the most common treatment site, followed by spine (31%), and others (8.8%). An average of 1.4 (±0.6) additional imaging exams for delineation was performed. Conformal 3D radiotherapy planning technique was used in 64.4%, and intensity modulated radiotherapy (IMRT) or volumetric-modulated arc therapy (VMAT) in the remaining 35.6% (p=0.0001). Higher rates of curative treatments were observed in FE, as well as more lung lesions, patients ≥ 70 years, 3D conformal, number of additional images and ECOG 0, and all presented p<0.05. The global rate of protocol statement was 79%, lung treatment being the most stated. Conclusion: SBRT application is rapidly increasing in our setting. Treatment sites and planning techniques are becoming more diversified and complex.

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Stereotactic Single-Dose Radiation Therapy of Liver Tumors: Results of a Phase I/II Trial

Abstract: Stereotactic single-dose radiation therapy is a feasible method for the treatment of singular inoperable liver metastases with the potential of a high local tumor control rate and low morbidity.

Cited by 487 publications

References 22 publications

Institutional experience in the treatment of colorectal liver metastases with stereotactic body radiation therapy

Institutional experience in the treatment of colorectal liver metastases with stereotactic body radiation therapy

Radiobiology of stereotactic body radiation therapy (SBRT)

Emerging radiotherapy technology in a developing country: A single Brazilian institution assessment of stereotactic body radiotherapy application

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