UK 2022 Consensus on Normal Tissue Dose-Volume Constraints for Oligometastatic, Primary Lung and Hepatocellular Carcinoma Stereotactic Ablative Radiotherapy

Díez, Patricia; Hanna, G.G.; Aitken, K.; As, N. van; Carver, Antony; Colaco, Rovel; Conibear, John; Dunne, Emma; Eaton, David J.; Franks, K.; Good, James; Harrow, Stephen; Hatfield, Paul; Hawkins, M.; Jain, Suneil; McDonald, Fiona; Patel, Rushil; Rackley, T.; Sanghera, Paul; Tree, A.; Murray, Louise

doi:10.1016/j.clon.2022.02.010

Cited by 56 publications

(35 citation statements)

References 51 publications

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“…In fact, after the pioneering work of Rubin and Cassaret [ 1 ] and the historical so-called Emami’s paper [ 2 ], the Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC) guidelines [ 3 , 4 , 5 ], based on dose/volume constraints (DVCs), were published in 2010. Subsequently, with the growing interest in hypofractionated treatments, especially delivered with stereotactic techniques, several recommendations were published on DVCs to be used with this dose fractionation [ 6 , 7 , 8 , 9 , 10 ]. In addition, specific DVC guidelines were published in particular clinical settings, such as Hodgkin’s lymphomas [ 11 ], breast carcinomas [ 12 , 13 , 14 ], and pediatric cancers [ 15 , 16 , 17 , 18 , 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, specific DVC guidelines were published in particular clinical settings, such as Hodgkin’s lymphomas [ 11 ], breast carcinomas [ 12 , 13 , 14 ], and pediatric cancers [ 15 , 16 , 17 , 18 , 19 , 20 ]. Finally, in the last few years, in parallel with the introduction of stereotactic ablative RT of ventricular arrythmia (STAR) [ 21 , 22 , 23 ], specific DVCs for this treatment were also proposed [ 6 , 8 , 21 , 22 , 24 ]. Therefore, a large number of guidelines or recommendations is now available to guide RT prescription and treatment plan evaluation and comparison.…”

Section: Introductionmentioning

confidence: 99%

“…The following supporting information can be downloaded at: , Supplementary Table S1: (DVCs for emerging OaRs), Supplementary Table S2: (DVCs for RT of Hodgkin’s lymphoma), Supplementary Table S3: (DVCs for RT of breast cancers), Supplementary Table S4: (DVCs for RT of pediatric tumors), Supplementary Table S5: (DVCs for stereotactic ablative RT of ventricular arrythmia) [ 6 , 8 , 11 , 13 , 14 , 15 , 16 , 17 , 18 , 20 , 21 , 22 , 23 , 24 , 35 , 40 , 68 , 79 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 ].…”

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Dose–Volume Constraints fOr oRganS At risk In Radiotherapy (CORSAIR): An “All-in-One” Multicenter–Multidisciplinary Practical Summary

et al. 2022

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Background: The safe use of radiotherapy (RT) requires compliance with dose/volume constraints (DVCs) for organs at risk (OaRs). However, the available recommendations are sometimes conflicting and scattered across a number of different documents. Therefore, the aim of this work is to provide, in a single document, practical indications on DVCs for OaRs in external beam RT available in the literature. Material and Methods: A multidisciplinary team collected bibliographic information on the anatomical definition of OaRs, on the imaging methods needed for their definition, and on DVCs in general and in specific settings (curative RT of Hodgkin’s lymphomas, postoperative RT of breast tumors, curative RT of pediatric cancers, stereotactic ablative RT of ventricular arrythmia). The information provided in terms of DVCs was graded based on levels of evidence. Results: Over 650 papers/documents/websites were examined. The search results, together with the levels of evidence, are presented in tabular form. Conclusions: A working tool, based on collected guidelines on DVCs in different settings, is provided to help in daily clinical practice of RT departments. This could be a first step for further optimizations.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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Dose–Volume Constraints fOr oRganS At risk In Radiotherapy (CORSAIR): An “All-in-One” Multicenter–Multidisciplinary Practical Summary

et al. 2022

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“…As stated in Tan and Palma’s review article, grade 3 or higher toxicities related to SABR have been reported in less than 3% of the patients in most trials. In order to achieve such low rates of toxicities, however, the radiation oncology society should pay the highest attention and make continuous efforts on standardizing SABR protocols outside clinical trials such as the United Kingdom SABR consortium [ 17 ]. Also needed by the radiation oncology society is the enthusiastic and intimate communication and collaboration with respects to the effectiveness, safety, optimal indications, and optimal sequencing of SABR in relation to systemic therapy regimens with their medical oncology partners.…”

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confidence: 99%

Oligometastasis: More Lessons to Be Learned

Kim¹,

Ahn²

2023

Cancer Res Treat

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The first use the term "oligometastasis' in the literature was done by Hellman and Weichselbaum, who also built its concept as "the status between localized and widely metastatic" [1]. Though not all previous trials that evaluated the role of local aggressive treatment (LAT) in oligometastatic settings were affirmative, it cannot be denied that LAT has a strong tendency of improving clinical outcomes, which was elucidated through the effort of Oligometastasis Working Group of Korea Cancer Association [2]. As the meaning of the prefix "oligo-", with Latin origin, contains "few, small, or little" in number, the definition of oligometastasis has mostly been based on the metastatic lesion number, and most clinical trials, in fact, have adopted the number-based definition. The metastatic state, however, is more of a spectrum from none to numerous, and an exact cut-off number defining the oligometastatic status [3].In this issue, Tan and Palma [4] summarized "10 lessons learned from clinical trials on oligometastasis", and suggested that, instead of the metastatic lesion number per se, the possibility of benefit to the patients by applying LAT should be more importantly considered. Since there should have existed a few practical limitations in counting the actual metastatic lesion number even with the most up-to-date diagnostic imaging studies. There has been no single perfect imaging modality, and all have varying ranges of false-negative and false-positive rates in almost all real-world clinical situations. The usually proposed numbers, therefore, are not the absolute criteria with "all or none" magic, but could usually serve as the useful guidance to the clinicians who encounter some important decision points. One of the extreme example has been elucidated in the National Comprehensive Cancer Network guideline for the management of metastatic brain tumors [5], in which the "limited metastasis" has been defined mainly based on the applicability of radiosurgery instead of whole-brain radiation therapy, while notwithstanding the number of metastatic lesions detected. In addition, shortly following the acceptance of Tan and Palma's review article on our journal, a substudy of the SABR-COMET-10 trial [6], ongoing randomized phase 3 trial that intends to assess the stereotactic ablative radiation therapy (SABR) effect in the patients having 4 to 10 metastatic lesions, was published. These authors have already started recruiting the patients with larger lesion number than the previously reports, which limitedly recruited those with 3 or 5 lesions [7-9], and found that the planning outcomes of the first 60 patients were within minimal compromise of dose constraints. This could serve another endorsement to the Tan and Palma's speculation. The simple counting the metastatic lesion number may not have as great critical significance when compared with the past era. This trend of broader criteria of oligometastasis may have been possible in close relation with the wide availability of highly reliable, safe, and effective LAT mod...

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“…In the second general article, Diez et al. [ 6 ] give a timely update to their original 2017 publication, providing an updated UK consensus on normal tissue constraints for SABR [ 7 ]. They review and update the recommended constraints based on the published literature, adding single-fraction recommendations to the existing fractionation schemes.…”

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confidence: 99%