Predictive parameters of symptomatic radiation pneumonitis following stereotactic or hypofractionated radiotherapy delivered using volumetric modulated arcs.

Purpose: To identify dosimetric factors that predict development of radiation pneumonitis (RP) following stereotactic or hypofractionated radiotherapy for lung tumors.

Methods: Seventy-nine consecutive patients with either a planning target volume (PTV)>100 cm(3) (n=69) or prior pneumonectomy or bi-lobectomy (n=13) were identified. Radiation doses (range: 5-50 Gy, with 5 Gy increments) were converted to equivalent doses (EQD(2 Gy)) (α/β=3).

Late radiologic changes after stereotactic ablative radiotherapy for early stage lung cancer: a comparison of fixed-beam versus arc delivery techniques.

Background And Purpose: To characterize the radiologic changes occurring following arc stereotactic ablative radiotherapy (SABR) for early-stage non-small cell lung cancer relative to those following fixed-beam SABR.

Methods: Twenty-nine patients treated with arc SABR without local recurrence and more than two years follow-up were retrospectively evaluated using a published scoring system. The late morphologic patterns, timing and severity of radiologic change were assessed and compared to 54 patients treated with fixed-beam SABR that we previously assessed using the same system.

Investigating strategies to reduce toxicity in stereotactic ablative radiotherapy for central lung tumors.

Background: [corrected] Stereotactic radiotherapy for central lung tumors has a narrower therapeutic index than that for peripheral tumors. Tumor tracking strategies have been proposed to reduce treatment volumes and toxicity, however they need to consider uncertainties in tumor size and shape change throughout respiration to ensure optimal local control. We quantified these uncertainties and explored strategies to account for them.

Digital tomosynthesis (DTS) for verification of target position in early stage lung cancer patients.

Purpose: The ability to verify intrafraction tumor position is clinically useful for hypofractionated treatments. Short arc kV digital tomosynthesis (DTS) could facilitate more frequent target verification. The authors used DTS combined with triangulation to determine the mean temporal position of small-volume lung tumor targets treated with stereotactic radiotherapy.

Best of International Stereotactic Radiosurgery Society Congress 2013: stereotactic body radiation therapy. Part II: nonspinal tumors.

The 11th biennial International Stereotactic Radiosurgery Society Congress represented another historical gathering of professionals in the field of stereotactic radiosurgery. This congress was held on 16-20 June 2013 in Toronto (ON, Canada), and the chairman was Arjun Sahgal, co-chair was Michael Schwartz and president of the society was Jean Regis. The congress attracted 550 attendants from all over the world and over 300 abstracts were presented.

Best of International Stereotactic Radiosurgery Society Congress 2013: stereotactic body radiation therapy. Part I: spinal tumors.

The 11th biennial International Stereotactic Radiosurgery Society Congress represented another historical gathering of professionals in the field of stereotactic radiosurgery. This congress was held on 16-20 June 2013 in Toronto (ON, Canada), and the chairman was Arjun Sahgal, the co-chair was Michael Schwartz and president of the society was Jean Regis. The congress attracted 550 attendants from all over the world and over 300 abstracts were presented.

Radical treatment of synchronous oligometastatic non-small cell lung carcinoma (NSCLC): patient outcomes and prognostic factors.

Objectives: Metastatic non-small cell lung carcinoma (NSCLC) generally carries a poor prognosis, and systemic therapy is the mainstay of treatment. However, extended survival has been reported in patients presenting with a limited number of metastases, termed oligometastatic disease. We retrospectively reviewed the outcomes of such patients treated at two centers.

Changes in non-surgical management of stage III non-small cell lung cancer at a single institution between 2003 and 2010.

Background: Concurrent chemo-radiotherapy (CON-CRT) is recommended for selected patients with stage III non-small cell lung cancer (NSCLC), but utilization varies. We assessed the response to national guidelines introduced in 2004 and the impact on outcomes.

Material And Methods: Retrospective study of stage III NSCLC patients treated with radical intent non-surgical treatment during 2003-2010 in a university medical center characterized by multidisciplinary assessment, routine use of four-dimensional computed tomography for radiotherapy planning, and rapid implementation of radiotherapy advances.

High-risk CT features for detection of local recurrence after stereotactic ablative radiotherapy for lung cancer.

Background And Purpose: Early detection of local recurrences following stereotactic ablative radiotherapy (SABR) for lung cancer may allow for curative salvage treatment, but recurrence can be difficult to distinguish from fibrosis. We studied the clinical performance of CT imaging high-risk features (HRFs) for detecting local recurrence.

Materials And Methods: Patients treated with SABR for early stage lung cancer between 2003 and 2012 who developed pathology-proven local recurrence (n=12) were matched 1:2 to patients without recurrences (n=24), based on baseline factors.

Digital tomosynthesis for verifying spine position during radiotherapy: a phantom study.

Monitoring the stability of patient position is essential during high-precision radiotherapy such as spine stereotactic body radiotherapy (SBRT). We evaluated the combination of digital tomosynthesis (DTS) and triangulation for spine position detection, using non-clinical DTS software and an anthropomorphic pelvic phantom that includes a bone-like spine structure. Kilovoltage cone beam CT projection images over 2-16° gantry rotation were used to generate single slice DTS images.

Dosimetric impact of the interplay effect during stereotactic lung radiation therapy delivery using flattening filter-free beams and volumetric modulated arc therapy.

Purpose: We investigated the dosimetric impact of the interplay effect during RapidArc stereotactic body radiation therapy for lung tumors using flattening filter-free (FFF) beams with different dose rates.

Methods And Materials: Seven tumors with motion ≤20 mm, treated with 10-MV FFF RapidArc, were analyzed. A programmable phantom with sinusoidal longitudinal motion (30-mm diameter "tumor" insert; period = 5 s; individualized amplitude from planning 4-dimensional computed tomography) was used for dynamic dose measurements.

Treatment of multiple primary lung cancers using stereotactic radiotherapy, either with or without surgery.

Background And Purpose: Multiple primary lung cancers (MPLC) are not an uncommon presentation. Current guidelines recommend a curative approach when early-stage MPLC is diagnosed as favorable outcomes have been reported after surgery. We studied outcomes following stereotactic ablative radiotherapy (SABR).

Frameless high dose rate stereotactic lung radiotherapy: intrafraction tumor position and delivery time.

Intrafraction change in tumor position (Δ) was evaluated for stereotactic lung radiotherapy delivered with flattening filter free volumetric modulated arc therapy. In 140 fractions from 32 patients mean Δ (±SD) was -0.7±1.

Radiotherapy for a second primary lung cancer arising post-pneumonectomy: planning considerations and clinical outcomes.

Background: Second primary non-small cell lung cancer (SPLC) is a significant cause of death amongst lung cancer survivors. As subsequent surgery is seldom feasible post-pneumonectomy, we studied the long-term clinical outcomes achieved with curative radiotherapy using modern delivery techniques.

Methods: Retrospective review of an institutional database between 2003-2011 identified 27 patients who had received curative radiotherapy for SPLC arising post-pneumonectomy.

Dosimetric impact of intrafraction motion during RapidArc stereotactic vertebral radiation therapy using flattened and flattening filter-free beams.

Purpose: To study the dosimetric impact of relatively short-duration intrafraction shifts during a single fraction of RapidArc delivery for vertebral stereotactic body radiation therapy (SBRT) using flattened (FF) and flattening filter-free (FFF) beams.

Methods And Materials: The RapidArc plans, each with 2 to 3 arcs, were generated for 9 patients using 6-MV FF and 10-MV FFF beams with maximum dose rates of 1000 and 2400 MU/min, respectively. A total of 1272 plans were created to estimate the dosimetric consequences in target and spinal cord volumes caused by intrafraction shifts during one of the arcs.

The clinical utility of prognostic scoring systems in patients with brain metastases treated with radiosurgery.

Purpose: The RTOG recursive partitioning analysis (RPA) classification is the gold standard for assessing the prognosis of patients with brain metastases (BM). Newer prognostic scoring systems for BM patients have been proposed, but their superiority over RPA needs to be established for patients treated with radiosurgery.

Methods: 380 patients with 1-3 BM were treated at the VUmc with radiosurgery (RS) from 2002 to 2011.

Planning of radiotherapy capacity and productivity.

Background And Purpose: In the late 1990s a period of shortage of radiotherapy capacity caused long waiting times in The Netherlands. Investments in treatment vaults, equipment and training capacity were made. The developments since then are described and the actual situation is compared with the predictions throughout the years.

Outcomes of stereotactic ablative radiotherapy for central lung tumours: a systematic review.

Background And Purpose: Stereotactic ablative radiotherapy (SABR) has improved the survival for medically inoperable patients with peripheral early-stage non-small cell lung cancer (NSCLC). We performed a systematic review of outcomes for central lung tumours.

Material And Methods: The systematic review was performed following PRISMA guidelines.

Evaluation of high ipsilateral subventricular zone radiation therapy dose in glioblastoma: a pooled analysis.

Purpose: Cancer stem cells (CSCs) may play a role in the recurrence of glioblastoma. They are believed to originate from neural stem cells in the subventricular zone (SVZ). Because of their radioresistance, we hypothesized that high doses of radiation (>59.

Comparing rigid and deformable dose registration for high dose thoracic re-irradiation.

For patients with locally-recurrent lung cancer, high dose thoracic re-irradiation can prolong survival. Deformable image registration improves the accuracy with which initial treatments are accounted for compared to rigid image registration. Using deformable image registration will improve correlative toxicity data, and may reduce toxicity for selected patients undergoing re-irradiation.

Stage I-II non-small-cell lung cancer treated using either stereotactic ablative radiotherapy (SABR) or lobectomy by video-assisted thoracoscopic surgery (VATS): outcomes of a propensity score-matched analysis.

Background: Video-assisted thoracoscopic surgery (VATS) lobectomy and stereotactic ablative radiotherapy (SABR) are both used for early-stage non-small-cell lung cancer. We carried out a propensity score-matched analysis to compare locoregional control (LRC).

Patients And Methods: VATS lobectomy data from six hospitals were retrospectively accessed; SABR data were obtained from a single institution database.

Serious complications associated with stereotactic ablative radiotherapy and strategies to mitigate the risk.

The clinical applications of stereotactic body radiotherapy or stereotactic ablative radiotherapy (SABR) for the treatment of primary and metastatic tumours of different organ sites have been expanding rapidly in the recent decade. SABR requires advanced technology in radiotherapy planning and image guidance to deliver a highly conformal ablative dose precisely to targets (or tumours) in the body. Although this treatment modality has shown promising results with regard to tumour control, some serious complications have been observed and reported.