High-dose MVCT image guidance for stereotactic body radiation therapy

2012 ◽  
Vol 39 (8) ◽  
pp. 4812-4819 ◽  
Author(s):  
David C. Westerly ◽  
Tracey E. Schefter ◽  
Brian D. Kavanagh ◽  
Edward Chao ◽  
Dan Lucas ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Image Guidance ◽  
Stereotactic Body Radiation Therapy ◽  
High Dose ◽  
Stereotactic Body Radiation

The treatment of primary and metastatic renal cell carcinoma (RCC) with stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14572-14572
Author(s):  
B. S. Teh ◽  
C. Bloch ◽  
A. C. Paulino ◽  
L. Doh ◽  
S. Chiang ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Brain Metastases ◽  
Local Control ◽  
Image Guidance ◽  
Stereotactic Body Radiation Therapy ◽  
High Dose ◽  
Stereotactic Body Radiation ◽  
Metastatic Lesions ◽  
Dose Radiation ◽  
Metastatic Rcc

14572 Background: RCC is often regarded as a radio-resistant tumor. However, brain metastases from RCC have been successful treated with SRS. Therefore, metastases to extra-cranial sites may be treated with similar success using stereotactic body radiation therapy (SBRT), where image-guidance allows for the delivery of precise high dose radiation in a few fractions. We report our experience with SRS/SBRT in the management of primary and metastatic RCC. Methods: The image-guided Novalis radiation therapy system was used. Thirty patients with brain metastases were treated with SRS (16–22 Gy in a single fraction). Five of these patients underwent resection of their metastatic lesions after SRS and their pathology were reviewed. Twenty patients with extra-cranial metastatic lesions (orbits, head and neck, lung, mediatinum, sternum, clavicle, scapula, humerus, rib, spine, abdomen) and 2 patients with biopsy proven primary RCC (not surgical candidates), were treated with SBRT (24–32 Gy in 3–4 fractions over 1–2 weeks). All patients were immobilized in body cast and image-guidance was used for all fractions. 4D-CT was utilized in the treatment planning to assess tumor motion. Results: Of the 30 patients who received SRS to brain metastases, 25 showed decreasing or stable lesion size. Five patients showed an increase in size and underwent resection. Their pathology revealed necrosis in >99% of the specimen, with no viable RCC. Nineteen patients who received SBRT to extra-cranial metastases achieved symptom relief. One patient had local progression, yielding a local control rate of 95%. In the 2 patients with primary RCC, tumor size remained unchanged but their pain improved, and their renal function was unchanged post SBRT. There was no significant treatment related side-effect. Conclusions: Precise high dose radiation can cause significant tumor cell death in “radio-resistant” metastases from RCC. It also offers excellent local control and symptom palliation, without significant toxicity. Therefore, SBRT may represent a novel non-invasive, nephron-sparing option for the treatment of primary RCC as well as extra-cranial metastatic RCC. A prospective clinical trial using SBRT for primary and metastatic RCC is on-going. No significant financial relationships to disclose.

Stereotactic Body Radiation Therapy in Multiple Organ Sites

2007 ◽  
Vol 25 (8) ◽  
pp. 947-952 ◽  
Author(s):  
Robert D. Timmerman ◽  
Brian D. Kavanagh ◽  
L. Chinsoo Cho ◽  
Lech Papiez ◽  
Lei Xing
Keyword(s):  
Radiation Therapy ◽  
Stereotactic Body Radiation Therapy ◽  
Advanced Technology ◽  
Dose Fractionation ◽  
Tumor Control ◽  
High Dose ◽  
Stereotactic Body Radiation ◽  
Phase Ii Studies ◽  
Prospective Phase ◽  
Prospective Trials

Introduction Stereotactic body radiation therapy (SBRT) uses advanced technology to deliver a potent ablative dose to deep-seated tumors in the lung, liver, spine, pancreas, kidney, and prostate. Methods SBRT involves constructing very compact high-dose volumes in and about the tumor. Tumor position must be accurately assessed throughout treatment, especially for tumors that move with respiration. Sophisticated image guidance and related treatment delivery technologies have developed to account for such motion and efficiently deliver high daily dose. All this serves to allow the delivery of ablative dose fractionation to the target capable of both disrupting tumor mitosis and cellular function. Results Prospective phase I dose-escalation trials have been carried out to reach potent tumoricidal dose levels capable of eradicating tumors with high likelihood. These studies indicate a clear dose-response relationship for tumor control with escalating dose of SBRT. Prospective phase II studies have been reported from several continents consistently showing very high levels of local tumor control. Although late toxicity requires further careful assessment, acute and subacute toxicities are generally acceptable. Patterns of toxicity, both clinical and radiographic, are distinct from those observed with conventionally fractionated radiotherapy as a result of the unique biologic response to ablative fractionation. Conclusion Prospective trials using SBRT have confirmed the efficacy of treatment in a variety of patient populations. Although mechanisms of ablative-dose injury remain elusive, ongoing prospective trials offer the hope of finding the ideal application for SBRT in the treatment arsenal.

Image-Guidance for Stereotactic Body Radiation Therapy

2007 ◽  
Vol 32 (2) ◽  
pp. 102-110 ◽  
Author(s):  
Martin Fuss ◽  
Judit Boda-Heggemann ◽  
Nikos Papanikolau ◽  
Bill J. Salter
Keyword(s):  
Radiation Therapy ◽  
Image Guidance ◽  
Stereotactic Body Radiation Therapy ◽  
Stereotactic Body Radiation
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