Stereotactic Body Radiation Therapy: Normal Tissue and Tumor Control Effects with Large Dose per Fraction

2011 ◽  
pp. 382-394 ◽  
Author(s):  
Robert Timmerman ◽  
Michael Bastasch ◽  
Debabrata Saha ◽  
Ramzi Abdulrahman ◽  
William Hittson ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Large Dose ◽  
Normal Tissue ◽  
Stereotactic Body Radiation Therapy ◽  
Tumor Control ◽  
Stereotactic Body Radiation ◽  
Dose Per Fraction

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.

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