• Title, Summary, Keyword: stereotactic body radiotherapy

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Radiobiological mechanisms of stereotactic body radiation therapy and stereotactic radiation surgery

  • Kim, Mi-Sook;Kim, Wonwoo;Park, In Hwan;Kim, Hee Jong;Lee, Eunjin;Jung, Jae-Hoon;Cho, Lawrence Chinsoo;Song, Chang W.
    • Radiation Oncology Journal
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    • v.33 no.4
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    • pp.265-275
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    • 2015
  • Despite the increasing use of stereotactic body radiation therapy (SBRT) and stereotactic radiation surgery (SRS) in recent years, the biological base of these high-dose hypo-fractionated radiotherapy modalities has been elusive. Given that most human tumors contain radioresistant hypoxic tumor cells, the radiobiological principles for the conventional multiple-fractionated radiotherapy cannot account for the high efficacy of SBRT and SRS. Recent emerging evidence strongly indicates that SBRT and SRS not only directly kill tumor cells, but also destroy the tumor vascular beds, thereby deteriorating intratumor microenvironment leading to indirect tumor cell death. Furthermore, indications are that the massive release of tumor antigens from the tumor cells directly and indirectly killed by SBRT and SRS stimulate anti-tumor immunity, thereby suppressing recurrence and metastatic tumor growth. The reoxygenation, repair, repopulation, and redistribution, which are important components in the response of tumors to conventional fractionated radiotherapy, play relatively little role in SBRT and SRS. The linear-quadratic model, which accounts for only direct cell death has been suggested to overestimate the cell death by high dose per fraction irradiation. However, the model may in some clinical cases incidentally do not overestimate total cell death because high-dose irradiation causes additional cell death through indirect mechanisms. For the improvement of the efficacy of SBRT and SRS, further investigation is warranted to gain detailed insights into the mechanisms underlying the SBRT and SRS.

Current status of stereotactic body radiotherapy for the treatment of hepatocellular carcinoma

  • Park, Jongmoo;Park, Jae Won;Kang, Min Kyu
    • Yeungnam University Journal of Medicine
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    • v.36 no.3
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    • pp.192-200
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    • 2019
  • Stereotactic body radiotherapy (SBRT) is an advanced form of radiotherapy (RT) with a growing interest on its application in the treatment of hepatocellular carcinoma (HCC). It can deliver ablative radiation doses to tumors in a few fractions without excessive doses to normal tissues, with the help of advanced modern RT and imaging technologies. Currently, SBRT is recommended as an alternative to curative treatments, such as surgery and radiofrequency ablation. This review discusses the current status of SBRT to aid in the decision making on how it is incorporated into the HCC management.

Stereotactic body radiotherapy for solitary spine metastasis

  • Lee, Sunyoung;Chun, Mison;Lee, MiJo
    • Radiation Oncology Journal
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    • v.31 no.4
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    • pp.260-266
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    • 2013
  • A clear consensus has not been established regarding the best treatment for solitary bone metastasis. Here, we reviewed the medical records of patients with a controlled primary malignancy who had only solitary spine metastasis without metastasis to the extraspinal bone or viscera and underwent treatment between April 2007 and December 2012 with stereotactic body radiosurgery using CyberKnife, with a total dose of 24 Gy in three to four fractions. During that time, there were only four cases. This was effective in each case, and all the four patients had no local failure and remained alive at a median follow-up of 68 months (range, 64 to 80 months). Although our experience is limited, this study suggests that stereotactic body radiotherapy could be a feasible, safe, effective, and noninvasive alternative treatment for solitary spine metastasis in patients who are medically inoperable or unsuitable for surgery.

Stereotactic radiotherapy for early stage non-small cell lung cancer

  • Ricardi, Umberto;Badellino, Serena;Filippi, Andrea Riccardo
    • Radiation Oncology Journal
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    • v.33 no.2
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    • pp.57-65
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    • 2015
  • Stereotactic body radiotherapy (SBRT) represents a consolidated treatment option for patients with medically inoperable early stage non-small cell lung cancer (NSCLC). The clinical evidence accumulated in the past decade supports its use as an alternative to surgery with comparable survival outcomes. Due to its limited toxicity, SBRT is also applicable to elderly patients with very poor baseline pulmonary function or other severe comorbidities. Recent comparative studies in operable patients raised the issue of the possible use of SBRT also for this subgroup, with quite promising results that still should be fully confirmed by prospective trials with long-term follow-up. Aim of this review is to summarize and discuss the major studies conducted over the years on SBRT and to provide data on the efficacy and toxicity of this radiotherapy technique for stage I NSCLC. Technical aspects and quality of life related issues are also discussed, with the goal to provide information on the current role and limitations of SBRT in clinical practice.

Stereotactic Body Radiotherapy: Does It Have a Role in Management of Hepatocellular Carcinoma?

  • Choi, Seo Hee;Seong, Jinsil
    • Yonsei Medical Journal
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    • v.59 no.8
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    • pp.912-922
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    • 2018
  • Stereotactic body radiotherapy (SBRT) is a form of radiotherapy that delivers high doses of irradiation with high precision in a small number of fractions. However, it has not frequently been performed for the liver due to the risk of radiation-induced liver toxicity. Furthermore, liver SBRT is cumbersome because it requires accurate patient repositioning, target localization, control of breathing-related motion, and confers a toxicity risk to the small bowel. Recently, with the advancement of modern technologies including intensity-modulated RT and image-guided RT, SBRT has been shown to significantly improve local control and survival outcomes for hepatocellular carcinoma (HCC), specifically those unfit for other local therapies. While it can be used as a standalone treatment for those patients, it can also be applied either as an alternative or as an adjunct to other HCC therapies (e.g., transarterial chemoembolization, and radiofrequency ablation). SBRT might be an effective and safe bridging therapy for patients awaiting liver transplantation. Furthermore, in recent studies, SBRT has been shown to have a potential role as an immunostimulator, supporting the novel combination strategy of immunoradiotherapy for HCC. In this review, the role of SBRT with some technical issues is discussed. In addition, future implications of SBRT as an immunostimulator are considered.

Determining the Optimal Dose Prescription for the Planning Target Volume with Stereotactic Body Radiotherapy for Non-Small Cell Lung Cancer Patients

  • Liu, Xi-Jun;Lin, Xiu-Tong;Yin, Yong;Chen, Jin-Hu;Xing, Li-Gang;Yu, Jin-Ming
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.5
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    • pp.2573-2577
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    • 2016
  • Objective: The aim of this study was to determine a method of dose prescription that minimizes normal tissue irradiation outside the planning target volume (PTV) during stereotactic body radiotherapy (SBRT) for patients with non-small cell lung cancer. Methods: Previous research and patients with typical T1 lung tumors with peripheral lesions in the lung were selected for analysis. A PTV and several organs at risk (OARs) were constructed for the dose calculated; six treatment plans employing intensity modulated radiotherapy (IMRT) were produced, in which the dose was prescribed to encompass the PTV, with the prescription isodose level (PIL) set at 50, 60, 70, 80, 90 or 95% of the isocenter dose. Additionally, four OARs around the PTV were constructed to evaluate the dose received in adjacent tissues. Results: The use of higher PILs for SBRT resulted in improved sparing of OARs, with the exception of the volume of lung treated with a lower dose. Conclusions: The use of lower PILs is likely to create significant inhomogeneity of the dose delivered to the target, which may be beneficial for the control of tumors with poor conformity indices.

Utility Estimation of the Manufactured Stereotactic Body Radiotherapy Immobilization (자체 제작한 정위적체부방사선치료(Stereotactic Body Radiotherapy) 고정용구의 유용성 평가)

  • Lee, Dong-Hoon;Ahn, Jong-Ho;Seo, Jeong-Min;Shin, Eun-Hyeok;Choi, Byeong-Gi;Song, Gi-Won
    • The Journal of Korean Society for Radiation Therapy
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    • v.23 no.1
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    • pp.1-6
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    • 2011
  • Purpose: Immobilizations used in order to maintain the reproducibility of a patient set-up and the stable posture for a long period are important more than anything else for the accurate treatment when the stereotactic body radiotherapy is underway. So the purpose of this study is to adapt the optimum immobilizations for the stereotactic body radiotherapy by comparing two commercial immobilizations with the self-manufactured immobilizations. Materials and Methods: Five people were selected for the experiment and three different immobilizations (A: Wing-board, B: BodyFix system, C: Arm up holder with vac-lock) were used to each target. After deciding on the target's most stable respiratory cycles, the targets were asked to wear a goggle monitor and maintain their respiration regularly for thirty minutes to obtain the respiratory signals. To analyze the respiratory signal, the standard deviation and the variation value of the peak value and the valley value of the respiratory signal were separated by time zone with the self-developed program at the hospital and each tie-downs were compared for the estimation by calculating a comparative index using the above. Results: The stability of each immobilizations were measured in consideration of deviation changes studied in each respiratory time lapse. Comparative indexes of each immobilizations of each experimenter are shown to be A: 11.20, B: 4.87, C: 1.63 / A: 3.94, B: 0.67, C: 0.13 / A: 2.41, B: 0.29, C: 0.04 / A: 0.16, B: 0.19, C: 0.007 / A: 35.70, B: 2.37, C: 1.86. And when all five experimenters wore the immobilizations C, the test proved the most stable value while four people wearing A and one man wearing D expressed relatively the most unstable respiratory outcomes. Conclusion: The self-developed immobilizations, so called the arm up holder vac-lock for the stereotactic body radiotherapy is expected to improve the effect of the treatment by decreasing the intra-fraction organ motions because it keeps the respiration more stable than other two immobilizations. Particularly in case of the stereotactic body therapy which requires the maintenance of set-up state for a long time, the self-developed immobilizations is thought to more useful for stereotactic body radiotherapy rather than the rest two immobilizations with instable respiratory cycle as time passes.

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A case report of a patient with squamous cell carcinoma of the face irradiated using a stereotactic technique

  • Pontoriero, Antonio;Iati, Giuseppe;Pergolizzi, Stefano
    • Radiation Oncology Journal
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    • v.33 no.3
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    • pp.261-264
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    • 2015
  • External beam radiotherapy can be used to treat cutaneous squamous cell carcinomas (SCC). Acute skin toxicity is the most common adverse event. In this case study we report on an elderly patient with nasal root cutaneous SCC treated with stereotactic technique using a dedicated linear accelerator (CyberKnife system). Grade 3 skin toxicity was observed but it was resolved after 6 weeks. The use of stereotactic radiotherapy permitted a clinical remission of SCC with good cosmetic results.

Study on The Development of A New Whole Body Fame

  • Chung, Jin-Bum;Suh, Tae-Suk;Chung, Won-Kyun;Choe, Bo-Young;Lee, Hyoung-Koo
    • Proceedings of the Korean Society of Medical Physics Conference
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    • pp.136-137
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    • 2002
  • We have been researching upgrade version of a stereotactic whole body frame, used for evaluating daily setup accuracy of the patient positioning during fractionated extra-cranial stereotactic radiotherapy. Currently, we are focusing on the development of a new stereotactic whole body frame, and then will handle organ movement produced by breathing at the next stage. MeV-Green is chosen for the best immobilizer possible and the epoxy board is for the frame with the dimension of 110 em in length, 50 cm in width in order to maximize transmission rate of the beam from lateral or posterior direction and to fit CT and PET scanners with an aperture of 55 cm at least. The key point of an upgraded stereotactic whole body frame will be set on the collision-free rotation of the gantry with the frame, and the development of the checking structure for the daily patient repositioning regarding internal target.

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The Effectiveness of Volumetric Modulated arc Radiotherapy to Treat Patients with Metastatic Spinal Tumors

  • Park, Hyo-Kuk;Kim, Sungchul
    • International Journal of Contents
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    • v.13 no.4
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    • pp.12-15
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    • 2017
  • Among the possible stereotactic body radiation therapy (SBRT) modalities used to treat patients with metastatic spinal tumors, this study compared Cyberknife, tomotherapy, and volumetric modulated arc radiotherapy (VMAT). We established treatment plans for each of them modality and quantitatively analyzed the dose evaluation factors of the dose-volume histogram (DVH) for all spinal bones, focusing on the tumor and spinal cord, in order to examine the usefulness of VMAT. For the treatment planning dose, the mean dose ($D_{max}$) and $D_{5%}$ showed statistical differences in the target dose, but no difference was shown in the spinal cord dose. For the DVH indices, tomotherapy showed the best performance was the best in terms of uniformity index, while VMAT showed better performance was better than the other two modalities in terms of the conformity index and the dose gradient index. VMAT had a much shorter treatment time than Cyberknife and tomotherapy. These findings suggest that VMAT FFF is the most effective therapy for SBRT of patients with metastatic spinal tumors for whom a high dose of radiation is prescribed.