• Title, Summary, Keyword: stereotactic radiotherapy

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Whole Brain Radiotherapy Combined with Stereotactic Radiotherapy Versus Stereotactic Radiotherapy Alone for Brain Metastases: a Meta-analysis

  • Duan, Lei;Zeng, Rong;Yang, Ke-Hu;Tian, Jin-Hui;Wu, Xiao-Lu;Dai, Qiang;Niu, Xiao-Dong;Ma, Di-Wa
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.2
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    • pp.911-915
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    • 2014
  • Aim: This study was to evaluate the effect of whole brain radiation (WBRT) combined with stereotactic radiotherapy (SRS) versus stereotactic radiotherapy alone for patients with brain metastases using a meta-analysis. Materials and Methods: We searched PubMed, EMBASE, Cochrane Library from their inception up to October 2013. Randomized controlled trials involving whole brain radiation combined with stereotactic radiotherapy versus stereotactic radiotherapy alone for brain metastases were included. Statistical analyses were performed using RevMan5.2 software. Results: Four randomized controlled trials including 903 patients were included. The meta-analysis showed statistically significant lowering of the local recurrence rate (OR=0.29, 95%CI: 0.17~0.49), new brain metastasis rate (OR=0.45, 95%CI: 0.28~0.71) and symptomatic late neurologic radiation toxicity rate (OR=3.92, 95%CI: 1.37~11.20) in the combined group. No statistically significant difference existed in the 1-year survival rate (OR=0.78, 95%CI: 0.60~1.03). Conclusions: The results indicate that whole brain radiotherapy combined with stereotactic radiotherapy has advantages in local recurrence and new brain metastasis rates, but stereotactic radiotherapy alone is associated with better neurological function. However, as the samples included were not large, more high-quality, large-sample size studies are necessary for confirmation.

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.

Landmarks in The Skull for Stereotactic Radiotherapy

  • Hiroki, Ohtani;Toraji, Irifune;Etsuo, Kunieda;Hidetoshi, Saitoh;Masahiro, Fukushi;Tsuguhisa, Katoh
    • Proceedings of the Korean Society of Medical Physics Conference
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    • pp.144-145
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    • 2002
  • Stereotactic radiotherapy is required to irradiate a small tumor accurately. The radiotherapy showing improves when making an accidental error little boundlessly. It is performed according to treatment planning that is established by the outside landmark of head. At present, when stereotactic radiotherapy for a head is done, the Leksell Flame is fixed on the head, and positioning based on the point and so on which it is in that fixed implement is performed. However, there are problems on the method done at present in the point such as reappearance when the fractionated irradiation method in which the Leksell Flame is removed and installed at every treatment is done because there are landmarks outside the head. Landmarks in the skull were decided, and that precision was examined for the purpose of the improvement of the radiation therapeutic gain. Linac-graphy with longitudinal and lateral view were taken with 6 MV photon beams. A distance to base point inside the skull, each film measured the angle from a center of the small irradiation field, and comparison was done. From the results, a large accidental error wasn't seen as a result of the measurement by every film. Stereotactic radiotherapy for a head treatment had an accidental error of about several millimeters when treatment positioning was done. Therefore, it was thought that there was no problem about an accidental error to arise by putting a landmark in the skull. And, because an accidental error was easy to discover, we thought that modification could be done easily. It was suggested that a landmark in the skull on thus study were useful for improvement of stereotactic radiotherapy.

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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.

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.

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.

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.

Reirradiation with Robotic Stereotactic Body Radiotherapy for Recurrent Nasopharyngeal Carcinoma

  • Dizman, Aysen;Coskun-Breuneval, Mehtap;Altinisik-Inan, Gonca;Olcay, Gokce Kaan;Cetindag, Mehmet Faik;Guney, Yildiz
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.8
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    • pp.3561-3566
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    • 2014
  • Background: Recurrent nasopharyngeal carcinoma (NPC) after previous radiotherapy is challenging. There is no standard approach for salvage treatment. Here we present toxicity and treatment results for recurrent NFC patients who underwent fractionated stereotactic radiotherapy (FSRT) as second line radiotherapy (RT). Materials and Methods: Between April 2009 and July 2012, 24 patients, with a male to female ratio of 3:1, were treated with CykerKnife$^{(R)}$ FSRT for recurrent NFC in our institution. Seven out of 24 patients had metastatic recurrent disease. Median age was 53 years (range, 20-70 years). Initial RT dose was 70Gy. The time period between initial RT and FSRT was a median of 33.2 months. The median prescription dose for FSRT was 30Gy (range, 24-30 Gy) in a median of 5 fractions (range, 4-6). Results: The median follow-up for all patients was 19.5 months (IQR: 12.2.-29.2 months). The locoregional control; progression free survival and overall survival (OS) rates for 1-, 2- and 3-year were 64%, 38%, 21%; 60%, 30%, 17% and 83%, 43%, 31%, respectively. Median OS for the entire cohort was 22 months (95% CI: 16.5-27.5). On multivariate analysis recurrent tumor stage was the only prognostic factor for OS (p=0.004). One patient exhibited grade III temporal lobe necrosis. One died because of grade IV mucositis and overlapping infection. Conclusions: The treatment of recurrent NPC is controversial. Fractionated stereotactic radiotherapy is promising. However, the published trials are heterogeneous with respect to the selection criteria and treatment details. Prospective studies with long term follow-up data are warranted.

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.