Journal of Radiosurgery and SBRT

Our randomized clinical study comparing stereotactic body radiotherapy (SBRT) and stereotactic body proton therapy (SBPT) for early stage non-small cell lung cancer (NSCLC) was closed prematurely owing to poor enrollment, largely because of lack of volumetric imaging and difficulty in obtaining insurance coverage for the SBPT group. In this article, we describe technology improvements in our new proton therapy center, particularly in image guidance with cone beam CT (CBCT) and CT on rail (CTOR), as well as motion management with real-time gated proton therapy (RGPT) and optical surface imaging...

Stereotactic body radiation therapy (SBRT) has emerged as a standard treatment approach for early-stage lung cancer and intrathoracic oligometastatic or oligoprogressive disease. While local control is often excellent with this modality when delivered with photon therapy, toxicities for select patients can be significant. Proton therapy offers a unique opportunity to widen the therapeutic window when treating patients with thoracic malignancies requiring or benefitting from ultra-high doses per fraction. Thoracic proton SBRT may be particularly beneficial in cases requiring dose escalation, for tumors >5 cm, for central or ultra-central tumors, for reirradiation, in patients with interstitial lung diseases, and when combining radiation with immunotherapy...

Stereotactic body proton radiotherapy (SBPT) has the potential to be an effective tool for treating liver malignancies. While proton therapy enables near-zero exit dose and could improve normal tissue sparing, including liver and other surrounding structures, there are challenges in implementing the SBPT technique for proton therapy, including respiratory motion, range uncertainties, dose regimen, treatment planning, and image guidance. This article summarizes the technical and clinical challenges facing SBPT, along with the potential benefits of SBPT for liver malignancies...

BACKGROUND: Proton beam therapy (PBT) is a non-surgical treatment that spares adjacent tissues compared to photon radiation and useful for Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (iCCA). We present a single center experience in HCC and iCCA treated with Pencil Beam Scanning (PBS) PBT. METHODS: Forty-four consecutive patients (22 patients in each group) receiving PBT were included and reviewed. PBT was delivered with hypofractionated or stereotactic body radiation therapy (SBRT) using PBS...

PURPOSE: To assess the resulting dosimetry characteristics of simulation and planning techniques for proton stereotactic body radiation therapy (SBRT) of primary and secondary liver tumors. METHODS: Consecutive patients treated under volumetric daily image guidance with liver proton SBRT between September 2019 and March 2022 at Emory Proton Therapy Center were included in this study. Prescriptions ranged from 40 Gy to 60 Gy in 3- or 5-fraction regimens, and motion management techniques were used when target motion exceeded 5 mm...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

This study presents the clinical experiences of the New York Proton Center in employing proton pencil beam scanning (PBS) for the treatment of lung stereotactic body radiation therapy. It encompasses a comprehensive examination of multiple facets, including patient simulation, delineation of target volumes and organs at risk, treatment planning, plan evaluation, quality assurance, and motion management strategies. By sharing the approaches of the New York Proton Center and providing recommendations across simulation, treatment planning, and treatment delivery, it is anticipated that the valuable experience will be provided to a broader proton therapy community, serving as a useful reference for future clinical practice and research endeavors in the field of stereotactic body proton therapy for lung tumors...

PURPOSE: Stereotactic body proton therapy (SBPT) is an emerging treatment strategy for lung tumors that aims to combine the excellent local control benefits of ultra-hypofractionation with the physical advantages of protons, which reduce the integral dose to organs at risk (OARs) compared to photons. To date, however, very little data delivering SBPT in 5 or fewer fractions to lung tumors have been reported. Given that photon stereotactic body radiation therapy can struggle to deliver ablative doses to high-risk tumors (i...

No abstract text is available yet for this article.

Radiation is an accepted standard of care for unresectable hepatocellular carcinoma (HCC), and while photon radiation is the current standard, the use of proton beam radiotherapy (PBT) is an active area of investigation given its ability to better spare uninvolved liver. Patients with HCC typically have background liver disease and many patients die of their underlying liver function in the absence of tumor progression. Early photon-based series showed promising rates of local control however the risk of non-classic radiation induced liver disease (RILD) remains relatively high and may be associated with poorer outcomes...

OBJECTIVES: Stereotactic body radiation therapy (SBRT) for the spine is challenging due to high-dose gradients sparing the cord in the treatment plans. We present our findings of initial setup error and intrafraction motion from Cone-beam computed tomography (CBCT) imaging. MATERIALS AND METHODS: A total of 47 patients treated with spine SBRT with a total of 154 fractions following a fractionation schedule of 16 Gy in 1, 24 Gy in 2, and 30 Gy in 5 fractions were part of this study...

No abstract text is available yet for this article.

We present the case of a 65-year-old male with tumor-induced osteomalacia (TIO) caused by an FGF23-secreting phosphaturic tumor of C2 treated definitively with stereotactic body radiation therapy (SBRT) and kyphoplasty. The patient exhibited notable reduction in FGF23 6 weeks following radiotherapy. He also received a dose of the FGF23 monoclonal antibody, burosumab. We discuss the case with emphasis on radiation in the management of TIO. This case demonstrates SBRT as a well-tolerated local treatment option for the management of unresectable FGF23-producing tumors...

PURPOSE: This study aims to establish criteria for convolution dose calculations and an efficient procedure to include the heterogeneity effects in GammaKnife radiosurgery (GKRS) treatment plans. METHODS AND MATERIALS: We analyzed 114 GKRS cases of various disease types, tumor locations, sizes, the number of fractions, and prescription doses. There was a total of 205 tumors. CT scans were performed in addition to routine MRI scans for all treatments. All treatment plans were created using the TMR10 algorithm (TMR10)...

Stereotactic body radiotherapy (SBRT) planning target volume (PTV) margins are influenced by multiple factors. Data is limited on intrafraction motion in bone SBRT, particularly non-spine lesions. We analyzed intrafraction motion in bone SBRT patients treated on a standard treatment couch without 6 degrees-of-freedom (6-DOF) correction. Extracranial bone SBRT patients were included. Patients were treated using two volumetric-modulated arcs and targets were localized using daily cone-beam computed tomography (CBCT) prior to each arc...

INTRODUCTION: Stereotactic body radiation therapy (SBRT) is increasingly utilized for patients with recurrent and metastatic sarcoma. SBRT affords the potential to overcome the relative radioresistance of sarcomas through delivery of a focused high biological effective dose (BED) as an alternative to invasive surgery. We report local control outcomes after metastatic sarcoma SBRT based on radiation dose and histology. METHODS: From our IRB-approved single-institution registry, all patients treated with SBRT for metastatic sarcoma between 2014 and 2020 were identified...

PURPOSE: In the implementation of the use of EncompassTM partially open immobilization mask to perform SRS of multiple brain metastasis, the evaluation of patient's intrafraction motion (IM) is deemed convenient to verify that the margins applied to the GTV are able to ensure adequate dose coverage to each lesion. METHODS: IM was determined by comparing the pre- and post-treatment CBCT images with respect to the simulation CT for a total of 23 fractions. The dosimetric impact on GTV coverage due to translational errors in patient positioning and rotational uncertainties of LINAC's performance was also evaluated...

OBJECTIVES: Stereotactic body radiotherapy (SBRT) can sterilize the portal vein tumour thrombus (PVTT) and may make the patient eligible for liver transplant. We assessed the radiological response of PVTT after SBRT and check incidence of radiation induced liver disease (RILD). METHODS: PVTT treatment response was measured at 4-6 weeks as per mRECIST criteria, volume of PVTT and its enhancement in arterial phase. Biochemical data and Child-Pugh scoring (CPC) were evaluated to determine RILD incidence...

PURPOSE: Optimal timing of SRS after surgical resection of brain metastases (BMs) remains debated but is generally advocated to occur within 4 weeks of surgery to account for cavity remodeling. Our study assesses this recommendation by examining cavity dynamics and any downstream effects on outcome. METHODS: Post-operative MRIs were used to compare target lesion volumes to target volume at time of SRS. Spearman's analysis identified a relationship between the time to SRS (ttSRS) and target remodeling...