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By Alessandro Franciscon doctor
Eric J Lehrer, Jennifer L Peterson, Nicholas G Zaorsky, Paul D Brown, Arjun Sahgal, Veronica L Chiang, Samuel T Chao, Jason P Sheehan, Daniel M Trifiletti
PURPOSE: Multifraction stereotactic radiosurgery (MF-SRS) purportedly reduces radionecrosis risk over single fraction SRS (SF-SRS) in the treatment of large brain metastases. The purpose of the current work is to compare local control (LC) and radionecrosis rates of SF-SRS and MF-SRS in the definitive (SF-SRSD and MF-SRSD ) and postoperative (SF-SRSP and MF-SRSP ) settings. METHODS/MATERIALS: PICOS/PRISMA/MOOSE guidelines were used to select articles where patients: diagnosed with "large" brain metastases (Group A: 4-14 cm3 , or about 2-3 cm; Group B: >14 cm3 , or > 3 cm); 1-year LC and/or rates of radionecrosis were reported; radiosurgery was administered definitively or postoperatively...
November 2, 2018: International Journal of Radiation Oncology, Biology, Physics
Carlos Eduardo Cintra Vita Abreu, Paula Pratti Rodrigues Ferreira, Fabio Ynoe de Moraes, Wellington Furtado Pimenta Neves, Rafael Gadia, Heloisa de Andrade Carvalho
For early-stage lung cancer, the treatment of choice is surgery. In patients who are not surgical candidates or are unwilling to undergo surgery, radiotherapy is the principal treatment option. Here, we review stereotactic body radiotherapy, a technique that has produced quite promising results in such patients and should be the treatment of choice, if available. We also present the major indications, technical aspects, results, and special situations related to the technique.
July 2015: Jornal Brasileiro de Pneumologia: Publicaça̋o Oficial da Sociedade Brasileira de Pneumologia e Tisilogia
Dale Ding, Robert M Starke, Hideyuki Kano, David Mathieu, Paul P Huang, Douglas Kondziolka, Caleb Feliciano, Rafael Rodriguez-Mercado, Luis Almodovar, Inga S Grills, Danilo Silva, Mahmoud Abbassy, Symeon Missios, Gene H Barnett, L Dade Lunsford, Jason P Sheehan
OBJECTIVE: ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations) found better short-term outcomes after conservative management compared with intervention for unruptured arteriovenous malformations (AVMs). However, because Spetzler-Martin (SM) grade I-II AVMs have the lowest treatment morbidity, sufficient follow-up of these lesions may show a long-term benefit from intervention. The aim of this multicenter, retrospective cohort study is to assess the outcomes after stereotactic radiosurgery (SRS) for ARUBA-eligible SM grade I-II AVMs...
June 2017: World Neurosurgery
Brett W Cox, Daniel E Spratt, Michael Lovelock, Mark H Bilsky, Eric Lis, Samuel Ryu, Jason Sheehan, Peter C Gerszten, Eric Chang, Iris Gibbs, Scott Soltys, Arjun Sahgal, Joe Deasy, John Flickinger, Mubina Quader, Stefan Mindea, Yoshiya Yamada
PURPOSE: Spinal stereotactic radiosurgery (SRS) is increasingly used to manage spinal metastases. However, target volume definition varies considerably and no consensus target volume guidelines exist. This study proposes consensus target volume definitions using common scenarios in metastatic spine radiosurgery. METHODS AND MATERIALS: Seven radiation oncologists and 3 neurological surgeons with spinal radiosurgery expertise independently contoured target and critical normal structures for 10 cases representing common scenarios in metastatic spine radiosurgery...
August 1, 2012: International Journal of Radiation Oncology, Biology, Physics
Stephanie G C Kroeze, Corinna Fritz, Morten Hoyer, Simon S Lo, Umberto Ricardi, Arjun Sahgal, Rolf Stahel, Roger Stupp, Matthias Guckenberger
BACKGROUND AND PURPOSE: Both stereotactic radiotherapy (SRT) and immune- or targeted therapy play an increasingly important role in personalized treatment of metastatic disease. Concurrent application of both therapies is rapidly expanding in daily clinical practice. In this systematic review we summarize severe toxicity observed after concurrent treatment. MATERIAL AND METHODS: PubMed and EMBASE databases were searched for English literature published up to April 2016 using keywords "radiosurgery", "local ablative therapy", "gamma knife" and "stereotactic", combined with "bevacizumab", "cetuximab", "crizotinib", "erlotinib", "gefitinib", "ipilimumab", "lapatinib", "sorafenib", "sunitinib", "trastuzumab", "vemurafenib", "PLX4032", "panitumumab", "nivolumab", "pembrolizumab", "alectinib", "ceritinib", "dabrafenib", "trametinib", "BRAF", "TKI", "MEK", "PD1", "EGFR", "CTLA-4" or "ALK"...
February 2017: Cancer Treatment Reviews
Audrey Keller, Mélanie Doré, Hélène Cebula, François Thillays, François Proust, Ioana Darié, Stéphane-André Martin, Gregory Delpon, François Lefebvre, Georges Noël, Delphine Antoni
PURPOSE: To retrospectively report the outcomes of a large multicenter cohort of patients treated with surgery and hypofractionated stereotactic radiation therapy (HFSRT) to the resection cavities of brain metastases (BMs). METHODS AND MATERIALS: Between March 2008 and February 2015, 181 patients with no prior whole-brain radiation therapy (WBRT) were treated by HFSRT to the surgical bed of BM at the dose of 33 Gy (3 × 11 Gy). The primary endpoint was local control...
December 1, 2017: International Journal of Radiation Oncology, Biology, Physics
Paul D Brown, Karla V Ballman, Jane H Cerhan, S Keith Anderson, Xiomara W Carrero, Anthony C Whitton, Jeffrey Greenspoon, Ian F Parney, Nadia N I Laack, Jonathan B Ashman, Jean-Paul Bahary, Costas G Hadjipanayis, James J Urbanic, Fred G Barker, Elana Farace, Deepak Khuntia, Caterina Giannini, Jan C Buckner, Evanthia Galanis, David Roberge
BACKGROUND: Whole brain radiotherapy (WBRT) is the standard of care to improve intracranial control following resection of brain metastasis. However, stereotactic radiosurgery (SRS) to the surgical cavity is widely used in an attempt to reduce cognitive toxicity, despite the absence of high-level comparative data substantiating efficacy in the postoperative setting. We aimed to establish the effect of SRS on survival and cognitive outcomes compared with WBRT in patients with resected brain metastasis...
August 2017: Lancet Oncology
Gregory M M Videtic, Jessica Donington, Meredith Giuliani, John Heinzerling, Tomer Z Karas, Chris R Kelsey, Brian E Lally, Karen Latzka, Simon S Lo, Drew Moghanaki, Benjamin Movsas, Andreas Rimner, Michael Roach, George Rodrigues, Shervin M Shirvani, Charles B Simone, Robert Timmerman, Megan E Daly
PURPOSE: This guideline presents evidence-based recommendations for stereotactic body radiation therapy (SBRT) in challenging clinical scenarios in early-stage non-small cell lung cancer (NSCLC). METHODS AND MATERIALS: The American Society for Radiation Oncology convened a task force to perform a systematic literature review on 4 key questions addressing: (1) application of SBRT to operable patients; (2) appropriate use of SBRT in tumors that are centrally located, large, multifocal, or unbiopsied; (3) individual tailoring of SBRT in "high-risk" clinical scenarios; and (4) SBRT as salvage therapy after recurrence...
September 2017: Practical Radiation Oncology
Dirk De Ruysscher, Corinne Faivre-Finn, Ditte Moeller, Ursula Nestle, Coen W Hurkmans, Cécile Le Péchoux, José Belderbos, Matthias Guckenberger, Suresh Senan
PURPOSE: To update literature-based recommendations for techniques used in high-precision thoracic radiotherapy for lung cancer, in both routine practice and clinical trials. METHODS: A literature search was performed to identify published articles that were considered clinically relevant and practical to use. Recommendations were categorised under the following headings: patient positioning and immobilisation, Tumour and nodal changes, CT and FDG-PET imaging, target volumes definition, radiotherapy treatment planning and treatment delivery...
July 2017: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Anita Mahajan, Salmaan Ahmed, Mary Frances McAleer, Jeffrey S Weinberg, Jing Li, Paul Brown, Stephen Settle, Sujit S Prabhu, Frederick F Lang, Nicholas Levine, Susan McGovern, Erik Sulman, Ian E McCutcheon, Syed Azeem, Daniel Cahill, Claudio Tatsui, Amy B Heimberger, Sherise Ferguson, Amol Ghia, Franco Demonte, Shaan Raza, Nandita Guha-Thakurta, James Yang, Raymond Sawaya, Kenneth R Hess, Ganesh Rao
BACKGROUND: After brain metastasis resection, whole brain radiotherapy decreases local recurrence, but might cause cognitive decline. We did this study to determine if stereotactic radiosurgery (SRS) to the surgical cavity improved time to local recurrence compared with that for surgical resection alone. METHODS: In this randomised, controlled, phase 3 trial, we recruited patients at a single tertiary cancer centre in the USA. Eligible patients were older than 3 years, had a Karnofsky Performance Score of 70 or higher, were able to have an MRI scan, and had a complete resection of one to three brain metastases (with a maximum diameter of the resection cavity ≤4 cm)...
August 2017: Lancet Oncology
Joern Wulf, Kurt Baier, Gerd Mueller, Michael P Flentje
The dose-response for local tumor control after stereotactic radiotherapy of 92 pulmonary tumors (36 NSCLC and 56 metastases) was evaluated. Short course irradiation of 1-8 fractions with different fraction doses was used. After a median follow-up of 14 months (2-85 months) 11 local recurrences were observed with significant advantage for higher doses. When normalization to a biologically effective dose (BED) is used a dose of 94Gy at the isocenter and 50Gy at the PTV-margin are demonstrated to give 50% probability of tumor control (TCD50)...
October 2005: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
Sashendra Senthi, Frank J Lagerwaard, Cornelis J A Haasbeek, Ben J Slotman, Suresh Senan
BACKGROUND: Stereotactic ablative radiotherapy (SABR) is increasingly used in the treatment of medically inoperable early stage non-small-cell lung cancer (NSCLC). Because patterns of late disease recurrence after SABR are not well characterised, we aimed to assess these outcomes in a cohort of patients with NSCLC. METHODS: Patients with (18)F-fluorodeoxyglucose ((18)F-FDG)-PET confirmed stage 1-2 NSCLC who were treated with SABR at the VU University Medical Center (Amsterdam, Netherlands) were identified from an institutional database...
August 2012: Lancet Oncology
Daniel Gorovets, Diandra Ayala-Peacock, David J Tybor, Paul Rava, Daniel Ebner, Deus Cielo, Georg Norén, David E Wazer, Michael Chan, Jaroslaw T Hepel
PURPOSE: Optimal patient selection for stereotactic radiosurgery (SRS) as the initial treatment for brain metastases is complicated and controversial. This study aimed to develop a nomogram that predicts survival without salvage whole brain radiation therapy (WBRT) after upfront SRS. METHODS AND MATERIALS: Multi-institutional data were analyzed from 895 patients with 2095 lesions treated with SRS without prior or planned WBRT. Cox proportional hazards regression model was used to identify independent pre-SRS predictors of WBRT-free survival, which were integrated to build a nomogram that was subjected to bootstrap validation...
February 1, 2017: International Journal of Radiation Oncology, Biology, Physics
Kristin J Redmond, Scott Robertson, Simon S Lo, Scott G Soltys, Samuel Ryu, Todd McNutt, Samuel T Chao, Yoshiya Yamada, Amol Ghia, Eric L Chang, Jason Sheehan, Arjun Sahgal
PURPOSE: To develop consensus contouring guidelines for postoperative stereotactic body radiation therapy (SBRT) for spinal metastases. METHODS AND MATERIALS: Ten spine SBRT specialists representing 10 international centers independently contoured the clinical target volume (CTV), planning target volume (PTV), spinal cord, and spinal cord planning organ at risk volume (PRV) for 10 representative clinical scenarios in postoperative spine SBRT for metastatic solid tumor malignancies...
January 1, 2017: International Journal of Radiation Oncology, Biology, Physics
Kristin J Redmond, Simon S Lo, Charles Fisher, Arjun Sahgal
Postoperative stereotactic body radiation therapy (SBRT) for metastatic spinal tumors is increasingly being performed in clinical practice. Whereas the fundamentals of SBRT practice for intact spinal metastases are established, there are as yet no comprehensive practice guidelines for the postoperative indications. In particular, there are unique considerations for patient selection and treatment planning specific to postoperative spine SBRT that are critical for safe and effective management. The purpose of this critical review is to discuss the rationale for treatment, describe those factors affecting surgical decision making, introduce modern surgical trends, and summarize treatment outcomes for both conventional postoperative external beam radiation therapy and postoperative spine SBRT...
August 1, 2016: International Journal of Radiation Oncology, Biology, Physics
S J Patrice, P K Sneed, J C Flickinger, D C Shrieve, B E Pollock, E Alexander, D A Larson, D S Kondziolka, P H Gutin, W M Wara, M W McDermott, L D Lunsford, J S Loeffler
PURPOSE: Between June 1988 and June 1994. 38 hemangioblastomas were treated with stereotactic radiosurgery (SR) at three SR centers to evaluate the efficacy and potential toxicity of this therapeutic modality as an adjuvant or alternative treatment to surgical resection. METHODS AND MATERIALS: SR was performed using either a 201-cobalt source unit or a dedicated SR linear accelerator. Of the 18 primary tumors treated, 16 had no prior history of surgical resection and were treated definitively with SR and two primary lesions were subtotally resected and subsequently treated with SR...
June 1, 1996: International Journal of Radiation Oncology, Biology, Physics
Giuseppe Minniti, Claudia Scaringi, Sergio Paolini, Gaetano Lanzetta, Andrea Romano, Francesco Cicone, Mattia Osti, Riccardo Maurizi Enrici, Vincenzo Esposito
PURPOSE: To investigate the local control and radiation-induced brain necrosis in patients with brain metastases >2 cm in size who received single-fraction or multifraction stereotactic radiosurgery (SRS); factors associated with clinical outcomes and the development of brain radionecrosis were assessed. METHODS AND MATERIALS: Two hundred eighty-nine consecutive patients with brain metastases >2.0 cm who received SRS as primary treatment at Sant'Andrea Hospital, University of Rome Sapienza, Rome, Italy, were analyzed...
July 15, 2016: International Journal of Radiation Oncology, Biology, Physics
Robert W Mutter, Fan Liu, Andres Abreu, Ellen Yorke, Andrew Jackson, Kenneth E Rosenzweig
PURPOSE: Chest wall (CW) pain has recently been recognized as an important adverse effect of stereotactic body radiation therapy (SBRT) for non-small-cell lung cancer (NSCLC). We developed a dose-volume model to predict the development of this toxicity. METHODS AND MATERIALS: A total of 126 patients with primary, clinically node-negative NSCLC received three to five fractions of SBRT to doses of 40-60 Gy and were prospectively followed. The dose-absolute volume histograms of two different definitions of the CW as an organ at risk (CW3cm and CW2cm) were examined for all 126 patients...
April 1, 2012: International Journal of Radiation Oncology, Biology, Physics
Kimmen Quan, Karen M Xu, Yongqian Zhang, David A Clump, John C Flickinger, Ron Lalonde, Steven A Burton, Dwight E Heron
Stereotactic ablative radiotherapy (SABR) with concomitant cetuximab is an effective treatment option for previously irradiated, locally recurrent squamous cell carcinoma of the head and neck. Its local control and overall survival are similar to those of other available treatment options. Each retreatment depends heavily on the prior treatment and every patient is a special case. Based on the experience of our institution and previously published studies, for patients who receive concomitant cetuximab with a median prior radiation therapy dose of 70Gy, we recommend a total dose of 40-44Gy delivered in 5 fractions on alternating days over 1-2 weeks...
April 2016: Seminars in Radiation Oncology
Jonathan W Lischalk, Ryan M Malik, Sean P Collins, Brian T Collins, Ismael A Matus, Eric D Anderson
BACKGROUND AND PURPOSE: Radiotherapy of central lung tumors carries a higher risk of treatment-related toxicity and local failure. In the era of aggressive oligometastic management the exploration of the proper dose-fractionation for metastatic central lung tumors is essential. MATERIALS AND METHODS: Patients diagnosed with high-risk metastatic lesions of the central pulmonary tree comprised this single-institutional retrospective analysis. "High-risk" central pulmonary lesions were defined as those with abutment and/or invasion of the mainstem bronchus...
February 27, 2016: Radiation Oncology
2016-04-05 14:20:16
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