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Normal tissue toxicity after small field hypofractionated stereotactic body radiation.

ABSTRACT: Stereotactic body radiation (SBRT) is an emerging tool in radiation oncology in which the targeting accuracy is improved via the detection and processing of a three-dimensional coordinate system that is aligned to the target. With improved targeting accuracy, SBRT allows for the minimization of normal tissue volume exposed to high radiation dose as well as the escalation of fractional dose delivery. The goal of SBRT is to minimize toxicity while maximizing tumor control. This review will discuss the basic principles of SBRT, the radiobiology of hypofractionated radiation and the outcome from published clinical trials of SBRT, with a focus on late toxicity after SBRT. While clinical data has shown SBRT to be safe in most circumstances, more data is needed to refine the ideal dose-volume metrics.

SUBMITTER: Milano MT

PROVIDER: S-EPMC2596155 | biostudies-literature | 2008 Oct

REPOSITORIES: biostudies-literature

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Normal tissue toxicity after small field hypofractionated stereotactic body radiation.

Milano Michael T MT Constine Louis S LS Okunieff Paul P

Radiation oncology (London, England) 20081031

Stereotactic body radiation (SBRT) is an emerging tool in radiation oncology in which the targeting accuracy is improved via the detection and processing of a three-dimensional coordinate system that is aligned to the target. With improved targeting accuracy, SBRT allows for the minimization of normal tissue volume exposed to high radiation dose as well as the escalation of fractional dose delivery. The goal of SBRT is to minimize toxicity while maximizing tumor control. This review will discuss ...[more]

PMID: 18976463

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Project description:Background Little is known about the effectiveness of hypofractionated radiation therapy (HFRT) or stereotactic body radiation therapy (SBRT) for the treatment of patients with oligometastatic (OM) or oligoprogressive (OP) thymic malignancies. Methods We retrospectively reviewed Stage IV patients with OM or OP thymic malignancies treated with HFRT or SBRT between 2009–2021. We defined OM as 5 or fewer sites of metastatic disease and OP as 5 or fewer sites of metastatic disease increasing in radiological size at the time of radiation. Analysis of local failure (LF, defined as failure within a treated lesion) and distant failure (DF, defined as failure outside the treated lesion) was done at the treatment course level using univariate analysis Fine-Gray regression adjusted for clustering. Analysis of overall survival (OS) and progression-free survival (PFS) was done at the patient level utilizing only the first course of treatment for each patient. Results Our analysis included 50 patients with 92 treatment courses. Patients had thymoma (50%), thymic carcinoma (TC, 40%), or atypical thymic carcinoid (ATC, 10%). The median biologic effective dose (BED) was 51 Gy (range, 38–106 Gy). With a median follow-up of 36 months, the median OS and PFS were 50 and 6.5 months, respectively. Patients with TC or ATC had significantly worse PFS than those with thymoma [hazard ratio (HR) 2.37; 95% confidence interval (CI): 1.18–4.76, P=0.013], but similar OS (P=0.55) and LF (P=0.729). Treated thymoma lesions had a lower hazard of DF than TC/ATC lesions, but this was not statistically significant (HR 0.59; 95% CI: 0.34–1.03, P=0.065). Lesions treated to a BED higher than 60 Gy had lower hazards of LF and DF, although this was not statistically significant (HR 0.29; 95% CI: 0.05–1.68, P=0.166 and HR 0.58; 95% CI: 0.3–1.1, P=0.096, respectively). Conclusions In our analysis, patients with TC or ATC had worse PFS than those with thymoma. Treated thymoma and TC/ATC lesions had similar hazards of LF, indicating similar radiation sensitivity in thymic lesions regardless of histology. There was a trend towards increased local control with higher BED regimens, but this did not reach statistical significance. Overall, our analysis points to the need for clinical trials on HFRT/SBRT for the treatment of these rare malignancies.

Project description:IntroductionThe recent results from the Nordic-HILUS study indicate stereotactic body radiation therapy (SBRT) is associated with high-grade toxicity for ultracentral (UC) tumors. We hypothesized that magnetic resonance-guided SBRT (MRgSBRT) or hypofractionated radiation therapy (MRgHRT) enables the safe delivery of high-dose radiation to central and UC lung lesions.MethodsPatients with UC or central lesions were treated with MRgSBRT/MRgHRT with real-time gating or adaptation. Central lesions were defined as per the Radiation Therapy Oncology Group and UC as per the HILUS study definitions: (1) group A or tumors less than 1 cm from the trachea and/or mainstem bronchi; or (2) group B or tumors less than 1 cm from the lobar bronchi. The Kaplan-Meier estimate and log-rank test were used to estimate survival. Associations between toxicities and other patient factors were tested using the Mann-Whitney U test and Fisher's exact test.ResultsA total of 47 patients were included with a median follow-up of 22.9 months (95% confidence interval: 16.4-29.4). Most (53%) had metastatic disease. All patients had central lesions and 55.3% (n = 26) had UC group A. The median distance from the proximal bronchial tree was 6.0 mm (range: 0.0-19.0 mm). The median biologically equivalent dose (α/β = 10) was 105 Gy (range: 75-151.2). The most common radiation schedule was 60 Gy in eight fractions (40.4%). Most (55%) had previous systemic therapy, 32% had immunotherapy and 23.4% had previous thoracic radiation therapy. There were 16 patients who underwent daily adaptation. The 1-year overall survival was 82% (median = not reached), local control 87% (median = not reached), and progression-free survival 54% (median = 15.1 mo, 95% confidence interval: 5.1-25.1). Acute toxicity included grade 1 (26%) and grade 2 (21%) with only two patients experiencing grade 3 (4.3%) in the long term. No grade 4 or 5 toxicities were seen.ConclusionsPrevious studies noted high rates of toxicity after SBRT to central and UC lung lesions, with reports of grade 5 toxicities. In our cohort, the use of MRgSBRT/MRgHRT with high biologically effective doses was well tolerated, with two grade 3 toxicities and no grade 4/5.

Project description:Purpose:This study aimed to report on our institutional experience in the use of stereotactic body radiation therapy (SBRT) for the treatment of adrenal gland metastases. Specifically, we examined the outcomes and toxicity from this treatment modality on adjacent organs at risk. Methods and Materials:Data were retrieved from patients with adrenal metastases who were treated with SBRT between 2008 and 2017. Patients with primary adrenal malignancies were excluded. Toxicities were graded in accordance with the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03. Time-to-event rates were calculated from the date of SBRT delivery. Results:In total, 35 patients with adrenal metastases were identified. Four patients were treated for bilateral disease. The median dose was 40?Gy (range, 20-54?Gy) in 5 fractions (range, 1-6 fractions). The median follow-up time was 37 months (range, 14-451 months) from disease diagnosis and 7 months (range, 1-54 months) from the SBRT start date. With death treated as a competing risk event, the cumulative incidence of local failure was 7.6% at 1 year after SBRT and 19.2% at 3 years. The median overall survival (OS) time was 19 months (95% confidence interval, 8-54 months) and tumor size correlated with survival (P?=?.0006). Patients with metastases <2.9?cm had a median OS of 54 months compared with 11 months for those with adrenal metastases ?2.9?cm (P?=?.01). Incidence of grade 2 toxicity was 17% with no case of grade ?3 toxicity. SBRT did not impact renal function with a mean estimated decline in glomerular filtration rate of only 2.6?±?8?mL/min/1.73?m2 compared with baseline. Combined kidneys V5 and combined renal cortex V17.5 did not correlate with a change in estimated glomerular filtration rate (P?=?.7 and P?=?.9, respectively). Conclusions:SBRT offers excellent local control for the treatment of adrenal gland metastases with very low toxicity rates and no significant short-term impact on renal function.

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Normal tissue toxicity after small field hypofractionated stereotactic body radiation.

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Normal tissue toxicity after small field hypofractionated stereotactic body radiation.

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