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Biologically effective dose (BED) escalation of stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma patients (?5?cm) with CyberKnife: protocol of study.

ABSTRACT: BACKGROUND:There is a lack of data on the biologically effective dose and the efficacy of stereotactic body radiotherapy in hepatocellular carcinoma patients, and this study was conducted to explore the relation between BED and efficacy. METHODS:This study is designed as a mono-center study. The participants are randomized into three group, and received the following recommended schedule: 49Gy/7f, 54Gy/6f and 55Gy/5f with BED10 in correspondence to 83.3Gy, 102.6Gy and 115.5Gy. The primary outcome measures are to calculate local control rates (LC), overall survival rates (OS) and progression-free survival rates (PFS). The secondary outcome measures are to observe radiation-induced liver injury (RILD) rates, Child-Pugh score and indocyanine green retention rate at 15?min (ICG-R15) value before and after CK-SBRT. Moreover, gastrointestinal toxicities are also observed. DISCUSSION:There is no uniform standard for CK-SBRT dose schedule of hepatocellular carcinoma. We propose to conduct a study determining the optimal CK-SBRT schedule of hepatocellular carcinoma patients (?5?cm). The trial protocol has been approved by the Institutional Review Board of 302 Hospital of PLA (People's Liberation Army). The Ethics number is 2017111D. TRAIL REGISTRATION:Clinical trails number: NCT03295500. Date of registration: November, 2017.

SUBMITTER: Sun J

PROVIDER: S-EPMC6986016 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Biologically effective dose (BED) escalation of stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma patients (≤5 cm) with CyberKnife: protocol of study.

Sun Jing J Zhang Aimin A Li Wengang W Wang Quan Q Li Dong D Zhang Dan D Duan Xuezhang X

Radiation oncology (London, England) 20200128 1

<h4>Background</h4>There is a lack of data on the biologically effective dose and the efficacy of stereotactic body radiotherapy in hepatocellular carcinoma patients, and this study was conducted to explore the relation between BED and efficacy.<h4>Methods</h4>This study is designed as a mono-center study. The participants are randomized into three group, and received the following recommended schedule: 49Gy/7f, 54Gy/6f and 55Gy/5f with BED<sub>10</sub> in correspondence to 83.3Gy, 102.6Gy and 1 ...[more]

PMID: 31992327

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Project description:IntroductionStereotactic 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.MethodsFrom our IRB-approved single-institution registry, all patients treated with SBRT for metastatic sarcoma between 2014 and 2020 were identified. Kaplan-Meier analysis was used to estimate local control and overall survival at 1 and 2 years. A receiver operating characteristic (ROC) curve was generated to determine optimal BED using an α/β ratio of 3. Local control was compared by SBRT dose using the BED cut point and evaluated by histology.ResultsForty-two patients with a total of 138 lesions met inclusion criteria. Median imaging follow up was 7.73 months (range 0.5-35.0). Patients were heavily pre-treated with systemic therapy. Median SBRT prescription was 116.70 Gy BED (range 66.70-419.30). Desmoplastic small round cell tumor, Ewing sarcoma, rhabdomyosarcoma, and small round blue cell sarcomas were classified as radiosensitive (n = 63), and all other histologies were classified as radioresistant (n = 75). Local control for all lesions was 66.7% (95% CI, 56.6-78.5) at 1 year and 50.2% (95% CI, 38.2-66.1) at 2 years. Stratifying by histology, 1- and 2-year local control rates were 65.3% and 55.0%, respectively, for radiosensitive, and 68.6% and 44.5%, respectively, for radioresistant histologies (p = 0.49). The ROC cut point for BED was 95 Gy. Local control rates at 1- and 2-years were 75% and 61.6%, respectively, for lesions receiving >95 Gy BED, and 46.2% and 0%, respectively, for lesions receiving <95 Gy BED (p = 0.01). On subgroup analysis, local control by BED > 95 Gy was significant for radiosensitive histologies (p = 0.013), and trended toward significance for radioresistant histologies (p = 0.25).ConclusionThere is a significant local control benefit for sarcoma SBRT when a BED > 95 Gy is used. Further investigation into the dose-response relationship is warranted to maximize the therapeutic index.

Project description:PurposeThe accuracy of dose calculation is the prerequisite for CyberKnife (CK) to implement precise stereotactic body radiotherapy (SBRT). In this study, CK-MLC treatment planning for early-stage non-small cell lung cancer (NSCLC) were compared using finite-size pencil beam (FSPB) algorithm, FSPB with lateral scaling option (FSPB_LS) and Monte Carlo (MC) algorithms, respectively. We concentrated on the enhancement of accuracy with the FSPB_LS algorithm over the conventional FSPB algorithm and the dose consistency with the MC algorithm.MethodsIn this study, 54 cases of NSCLC were subdivided into central lung cancer (CLC, n=26) and ultra-central lung cancer (UCLC, n=28). For each patient, we used the FSPB algorithm to generate a treatment plan. Then the dose was recalculated using FSPB_LS and MC dose algorithms based on the plans computed using the FSPB algorithm. The resultant plans were assessed by calculating the mean value of pertinent comparative parameters, including PTV prescription isodose, conformity index (CI), homogeneity index (HI), and dose-volume statistics of organs at risk (OARs).ResultsIn this study, most dose parameters of PTV and OARs demonstrated a trend of MC > FSPB_LS > FSPB. The FSPB_LS algorithm aligns better with the dose parameters of the target compared to the MC algorithm, which is particularly evident in UCLC. However, the FSPB algorithm significantly underestimated the does of the target. Regarding the OARs in CLC, differences in dose parameters were observed between FSPB and FSPB_LS for V10 of the contralateral lung, as well as between FSPB and MC for mean dose (Dmean) of the contralateral lung and maximum dose (Dmax) of the aorta, exhibiting statistical differences. There were no statistically significant differences observed between FSPB_LS and MC for the OARs. However, the average dose deviation between FSPB_LS and MC algorithms for OARs ranged from 2.79% to 11.93%. No significant dose differences were observed among the three algorithms in UCLC.ConclusionFor CLC, the FSPB_LS algorithm exhibited good consistency with the MC algorithm in PTV and demonstrated a significant improvement in accuracy when compared to the traditional FSPB algorithm. However, the FSPB_LS algorithm and the MC algorithm showed a significant dose deviation in OARs of CLC. In the case of UCLC, FSPB_LS showed better consistency with the MC algorithm than observed in CLC. Notwithstanding, UCLC's OARs were highly sensitive to radiation dose and could result in potentially serious adverse reactions. Consequently, it is advisable to use the MC algorithm for dose calculation in both CLC and UCLC, while the application of FSPB_LS algorithm should be carefully considered.

Dataset Information

Biologically effective dose (BED) escalation of stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma patients (?5?cm) with CyberKnife: protocol of study.

Publications

Biologically effective dose (BED) escalation of stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma patients (≤5 cm) with CyberKnife: protocol of study.

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