Extracranial Stereotactic Radiotherapy and Radiosurgery

Front cover......Page 1
Preface......Page 6
Contents......Page 8
Contributors......Page 12
1 Introduction......Page 16
INTRODUCTION......Page 20
The Stereotactic Reference System......Page 21
Breathing Control......Page 22
Dose Absorption of the SBF......Page 23
ACCURACY OF PATIENT AND TARGET REPRODUCIBILITY IN THE SBF......Page 24
TREATMENT PLANNING AND DELIVERY Patient Positioning in the SBF and CT-Planning Study......Page 28
Target Definition and 3D-Treatment Planning......Page 29
Target Verification and Irradiation......Page 30
REFERENCES......Page 32
INTRODUCTION......Page 34
SYSTEM DESCRIPTION......Page 35
PATIENT POSITIONING Description......Page 36
VERIFICATION AND CLINICAL VALIDATION Phantom Measurements......Page 43
Patient Studies......Page 45
Table 1 Average Residual Setup Error (mm) and Standard Deviation (in Parenth-eses)......Page 47
Discussion......Page 49
TREATMENT PLANNING AND TREATMENT DELIVERY Dynamic Arc......Page 51
IMRS......Page 52
TREATMENT VERIFICATION The AZ-VUB Approach......Page 55
The UCLA Approach......Page 68
TREATMENT OF MOVING TARGETS......Page 72
CAPABILITIES AND LIMITATIONS OF THE TECHNIQUE......Page 79
REFERENCES......Page 80
INTRODUCTION......Page 86
Technological Limitations......Page 87
Related Work......Page 88
INVERSE PLANNING......Page 90
Phase 2: Beam Weighting......Page 92
RESPIRATION TRACKING......Page 93
CLINICAL TRIALS......Page 99
REFERENCES......Page 101
SYSTEM DESCRIPTION AND OPERATION......Page 104
PATIENT IMMOBILIZATION AND ALIGNMENT......Page 106
TREATMENT PLANNING......Page 109
Case Report......Page 111
TREATMENT VERIFICATION......Page 115
TREATMENT OF MOVING TARGETS......Page 119
LOGISTICS OF THE METHOD......Page 121
FUTURE DIRECTIONS......Page 122
REFERENCES......Page 123
INTRODUCTION......Page 124
APPROPRIATE SELECTION OF PATIENTS......Page 125
The Role of Imaging in the Selection of Patients with Lung Cancer......Page 126
The Role of Imaging in the Selection of Patients with Vertebral Metastases......Page 127
GENERAL PRINCIPLES OF TARGET DEFINITION......Page 128
GENERATING REPRESENTATIVE PLANNING CT SCANS......Page 129
Full Characterization and Incorporation of Internal Mobility......Page 130
Minimizing Respiratory Motion......Page 131
Respiratory Gating......Page 132
Tumor Tracking Radiotherapy......Page 133
REPEATED TREATMENT PLANNING IN BETWEEN FRACTIONS......Page 134
SITE SPECIFIC COMMENTS Table: Site-Specific Aspects of Imaging for ECSRT......Page 135
REFERENCES......Page 137
INTRODUCTION: CLINICAL RADIOBIOLOGY AS A FOUR-DIMENSIONAL PROBLEM......Page 146
The 4 Rs of Fractionation Radiobiology......Page 148
Empirical Power–Laws......Page 149
Mechanistic Models and Cell Survival Curves......Page 151
Biologically Effective Dose (BED)......Page 156
The Incomplete Repair Model......Page 158
TCP and NTCP......Page 160
FROM TEMPORAL PROBLEM TO SPATIAL CONSIDERATION: THE ‘‘DOUBLE-TROUBLE’’ EFFECT......Page 161
RADIOBIOLOGY PROBLEM ALONG THE SPATIAL DOMAIN: THE VOLUME EFFECT......Page 163
Partial Organ Irradiation and Heterogeneous Dose Distribution......Page 164
Tissue Organization......Page 173
Equivalent Uniform Dose (EUD)......Page 177
Equivalent Uniform Biologically Equivalent Dose (EUBED)......Page 178
SPECIFIC ISSUES REGARDING SRS AND SRT......Page 179
Tumor Debulking with SRS vs. Radical Field Coverage......Page 180
Treatment Field Margins......Page 181
Unconventional Fractionation for SRT......Page 182
Coverage, Homogeneity, and Conformality......Page 183
NOTE ADDED IN PROOF Simultaneous Integrated Boost (SIB)......Page 184
The Role of Ultra-Precision Oriented Radiation Therapy in Cancer Medicine......Page 185
Table 1 Comparison for Five-Year Survival Rates Between Local and Systemic......Page 186
REFERENCES......Page 187
INTRODUCTION......Page 192
INCIDENCE......Page 193
THE ROLE OF STEREOTACTIC BODY RADIATION THERAPY IN THE MULTI-DISCIPLINARY TREATMENT ARSENAL......Page 194
ORGAN-SPECIFIC DIFFICULTIES Organ Motion......Page 196
Imaging for Treatment Planning and Setup Assessment Prior to Treatment Delivery......Page 197
Dose Escalation in the Normal Liver......Page 198
PARTIAL LIVER-RADIATION USING STEREOTACTIC SETUP Hypofractionation......Page 200
Radiosurgery......Page 201
ONGOING STUDIES......Page 204
FUTURE RESEARCH......Page 205
REFERENCES......Page 206
INTRODUCTION......Page 212
Table 1 Suggested Indications for Stereotactic Irradiation of Pulmonary Tumors......Page 213
Standard Treatment for Pulmonary Tumors Amenable for Stereotactic Irradiation NSCLC Stage I/II......Page 215
LUNG METASTASES......Page 217
RADIOBIOLOGY Normal Tissue Considerations......Page 218
Tumor Control Considerations......Page 221
RADIATION TOLERANCE OF PULMONARY TISSUES......Page 222
Table 2 RTOG Proposed Radiation Tolerances of Thoracic Normal Tissue......Page 224
Treatment Delivery......Page 225
Target Definition......Page 228
Treatment Planning......Page 229
Tissue Heterogeneity Issues......Page 230
TREATMENT OUTCOME......Page 231
Hypofractionation with 5–15 Fractions......Page 232
LOCAL CONTROL AND SURVIVAL......Page 235
Toxicity......Page 240
CONCLUSION AND FUTURE DIRECTIONS......Page 241
REFERENCES......Page 242
THE TEKNON EXPERIENCE INTRODUCTION AND RATIONALE Rationale for Dose Escalation in Curative Treatment of Localized Prostate Cancer......Page 246
Radiobiology of Prostate Cancer: Hypofractionation......Page 247
HYPOFRACTIONATED BOOST WITH INTENSITY MODULATED X-RAY BEAMS UNDER STEREOTACTIC CONDITIONS: A PILOT STUDY Preliminary Considerations......Page 248
Table 1 Patient Distribution According to Clinical Stage,......Page 249
Treatment Description......Page 250
Boost (PTV2) Treatment Planning......Page 251
Patient Immobilization......Page 252
Preliminary Results: Feasibility, Treatment Tolerance, and Outcome......Page 253
Table 3 Acute Urinary Toxicity According to Boost Dose (EORTC Score)......Page 256
Table 5 Late Radiation Morbidity Scoring System......Page 257
Table 7 Late Rectal Toxicity According to Boost Dose (RTOG Score)......Page 258
FINAL COMMENTS AND CONCLUSIONS......Page 259
TREATMENT PROTOCOL AND IRRADIATION TECHNIQUE......Page 261
CLINICAL FOLLOW-UP......Page 263
Table 8 Characteristics of the First 100 Patients Treated on the Novalis System at......Page 264
REFERENCES......Page 265
INTRODUCTION AND CLINICAL INDICATIONS Tumors of the Spine and the Spinal Cord......Page 272
Radiosurgery of the Spine......Page 273
Table 1 History of Spine Stereotaxy......Page 274
TECHNIQUES FOR SPINAL RADIOSURGERY......Page 275
Immobilization and Simulation......Page 276
Treatment Planning......Page 278
Patient Setup and Target Localization......Page 282
Treatment Delivery......Page 284
Treatment Verification and Quality Assurance......Page 286
Dosimetric Consideration of Spinal Cord Dose......Page 290
Clinical Outcome in Single Spinal Metastasis......Page 292
Treatment Failure and Complications......Page 293
Table 2 HFH Spinal Radiosurgery for Spinal Metastasis......Page 294
REFERENCES......Page 295
INTRODUCTION......Page 300
BACKGROUND Stereotactic Radiosurgery......Page 301
Stereotactic Radiotherapy—Fractionated......Page 303
TECHNIQUE AND INDICATIONS Fractionated Stereotactic Radiotherapy......Page 304
Nasopharyngeal Carcinoma......Page 307
Chemodectoma......Page 310
Paranasal Sinus Carcinomas......Page 312
Skin Carcinoma—Perineural Spread......Page 314
Retinoblastoma......Page 315
HN Tumors......Page 319
Stereotactic Radiosurgery......Page 320
INCIDENCE......Page 323
ORGAN SITE-SPECIFIC DIFFICULTIES......Page 324
FRACTIONATED DOSE SELECTION......Page 326
TREATMENT DELIVERY Stereotactic Radiosurgery......Page 328
LOGISTICS......Page 329
FUTURE USE AND RESEARCH......Page 331
REFERENCES......Page 332
Index......Page 336
Back cover......Page 368