Stereotactic Body Radiation Therapy: Principles and Practices

Preface
Contents
Part I: Introduction
	Chapter 1: Introduction and History of Stereotactic Body Radiation Therapy (SBRT)
		1.1 Introduction
		1.2 Intracranial Radiosurgery
		1.3 Principles and Methods
		1.4 Dose Fractionation and Normal Tissue Dose Constraints
		1.5 Terminology
		1.6 Survey of SBRT in Japan and Its Current Status
		References
Part II: Basic Principles
	Chapter 2: Radiobiology of Stereotactic Ablative Radiation Therapy
		2.1 Introduction
		2.2 More Than DNA Damage Is Involved in The Cell Death by High-Dose Hypofractionated Radiotherapy
		2.3 Effect of High-Dose Hypofractionated Irradiation on Tumor Vasculatures and TME
		2.4 Vascular Damages by High-Dose Hyperfractionated Irradiation
		2.5 Indirect Cell Death Due to Vascular Damages
		2.6 Immunologic Effects of SABR
		2.7 The 5Rs and Fractionation in SABR
			2.7.1 Reoxygenation of Hypoxic Cells
			2.7.2 Repair of Sublethal Radiation Damage in Tumor Cells
			2.7.3 Redistribution of Cells in Cell Cycle Phase
			2.7.4 Repopulation of Tumor Cells
			2.7.5 Radiosensitivity of Tumor Cells
		2.8 The Linear Quadratic Model in SABR
		2.9 Summary
		References
	Chapter 3: Physics of SBRT
		3.1 Electromagnetic Wave: X-Rays, Gamma Rays
		3.2 Interactions of Photons with Matter
			3.2.1 Photoelectric Effect
			3.2.2 Compton Scattering
			3.2.3 Pair Production
		3.3 Photon Flux in Matter
		3.4 Energy Deposition by Incident Photons to Matter
		3.5 Energy Spectrum and Dose Distribution of Therapeutic X-Rays from a Linear Accelerator (Linac)
		References
	Chapter 4: Quality Assurance in SBRT
		4.1 Introduction
		4.2 Physics QA in SBRT
			4.2.1 Staffing and Equipment
			4.2.2 Facility-Based Physics QA
				4.2.2.1 Commissioning
				4.2.2.2 Simulation
				4.2.2.3 Planning
				4.2.2.4 RMM
				4.2.2.5 IGRT
				4.2.2.6 Third Parity Evaluation
			4.2.3 Multifacility-Based Physics QA
				4.2.3.1 Physical QA in Clinical Trials
					4.2.3.1.1 Credentialing
					4.2.3.1.2 Individual Case Review
				4.2.3.2 Secondary Analysis
		4.3 Perspective of Physics QA for SBRT
		4.4 Conclusion
		References
	Chapter 5: Patient Immobilization, IGRT, Respiratory Motion Management
		5.1 Image-Guided Radiation Therapy (IGRT)
			5.1.1 Objective of IGRT
			5.1.2 Uncertainties in IGRT
			5.1.3 IGRT Devices and Methods
		5.2 Patient Immobilization
			5.2.1 Objective of Patient Immobilization
			5.2.2 Immobilization Devices
			5.2.3 Setup Accuracy Using Immobilization Devices
			5.2.4 Influence on Dose Distribution
		5.3 Respiratory Motion Management
			5.3.1 Objective of Respiratory Motion Management
			5.3.2 RPM Methods
			5.3.3 Evaluation of RPM
		References
	Chapter 6: Dose Calculation Algorithm
		6.1 Basics of Dose Calculation Algorithm
			6.1.1 Model-Based Algorithm
				6.1.1.1 Convolution-Superposition Algorithm
				6.1.1.2 Analytical Anisotropic Dose Calculation Algorithm
			6.1.2 MC and GBBS
			6.1.3 Medium of Dose Deposition and Radiation Transport
		6.2 Comparison of Dose Calculation Algorithms for SBRT
			6.2.1 Issues in Clinical Cases with Low-Density Material
			6.2.2 Issues in Clinical Cases with High-Density Material
			6.2.3 Impact of Dose Prescription
			6.2.4 Impact of Dose Grid Size
		6.3 Recommendations
		References
	Chapter 7: Treatment Planning
		7.1 Respiratory Motion
		7.2 Patient Fixation
		7.3 Computed Tomography and Determination of Internal Target Volume
			7.3.1 Computed Tomography Slice Thickness
			7.3.2 Respiratory Motion Management
				7.3.2.1 Inhibition of Respiratory Motion by Abdominal Compression
					7.3.2.1.1 Inhale/Exhale Breath-Hold Computed Tomography
					7.3.2.1.2 Slow Computed Tomography
					7.3.2.1.3 Four-Dimensional Computed Tomography
				7.3.2.2 Breath-Holding
				7.3.2.3 Respiratory-Gating and Real-Time Tumor Tracking
		7.4 Targeting
			7.4.1 Gross Tumor Volume and Clinical Target Volume
			7.4.2 ITV or iGTV
			7.4.3 PTV
		7.5 Beam Arrangement
		7.6 Beam Energy
		7.7 Dose Calculation
		7.8 Normal Tissue Dose Tolerance
		7.9 Treatment Plan Reporting
		References
Part III: Clinical Applications
	Chapter 8: Lung: Peripheral
		8.1 Introduction
		8.2 Japanese Experience
		8.3 Western Countries Studies
		8.4 Phase III Study
		8.5 Conclusion
		References
	Chapter 9: Lung: Central
		9.1 Centrally and Ultra-Centrally Located Lung Tumors
		9.2 Fatal Toxicity
		9.3 Treatment Outcomes
		9.4 Treatment Planning
		References
	Chapter 10: Lung: Toxicities
		10.1 Introduction
		10.2 Toxicities by Sites
			10.2.1 Lung
				10.2.1.1 Clinical Manifestations
				10.2.1.2 Dose Constraints
			10.2.2 Heart
				10.2.2.1 Clinical Manifestations
				10.2.2.2 Dose Constraints
			10.2.3 Brachial Plexus
				10.2.3.1 Clinical Manifestations
				10.2.3.2 Dose Constraints
			10.2.4 Central Airways
				10.2.4.1 Clinical Manifestations
				10.2.4.2 Dose Constraints
			10.2.5 Esophagus
				10.2.5.1 Clinical Manifestations
				10.2.5.2 Dose Constraints
			10.2.6 Great Vessels
				10.2.6.1 Dose Constraints
			10.2.7 Chest Wall and Ribs
				10.2.7.1 Clinical Manifestations
				10.2.7.2 Dose Constraints
			10.2.8 Skin
				10.2.8.1 Clinical Manifestations
				10.2.8.2 Dose Constraints
		10.3 Considerations on Re-irradiation
		10.4 Summary
		References
	Chapter 11: Liver
		11.1 Etiology and Epidemiology
		11.2 External-Beam Radiation Therapy (EBRT)
		11.3 Dose Prescription
		11.4 Number and Size
		11.5 Dose Constraints: Liver
		11.6 Dose Constraints: GI Tract
		11.7 Clinical Results of Stereotactic Body Radiation Therapy (SBRT)
		11.8 Comparison of Outcomes by Treatment Modalities
		11.9 Application of SBRT/EBRT to Advanced Lesions
		11.10 CT Appearance of Tumor Response After SBRT
		11.11 Summary—Eligibility of SBRT for HCC
		References
	Chapter 12: Kidney
		12.1 Reasons Why SBRT Is Receiving Attention for Renal Cancer Therapy
			12.1.1 Renal Cancer Shows Lower α/β Compared to Other Cancers
			12.1.2 RCC Has Traditionally Been Considered to be Radio-Resistant
			12.1.3 After Removal of the Affected Kidney, Recurrence of Cancer Frequently Occurs in the Remaining Kidney, and the Patient Is Forced to Undergo Dialysis After the Second Nephrectomy.
			12.1.4 An Increase of Abscopal Effect Can Be Expected After a Single Irradiation with a High Dose, and the Effect May Be Further Enhanced by Combined Use of Immune Checkpoint Inhibitors.
		12.2 Techniques of SBRT for RCC
		12.3 Problems in Planning SBRT for Renal Cancer
		12.4 Examples of SBRT for RCC
		12.5 Results of SBRT for RCC
		12.6 Comparison with Other Therapeutic Modalities
		12.7 Summary and Future Outlook
		References
	Chapter 13: Spine
		13.1 Overview of Spine Stereotactic Body Radiotherapy (SBRT)
		13.2 Patient Selection
		13.3 Methodology
			13.3.1 Planning Images
				13.3.1.1 Treatment Planning Computed Tomography (CT)
				13.3.1.2 MRI
			13.3.2 Contouring
				13.3.2.1 Target Volume Definition
				13.3.2.2 Defining Organs-at-Risk
			13.3.3 Optimal Dose Fractionation Schedule
			13.3.4 Optimizing the Target Dose Distribution
			13.3.5 Dose Constraints
				13.3.5.1 Spinal Cord and Cauda Equina
				13.3.5.2 Esophagus
			13.3.6 MESCC
				13.3.6.1 Treatment Strategy
				13.3.6.2 Separation Surgery
			13.3.7 Follow-Up
				13.3.7.1 Evaluation of LC
				13.3.7.2 Evaluation of Pain Response
			13.3.8 Adverse Effects
				13.3.8.1 Pain Flare
				13.3.8.2 Pharyngeal and Esophageal Toxicity
				13.3.8.3 VCF
				13.3.8.4 Radiation Myelopathy
		References
	Chapter 14: Oligomets
		14.1 Definition of Oligometastatic Disease
			14.1.1 Classification of OMD
			14.1.2 Non-small Cell Lung Cancer
			14.1.3 Clinical Trials for De Novo OMD (Synchronous OMD, Metachronous OMD) with Non-Small Cell Lung Cancer
			14.1.4 Clinical Trials for Induced OMD and Repeat OMD with Non-Small Cell Lung Cancer
			14.1.5 Ongoing Trials for OMD with Non-small Cell Lung Cancer
		14.2 Breast Cancer
			14.2.1 Clinical Trials for OMD with Breast Cancer
			14.2.2 Ongoing Trials for OMD with Breast Cancer
		14.3 Prostate Cancer
			14.3.1 Clinical Trials for OMD with Prostate Cancer
			14.3.2 Ongoing Trials for OMD with Prostate Cancer
		14.4 OMD with Other Primary Cancers
			14.4.1 Clinical Trials for OMD with Other Primary Cancers
		14.5 OMD in Mixed Primaries
			14.5.1 Clinical Trials for OMD with Mixed Primaries
			14.5.2 Ongoing Trials for OMD with Mixed Primaries
		14.6 Conclusions
		References
	Chapter 15: Other Indications
		15.1 Stereotactic Body Radiation Therapy (SBRT) for Prostate Cancer
			15.1.1 Treatment Strategy
			15.1.2 Treatment Techniques
			15.1.3 Clinical Outcomes
			15.1.4 Future Directions
		15.2 SBRT for Pancreatic Cancer
			15.2.1 Treatment Strategy
			15.2.2 Treatment Techniques
			15.2.3 Clinical Outcomes
		15.3 SBRT for Adrenal Gland Tumor
			15.3.1 Treatment Strategy
			15.3.2 Clinical Outcomes
		15.4 SBRT for Head and Neck Cancer
			15.4.1 Treatment Strategy
			15.4.2 Clinical Outcomes
		15.5 SBRT for Locally Advanced Non-Small Cell Lung Cancer
		References
Part IV: Development of Machines
	Chapter 16: Vero4DRT System and Dynamic Tumor Tracking SBRT
		16.1 Introduction
		16.2 Specification of the Vero4DRT
		16.3 History of the Development
		16.4 Physics Evaluation and Clinical Application
			16.4.1 Physics Evaluation
			16.4.2 Initial Clinical Application
			16.4.3 Dynamic Tumor Tracking SBRT
		16.5 Summary
		References
	Chapter 17: Real-Time Tumor-Tracking Radiotherapy (RTRT), SyncTraX
		17.1 Introduction
		17.2 Physical Aspects and Clinical Application of the RTRT System
		17.3 Method of Gold Marker Insertion
			17.3.1 Non-small Cell Lung Cancer
			17.3.2 Liver and Prostate
		17.4 CT Acquisition and Treatment Planning
		17.5 Clinical Results
			17.5.1 Non-small Cell Lung Cancer
			17.5.2 Hepatocellular Carcinomas
			17.5.3 Other Tumors
		17.6 Marker Movement Analysis
		17.7 Future Directions
		17.8 Summary
		References
	Chapter 18: CyberKnife®
		18.1 Introduction
		18.2 Xsight® Spine Tracking
		18.3 Fiducial Marker Tracking
		18.4 Synchrony Respiratory Motion Tracking System
		18.5 Xsight® Lung Tracking
		18.6 Summary
		References
	Chapter 19: Tomotherapy
		19.1 General
		19.2 Beam Model
			19.2.1 Common Model
			19.2.2 Machine-Specific Model
		19.3 Treatment Planning
		19.4 Quality Assurance
		19.5 Synchrony®
		19.6 Practicality of SBRT
		References
	Chapter 20: MR-LINAC: Elekta Unity
		20.1 Introduction
		20.2 History of Unity
		20.3 Characteristics of Unity
		References
	Chapter 21: ViewRay MR-Linac
		21.1 Machine Specification
		21.2 Patient Positioning
		21.3 Gated Radiotherapy
		21.4 Online Adaptive Radiotherapy
		21.5 Offline Adaptive Radiotherapy
		21.6 Commissioning
		21.7 Stereotactic Body Radiation Therapy (SBRT) in Lung Cancer
		21.8 Safety Control and Quality Management
		21.9 Machine Installation
		References
Part V: Future Perspectives
	Chapter 22: Future of SBRT with AI (Artificial Intelligence)
		22.1 Introduction
		22.2 Application of AI for SBRT
			22.2.1 Auto-segmentation
			22.2.2 Auto-Planning and Synthetic Image
			22.2.3 Automated QA
			22.2.4 Outcome Prediction
		References
	Chapter 23: Future of SBRT with Photon and Charged Particles
		23.1 FLASH Radiotherapy (FLASH-RT)
		23.2 Combination with Systemic Therapy
		23.3 Assessment of Recurrence Risk
		23.4 New Indications for SBRT
		23.5 Charged Particle: Proton and Carbon
		23.6 Future Perspectives on Charged Particle Therapy Technology
		References
Index