Stereotactic radiosurgery and stereotactic body radiation therapy : a comprehensive guide

Foreword
Preface
Contents
Contributors
Part I: Radiobiology of Radiosurgery and Stereotactic Body Radiation Therapy
	Vascular-Mediated Mechanisms and SRS/SBRT
		Introduction
		Background and History
			Tumor Angiogenesis
			Characteristics of Tumor Vasculature and Blood Flow
			Tumor Vasculature and Radiosensitivity
		Recent Advances: Vascular-Mediated Mechanisms of Tumor Response
			Observed Vascular Effects of High-Dose Radiation
			Mechanisms of Vascular Damage and Vascular Collapse
			Endothelial Cell Damage Leads to Indirect Tumor Cell Death
		Future Directions: Enhancing the Vascular Response with Combination Therapies
		Conclusions
		References
	Radio-Immunology of Ablative Radiation
		Tumor Immunity Is Critical for Local Control of Tumors After Ablative Radiation
		Radiation-Enhanced Antigen Presentation (REAP)
		Radiation-Induced DAMP Signals
		Radiation-Induced Viral Mimicry
		Immunosuppressive Properties of RT
		Immune Evasion by Tumors and Radioresistance
		Radiation as an Immunomodulatory Drug: Effect of Dose and Fractionation of RT
			Immuno-ablative RT (IART)
			Immunomodulatory RT (IMRT)
			Tumor Microenvironment Modulating RT (TMEM-RT)
		Roadmap for Combination of Immunotherapy with SBRT
		References
	Rationale for Fractionated SRS and Single SRS Session Approaches
		Introduction
		The Radiobiology of Fractionation
		Factors Predicting Toxicity with SRS
		Clinical Outcomes of HF-SRS
		Conclusion
		References
Part II: Intracranial Radiosurgery Technique
	Physics of Radiosurgery
		Introduction
		History of Radiosurgery
			Discovery and Initial Advances in Radiotherapy
			Advances in Neurosurgery and the Invention of Stereotaxy
			Higher-Energy Radiotherapy
			Lars Leksell and the Invention of Radiosurgery
			Teletherapy and Linear Accelerator-Based Radiosurgery
		Recent Advances
			Relocatable Stereotactic Frames
			Integration of On-Board Imaging
			Multileaf Collimators and IMRT
			Conformal Arcs and VMAT
		Limitations
			SRS Is a Local Therapy
			Total Number/Volume of Lesions Treated
			Level of Evidence for Dose/Fractionation
		Future Directions
			Increased Automation
			Functional Biological Imaging
			Biological Optimization
			Immunotherapy
			Further Improvements in Spreading Out Energy
			Nonionizing Techniques
			MR-LINAC
		Practical Considerations
			Small Field Dosimetry
			Differences in Radiation Biology
			Considerations for SRS Treatment Planning
			Understanding of the Total Uncertainty Chain
			Proper Training and Credentialing
		References
	Leksell Gamma Knife Radiosurgery
		Introduction
		History
			Early Vision and Initial System Designs
			Revisiting the Design: The Gamma Knife Model U and Commercialization
			Evolution of Imaging and Treatment Planning for Gamma Knife Radiosurgery
		Recent Developments: Hypofractionation and Onboard Image Guidance
			Extend™ System for Gamma Knife Perfexion
			Gamma Knife Icon™
		Limitations of Gamma Knife Stereotactic Radiosurgery
			Restriction to Intracranial Indications
			Long Beam-Delivery Duration
			Dose Rate Decay and Potential Implications for Radiobiological Effectiveness
			Requirement for Source Reloading
		Future Directions
		Practical Considerations
		References
	CyberKnife Robotic Stereotactic Radiosurgery
		Introduction
		History
		Recent Advances
		Limitations
		Future Directions
		Practical Considerations
			Patient Setup
			Target Definition and Treatment Planning
			Treatment Delivery
		References
	Linear Accelerator-Based Radiosurgery: Technique
		Introduction
		Head Ring Application
		Stereotactic Angiography
		Stereotactic MR Imaging and Image Fusion
		Stereotactic CT Scan
			Image Processing
		Radiosurgery Treatment Planning
			Goals of Radiosurgery Treatment Planning
			Dose Concentration Through the Use of Intersecting Beams
			Treatment Planning Tools
				Arc Elimination
				Differential Collimator Sizes
				Multiple Isocenters
				Multileaf Collimators
		Dose Selection
		References
	Fractionated Radiosurgery
		Introduction
		Recent Advances
		Limitations
		Future Research
		Practical Considerations
		References
	Charged-Particle Proton Radiosurgery
		Introduction/History
		Dosimetric Data
		Clinical Data
			Meningioma
				Practical Considerations When Utilizing PBT for Meningiomas
			Arteriovenous Malformations
				Practical Considerations When Utilizing PBT for AVMs
			Pituitary Adenomas
				Practical Considerations When Utilizing PBT for Pituitary Adenomas
			Vestibular Schwannoma/Acoustic Neuroma
				Considerations for VS/AN
		Limitations
		Decision Criteria When Deciding Between Proton and Photon Treatments
		Conclusion
		References
Part III: Intracranial Radiosurgery by Indication
	Stereotactic Radiosurgery for Brain Metastases
		Introduction
		Treatment Options
		SRS Alone
		SRS and Targeted Therapy
		Dose, Fractionation, and Isodose Line Selection
		Practical Considerations
		References
	Stereotactic Radiosurgery for Pituitary Adenoma
		Introduction
		Site-Specific Considerations
		Clinical Evidence
			Outcomes of Radiosurgery for Nonfunctioning Pituitary Adenomas
			Outcomes of Radiosurgery for Functioning Pituitary Adenomas
		Toxicity
			Hypopituitarism and Hypothalamic Dysfunction
			Cranial Neuropathy
			Late Delayed RE
		Plan Quality
		Dose Prescriptions
		Future Directions
			Role of Upfront Radiosurgery
			Efficacy of SRS in Treating Various Histological Entities of Nonfunctioning Adenomas
			The Treatment Strategy for Functioning Adenomas Depends on Their Histological Characteristics
			Radioresistant Effects of Antisecreting Medications
			Whole-Sellar SRS for MR Indeterminate Functioning Adenomas
		Practical Considerations
		References
	Stereotactic Radiosurgery for Meningioma
		Introduction
		Site-Specific Considerations
		Clinical Evidence
		Toxicity
		Plan Quality
		Future Directions
		Practical Considerations
		References
	Stereotactic Radiosurgery for Intracranial Arteriovenous Malformations
		Introduction
		Natural History
		History and Pathophysiology of AVM Radiosurgery
			Brief History
			Grading Scales
			Pathophysiologic Changes Post-SRS
		Indications for Use of SRS
			Treatment of Unruptured Versus Ruptured AVMs
			Indications for the Use of SRS in AVMs
			Endovascular Embolization
			Volume-Staged and Dose-Staged SRS
		Outcomes of SRS for AVMs
			Obliteration Rates
			Latency-Period Hemorrhage
			Seizure Outcomes
		Complications and Follow-Up
			Adverse Radiation Effects
			Cyst Formation
			Follow-Up and Retreatment
		Conclusion
		Guidelines
		References
	Radiosurgical Management of Trigeminal Neuralgia
		Introduction
		Diagnosis, Etiology, and Pathophysiology
		Stereotactic Radiosurgery (SRS) for Trigeminal Neuralgia
			Delivery
			Assessment
			Radiation Planning, Toxicity, and Mitigation Strategies
			Dose
			Target Length
			Brainstem Volume
		Primary Trigeminal Neuralgia
		Secondary Trigeminal Neuralgia
			Compressive Mass Lesions
			Multiple Sclerosis
		Recurrent Trigeminal Neuralgia
		Conclusion
		References
	Radiosurgery for Vestibular Schwannomas
		Introduction
		Stereotactic Radiosurgery
			Stereotactic Radiosurgery Technique
			Dose Planning
			Gamma Knife® Radiosurgery: Clinical Results
			Hearing Preservation
			Facial Nerve and Trigeminal Nerve Preservation
			Neurofibromatosis 2
			Proton Beam Radiosurgery
			LINAC Radiosurgery
			Stereotactic Radiotherapy (SRT)
		Comparing Outcomes for Radiosurgery and Surgical Resection
			Tumor Control
			Timing of Care and Hearing Preservation
			Facial Nerve Preservation in Decision Making
			Quality of Life
		Future Directions
		References
	Stereotactic Radiosurgery for Glial Tumors
		Background
		The Role of Radiosurgery
		Pilocytic Astrocytoma
		Grade 2 Astrocytoma
		Anaplastic (Grade 3) Gliomas
		Glioblastoma Multiforme
		The Controversial Role of SRS for Glioblastoma
		Radiosurgery in Combination with Bevacizumab
		Conclusion
		References
Part IV: Stereotactic Body Radiation Therapy Technique
	Physics of Stereotactic Body Radiotherapy
		Introduction
		Uncertainties and Margins
			Localization Accuracy, Patient Stability, and Baseline Shifts
			Respiratory Motion
			Target Delineation
			Machine-Related Uncertainties
			Imaging-Related Uncertainties
		Treatment Planning and Delivery
			Beam Geometry
			Delivery Technology
			Treatment Planning Systems
			Collimation System
			Prescription Dose: Effect of Dose Heterogeneity
			Practical Considerations
		Small-Field Dosimetry
			Reference Dosimetry
			Relative Dosimetry
			Detector Selection
		References
	Immobilization for SBRT: A Crucial Prerequisite Toward Accurate Treatment
		Introduction
		History of Immobilization for SBRT
		Recent Advances in Immobilization
			Frames
			Mattresses
			Masks
			Immobilization for Moving Target Volumes
		Limitations of Immobilization
		Future of Immobilization
		References
	Motion Management in Stereotactic Body Radiation Therapy
		Scope
		Introduction
			Respiratory Motion Management
		Sources of Motion
			Voluntary Motion
			Involuntary Motion
				Respiration
				Bladder and Gastrointestinal Filling
		Concepts for Motion Management
			Planning for Tumor Motion
				Internal Motion Margin
			Tumor Motion Detection: Treatment Compared to Planning
			Restricting Tumor Motion
				Breath-Hold Approaches
		Deep Inspiration Breath-Hold
		Active Breathing Control (ABC)
			Abdominal Compression to Force Shallow Breathing
			Gating the Beam During Treatment
			Tumor Tracking and Real-Time Beam Adaptation
		Systems for Monitoring and Measuring Motion
			Radiation-Based Systems
				X-Ray Sources
				Imaging Detectors
				Clinical Systems and Their Use in Motion Monitoring and Management
		kV Imaging
		MV Imaging
			Non-radiation-Based Systems
				Camera-Based Systems
				Radio-Frequency-Based System
				Magnetic Resonance Imaging Linear Accelerator Systems
		Summary
		References
	Charged Particle Stereotactic Body Radiation Therapy
		Introduction
		Hypofractionated/SBRT Proton Therapy for Early-Stage Primary Non-small Cell Lung Cancer (Fig. 1)
			Clinical
			Dosimetric
		Hypofractionated/SBRT Proton Therapy for Liver Tumors
			Clinical
			Dosimetric
		Hypofractionated/SBRT Proton Therapy for Pancreatic Tumors
			Clinical
			Dosimetric
		Hypofractionated/SBRT Proton Therapy for Prostate Cancer
			Clinical
			Dosimetric
		Conclusion
		References
Part V: Stereotactic Body Radiation Therapy by Indication
	Stereotactic Body Radiation Therapy (SBRT) for Primary Lung Cancer
		Introduction
		Site-Specific Considerations
		Clinical Evidence
		Toxicity
		Plan Quality
		Future Directions
		Practical Considerations
		References
	Stereotactic Body Radiation Therapy (SBRT) for Lung Metastases
		Introduction
		Site-Specific Considerations
		Clinical Evidence
			Prospective Trials
			Retrospective Studies
		Toxicity
			Peripheral Tumors
			Central Tumors
			Management of Toxicities
		Plan Quality
		Future Directions: SBRT in the Rapidly Evolving Landscape of Systemic Therapy
		Practical Considerations
		References
	Stereotactic Body Radiation Therapy (SBRT) for Spinal Tumors
		Introduction
		Site-Specific Considerations
		Clinical Evidence
			Treatment of De Novo Metastases
			Postoperative Spine SBRT
			Reirradiation Spine SBRT
		Toxicities
			Pain Flare
			Myelopathy
			Gastrointestinal Toxicity
			Vertebral Compression Fracture
		Plan Quality
			Treatment Planning
			Plan Evaluation
		Future Directions
		Practical Considerations
		References
	Stereotactic Body Radiation Therapy for Gastrointestinal Cancers
		Introduction
		Site-Specific Considerations
			Primary and Secondary Liver Cancer
			Pancreatic Cancer
		Clinical Evidence
			HCC
			Liver Metastases
			Pancreatic Cancer
		Toxicity
		Plan Quality
			Liver SBRT
			Pancreatic Cancer
		Future Directions
		Practical Considerations
			Primary and Secondary Liver Cancer
			Pancreatic Cancer
		References
	SAbR for Primary Prostate Cancer
		Introduction
		Site Specific Considerations: Radiobiologic Rationale for Prostate SAbR
		Clinical Evidence: Selected Clinical Data for Prostate SAbR
		Toxicity: The UT Southwestern Experience – Phase I and II Trials
		Prostate SAbR Simulation, Planning, and Treatment Delivery Techniques
			Pre-treatment Preparation
			Simulation
			Plan Quality: Planning and Constraints
			Treatment Delivery
		Future Directions in SAbR for Prostate Cancer
		Practical Considerations in SAbR for Prostate Cancer
		References
	Stereotactic Ablative Radiotherapy (SAbR) for Primary Renal Cell Carcinoma
		Introduction
		Radiobiological Rationale
		Outcomes and Adverse Events of SAbR for Primary RCC
			Evidence from Prospective Clinical Trials
		Stereotactic Ablative Radiotherapy for Kidney Tumors: Technical Considerations
			Secure Immobilization
			Motion Assessment and Management
			Target Delineation
			Contouring Critical Structures
			Dosimetry and Target Prescription Dose
			Treatment Delivery and Image Guidance
			Successful Treatment Planning: Characteristics of a Good Treatment Plan
		Future Directions
		Conclusions
		Practical Considerations
		References
	Head and Neck Stereotactic Body Radiation Therapy
		Introduction
		Site-Specific Considerations
			Patient Eligibility
			Staging and Workup Considerations
		Clinical Evidence
			SBRT as Primary Treatment
			Hypofractionation as a Boost
			Re-irradiation for Disease Recurrence or Second Primary Malignancy
		Toxicity
			Toxicities for Primary Treatment
			Toxicities for Re-irradiation
				Carotid Blowout Syndrome
		Plan Quality
			Simulation and Treatment Technique
			Planning
			Contouring
			Recommended Dose-Volume Constraints
		Future Directions
		Practical Considerations
			Patient Selection
				Indications
				Relative Contraindications
			Contouring
			Follow-Up
		References
	Pediatric Radiosurgery
		Introduction
		AVM
		Craniopharyngioma
		Vestibular Schwannoma
		Ependymoma
		Gliomas
		Medulloblastoma
		Treatment of Oligometastatic Disease
		Practical Considerations
		Toxicity
		Future Directions
		References
Part VI: The Future of Radiosurgery and SBRT
	Patient Selection in SBRT and SRS
		Introduction
		Patient Selection for Intracranial Radiosurgery
			Malignant CNS Tumors
				Metastases
				Glioblastoma
			Benign CNS Tumors
				Vestibular Schwannomas
				Meningiomas
				Pituitary Adenomas
		Patient Selection for Extracranial Stereotactic Body Radiotherapy
			Lung SBRT
				Primary Lung Cancer
				Lung Metastases
			GU Malignancies
				Prostate
				Renal Cell Carcinoma
			Head and Neck Malignancies
				Reirradiation
				Primary Treatment
			GI Malignancies
				Liver
				Pancreas
			Spine Metastases
		Conclusions
		Practical Considerations
			Metastatic CNS Disease
			Primary and Benign CNS Tumors
			Primary and Metastatic Lung Cancer
			GU (Prostate and Renal)
			Head and Neck
			GI (Pancreas and Liver)
			Spine Metastases
		References
	SRS and SBRT Complications and Management
		Introduction
		Site-specific Considerations/Clinical Evidence
			Stereotactic Radiosurgery
				Radiation Necrosis
				Radiation Optic Neuropathy
				Radiation Myelopathy
			Stereotactic Body Radiation Therapy
				Vertebral Compression Fractures
				Radiation Pneumonitis/Pulmonary Fibrosis
				Esophageal Toxicities
				Radiation Plexopathy
				Bowel Toxicities
				Non-spine Bone SBRT and Musculoskeletal Toxicity
				Vascular Toxicity
		Concomitant Systemic Therapy
		Plan Quality: Compiled Published Dose Constraints for SRS/SBRT
		Future Directions/Conclusion
		Practical Considerations
		References
	SRS and SBRT Integration with Supportive Care
		Introduction
		Site-Specific Considerations
			Importance of Estimating Life Expectancy
			Evolving Role of SRS/SBRT
			Evidence for Supportive Care in Advanced Cancer
		Clinical Evidence
			Brain Metastases
			Bone Metastases
			Lung Cancer and Lung Metastases
			Liver Metastases
			Adrenal Metastases
		Toxicity and Rationale to Adopt SRS/SBRT
			Brain Metastases
			Bone Metastases
		Future Directions
		Practical Considerations
		References
	Targeted Agents and Immunotherapy
		Introduction
		Unique Challenges and Biology of Using Systemic Treatment for BM
		Lung Cancer and Brain Metastases
			EGFR Tyrosine Kinase Inhibitors
			ALK Tyrosine Kinase Inhibitors
			Vascular Endothelial Growth Factor (VEGF) Inhibitors
			Small Cell Lung Cancer (SCLC) and Brain Metastases
		Breast Cancer and Brain Metastases
		Melanoma and Brain Metastases
		Conclusions/Future Directions
		Practical Considerations
		References
	Diagnostic Imaging Advances
		Part I. Stereotactic Radiosurgery: Intracranial Applications
			Vestibular Schwannoma
				Complications and Toxicity
				Future Directions
			Meningioma
				Complications and Toxicity
				Future Directions
			Trigeminal Neuralgia
				Complications and Toxicity
				Future Directions
			Arteriovenous Malformation
				Complications and Toxicity
				Future Directions
			Intracranial Metastasis
				Complications and Toxicity
				Future Directions
			Practical Considerations
		Part II. Stereotactic Ablative Radiotherapy: Applications in the Lung
			Complications and Toxicity
				Lung Parenchyma
				Trachea and Mainstem Bronchi
				Esophagus and Great Vessels
				Chest Wall
			Future Directions
			Practical Considerations
		Part III. Stereotactic Ablative Radiotherapy: Applications in the Prostate
			Complications and Toxicity
			Future Directions
			Practical Considerations
		References
	Comparative Effectiveness of SBRT
		Introduction
		Brain
			Prospective and Retrospective Series
			Large Database Studies
			Cost-Effectiveness Studies
		Prostate Cancer
			Prospective and Retrospective Series
			Large Database Studies
			Cost-Effectiveness Studies
		Lung
			Prospective and Retrospective Series
			Large Database Studies
			Cost-Effectiveness Studies
		Liver
			Prospective and Retrospective Series
			Large Database Studies
			Cost-Effectiveness Studies
		Conclusion
		References
Index