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Suresh Senan - One of the best experts on this subject based on the ideXlab platform.
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stage i nonsmall cell lung cancer in patients aged 75 years outcomes after Stereotactic Radiotherapy
Cancer, 2010Co-Authors: Cornelis J A Haasbeek, Frank J Lagerwaard, Ben J Slotman, Marilisa E Antonisse, Suresh SenanAbstract:BACKGROUND: The number of patients aged ≥75 years who present with a stage I nonsmall cell lung cancer (NSCLC) is increasing. Elderly patients often have significant comorbidity and may be unfit for surgery. Furthermore, surgery in the elderly is associated with increased mortality and morbidity. In this study, the authors evaluated the outcomes of Stereotactic Radiotherapy (SRT) in elderly patients. METHODS: Since 2003, 203 tumors in 193 patients aged ≥75 years were treated using SRT (118 T1 tumors, 85 T2 tumors). The median patient age was 79 years, 80% of patients were considered medically inoperable, and 20% of patients declined surgery. The median Charlson comorbidity score was 4, and severe chronic obstructive pulmonary disease (Global Initiative for Chronic Obstructive Lung Disease Class III or greater) was present in 25% of patients. Risk-adapted SRT schemes were used with the same total dose of 60 grays in 3 fractions (33%), 5 fractions (50%), or 8 fractions (17% of patients), depending on the patient's risk for toxicity. RESULTS: SRT was well tolerated, and all but 1 patient completed treatment. Survival rates at 1 year and 3 years were 86% and 45%, respectively. Survival was correlated with performance score (P = .001) and pre-SRT lung function (P = .04). The actuarial local control rate at 3 years was 89%. Acute toxicity was uncommon, and late Radiation Therapy Oncology Group grade ≥3 toxicity was observed in <10% of patients. CONCLUSIONS: SRT achieved high local control rates with minimal toxicity in patients aged ≥75 years despite their significant medical comorbidities. These results indicated that more active diagnostic and therapeutic approaches are justified in elderly patients and that SRT should be considered and discussed as a curative treatment alternative. Cancer 2010. © 2010 American Cancer Society.
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recommendations for implementing Stereotactic Radiotherapy in peripheral stage ia non small cell lung cancer report from the quality assurance working party of the randomised phase iii rosel study
Radiation Oncology, 2009Co-Authors: Coen W Hurkmans, Frank J Lagerwaard, Johan P Cuijpers, Joachim Widder, Uulke A Van Der Heide, D Schuring, Suresh SenanAbstract:A phase III multi-centre randomised trial (ROSEL) has been initiated to establish the role of Stereotactic Radiotherapy in patients with operable stage IA lung cancer. Due to rapid changes in Radiotherapy technology and evolving techniques for image-guided delivery, guidelines had to be developed in order to ensure uniformity in implementation of Stereotactic Radiotherapy in this multi-centre study. A Quality Assurance Working Party was formed by radiation oncologists and clinical physicists from both academic as well as non-academic hospitals that had already implemented Stereotactic Radiotherapy for lung cancer. A literature survey was conducted and consensus meetings were held in which both the knowledge from the literature and clinical experience were pooled. In addition, a planning study was performed in 26 stage I patients, of which 22 were stage 1A, in order to develop and evaluate the planning guidelines. Plans were optimised according to parameters adopted from RTOG trials using both an algorithm with a simple homogeneity correction (Type A) and a more advanced algorithm (Type B). Dose conformity requirements were then formulated based on these results. Based on current literature and expert experience, guidelines were formulated for this phase III study of Stereotactic Radiotherapy versus surgery. These guidelines can serve to facilitate the design of future multi-centre clinical trials of Stereotactic Radiotherapy in other patient groups and aid a more uniform implementation of this technique outside clinical trials.
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recommendations for implementing Stereotactic Radiotherapy in peripheral stage ia non small cell lung cancer report from the quality assurance working party of the randomised phase iii rosel study
Radiation Oncology, 2009Co-Authors: Coen W Hurkmans, Frank J Lagerwaard, Johan P Cuijpers, Joachim Widder, Uulke A Van Der Heide, D Schuring, Suresh SenanAbstract:Background A phase III multi-centre randomised trial (ROSEL) has been initiated to establish the role of Stereotactic Radiotherapy in patients with operable stage IA lung cancer. Due to rapid changes in Radiotherapy technology and evolving techniques for image-guided delivery, guidelines had to be developed in order to ensure uniformity in implementation of Stereotactic Radiotherapy in this multi-centre study.
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outcomes of risk adapted fractionated Stereotactic Radiotherapy for stage i non small cell lung cancer
International Journal of Radiation Oncology Biology Physics, 2008Co-Authors: Frank J Lagerwaard, Cornelis J A Haasbeek, Ben J Slotman, Egbert F Smit, Suresh SenanAbstract:Purpose High local control rates can be achieved using Stereotactic Radiotherapy in Stage I non–small-cell lung cancer (NSCLC), but reports have suggested that toxicity may be of concern. We evaluated early clinical outcomes of "risk-adapted" fractionation schemes in patients treated in a single institution. Methods and Materials Of 206 patients with Stage I NSCLC, 81% were unfit to undergo surgery and the rest refused surgery. Pathologic confirmation of malignancy was obtained in 31% of patients. All other patients had new or growing 18F-fluorodeoxyglucose positron emission tomography positive lesions with radiologic characteristics of malignancy. Planning four-dimensional computed tomography scans were performed and fractionation schemes used (3 × 20 Gy, 5 × 12 Gy, and 8 × 7.5 Gy) were determined by T stage and risk of normal tissue toxicity. Results Median overall survival was 34 months, with 1- and 2-year survivals of 81% and 64%, respectively. Disease-free survival (DFS) at 1 and 2 years was 83% and 68%, respectively, and DFS correlated with T stage ( p = 0.002). Local failure was observed in 7 patients (3%). The crude regional failure rate was 9%; isolated regional recurrence was observed in 4%. The distant progression-free survival at 1 and 2 years was 85% and 77%, respectively. SRT was well tolerated and severe late toxicity was observed in less than 3% of patients. Conclusions SRT is well tolerated in patients with extensive comorbidity with high local control rates and minimal toxicity. Early outcomes are not inferior to those reported for conventional Radiotherapy. In view of patient convenience, such risk-adapted SRT schedules should be considered treatment of choice in patients presenting with medically inoperable Stage I NSCLC.
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is adaptive treatment planning required for Stereotactic Radiotherapy of stage i non small cell lung cancer
International Journal of Radiation Oncology Biology Physics, 2007Co-Authors: Cornelis J A Haasbeek, Frank J Lagerwaard, Johan P Cuijpers, Ben J Slotman, Suresh SenanAbstract:Purpose: Changes in position or size of target volumes have been observed during Radiotherapy for lung cancer. The need for adaptive treatment planning during Stereotactic Radiotherapy of Stage I tumors was retrospectively analyzed using repeat four-dimensional computed tomography (4DCT) scans. Methods and Materials: A planning study was performed for 60 tumors in 59 patients using 4DCT scans repeated after two or more treatment fractions. Planning target volumes (PTV) encompassed all tumor mobility, and dose distributions from the initial plan were projected onto PTVs derived from the repeat 4DCT. A dosimetric and volumetric analysis was performed. Results: The repeat 4DCT scans were performed at a mean of 6.6 days (range, 2-12 days) after the first fraction of Stereotactic Radiotherapy. In 25% of cases the repeat PTV was larger, but the difference exceeded 1 mL in 5 patients only. The mean 3D displacement between the center of mass of both PTVs was 2.0 mm. The initial 80% prescription isodose ensured a mean coverage of 98% of repeat PTVs, and this isodose fully encompassed the repeat internal target volumes in all but 1 tumor. "Inadequate" coverage in the latter was caused by a new area of atelectasis adjacent to the tumor on the repeat 4DCT. Conclusions: Limited "time trends" were observed in PTVs generated by repeated uncoached 4DCT scans, and the dosimetric consequences proved to be minimal. Treatment based only on the initial PTV would not have resulted in major tumor underdosage, indicating that adaptive treatment planning is of limited value for fractionated Stereotactic Radiotherapy.
Matthias Guckenberger - One of the best experts on this subject based on the ideXlab platform.
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definition and quality requirements for Stereotactic Radiotherapy consensus statement from the degro dgmp working group Stereotactic Radiotherapy and radiosurgery
Strahlentherapie Und Onkologie, 2020Co-Authors: Matthias Guckenberger, Wolfgang W Baus, Oliver Blanck, Stephanie E Combs, Jurgen Debus, Rita Engenhartcabillic, Tobias Gauer, Anca L Grosu, Daniela Schmitt, Stephanie TanadinilangAbstract:Stereotactic Radiotherapy with its forms of intracranial Stereotactic radiosurgery (SRS), intracranial fractionated Stereotactic Radiotherapy (FSRT) and Stereotactic body Radiotherapy (SBRT) is today a guideline-recommended treatment for malignant or benign tumors as well as neurological or vascular functional disorders. The working groups for radiosurgery and Stereotactic Radiotherapy of the German Society for Radiation Oncology (DEGRO) and for physics and technology in Stereotactic Radiotherapy of the German Society for Medical Physics (DGMP) have established a consensus statement about the definition and minimal quality requirements for Stereotactic Radiotherapy to achieve best clinical outcome and treatment quality in the implementation into routine clinical practice.
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icru report 91 on prescribing recording and reporting of Stereotactic treatments with small photon beams statement from the degro dgmp working group Stereotactic Radiotherapy and radiosurgery
Strahlentherapie Und Onkologie, 2019Co-Authors: Lotte Wilke, Ancaligia Grosu, Oliver Blanck, Stephanie E Combs, Daniela Schmitt, Nicolaus Andratschke, Thomas Brunner, Christos Moustakis, Wolfgang Baus, Matthias GuckenbergerAbstract:The International Commission on Radiation Units and Measurements (ICRU) report 91 with the title "prescribing, recording, and reporting of Stereotactic treatments with small photon beams" was published in 2017. This extensive publication covers different relevant aspects of Stereotactic Radiotherapy such as small field dosimetry, accuracy requirements for volume definition and planning algorithms, and the precise application of treatment by means of image guidance. Finally, recommendations for prescribing, recording and reporting are given.
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toxicity of concurrent Stereotactic Radiotherapy and targeted therapy or immunotherapy a systematic review
Cancer Treatment Reviews, 2017Co-Authors: Stephanie G C Kroeze, C Fritz, Morten Hoyer, Umberto Ricardi, Arjun Sahgal, Rolf A Stahel, Roger Stupp, Matthias GuckenbergerAbstract:Abstract Background and purpose Both Stereotactic Radiotherapy (SRT) and immune- or targeted therapy play an increasingly important role in personalized treatment of metastatic disease. Concurrent application of both therapies is rapidly expanding in daily clinical practice. In this systematic review we summarize severe toxicity observed after concurrent treatment. Material and methods PubMed and EMBASE databases were searched for English literature published up to April 2016 using keywords “radiosurgery”, “local ablative therapy”, “gamma knife” and “Stereotactic”, combined with “bevacizumab”, “cetuximab”, “crizotinib”, “erlotinib”, “gefitinib”, “ipilimumab”, “lapatinib”, “sorafenib”, “sunitinib”, “trastuzumab”, “vemurafenib”, “PLX4032”, “panitumumab”, “nivolumab”, “pembrolizumab”, “alectinib”, “ceritinib”, “dabrafenib”, “trametinib”, “BRAF”, “TKI”, “MEK”, “PD1”, “EGFR”, “CTLA-4” or “ALK”. Studies performing SRT during or within 30 days of targeted/immunotherapy, reporting severe (⩾Grade 3) toxicity were included. Results Concurrent treatment is mostly well tolerated in cranial SRT, but high rates of severe toxicity were observed for the combination with BRAF-inhibitors. The relatively scarce literature on extra-cranial SRT shows a potential risk of increased toxicity when SRT is combined with EGFR-targeting tyrosine kinase inhibitors and bevacizumab, which was not observed for cranial SRT. Conclusions This review gives a best-possible overview of current knowledge and its limitations and underlines the need for a timely generation of stronger evidence in this rapidly expanding field.
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reliability of the bony anatomy in image guided Stereotactic Radiotherapy of brain metastases
International Journal of Radiation Oncology Biology Physics, 2007Co-Authors: Matthias Guckenberger, Kurt Baier, Juergen Wilbert, Iris Guenther, Anne Richter, Otto A Sauer, Dirk Vordermark, Michael FlentjeAbstract:Purpose: To evaluate whether the position of brain metastases remains stable between planning and treatment in cranial Stereotactic Radiotherapy (SRT). Methods and Materials: Eighteen patients with 20 brain metastases were treated with single-fraction (17 lesions) or hypofractionated (3 lesions) image-guided SRT. Median time interval between planning and treatment was 8 days. Before treatment a cone-beam CT (CBCT) and a conventional CT after application of i.v. contrast were acquired. Setup errors using automatic bone registration (CBCT) and manual soft-tissue registration of the brain metastases (conventional CT) were compared. Results: Tumor size was not significantly different between planning and treatment. The three-dimensional setup error (mean {+-} SD) was 4.0 {+-} 2.1 mm and 3.5 {+-} 2.2 mm according to the bony anatomy and the lesion itself, respectively. A highly significant correlation between automatic bone match and soft-tissue registration was seen in all three directions (r {>=} 0.88). The three-dimensional distance between the isocenter according to bone match and soft-tissue registration was 1.7 {+-} 0.7 mm, maximum 2.8 mm. Treatment of intracranial pressure with steroids did not influence the position of the lesion relative to the bony anatomy. Conclusion: With a time interval of approximately 1 week between planning and treatment, the bonymore » anatomy of the skull proved to be an excellent surrogate for the target position in image-guided SRT.« less
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Stereotactic Radiotherapy of primary liver cancer and hepatic metastases
Acta Oncologica, 2006Co-Authors: Joern Wulf, Matthias Guckenberger, Ulrich Haedinger, Ulrich Oppitz, Gerd Mueller, Kurt Baier, Michael FlentjeAbstract:The purpose was to evaluate the clinical results of Stereotactic Radiotherapy in primary liver tumors and hepatic metastases. Five patients with primary liver cancer and 39 patients with 51 hepatic metastases were treated by Stereotactic Radiotherapy since 1997. Twenty-eight targets were treated in a “low-dose”-group with 3×10 Gy (n = 27) or 4×7 Gy (n = 1) prescribed to the PTV-encl. 65%-isodose. In a “high-dose”-group patients were treated with 3×12 − 12.5 Gy (n = 19; same dose prescription) or 1×26 Gy/PTV-enclosing 80%-isodose (n = 9). Median follow-up was 15 months (2–48 months) for primary liver cancer and 15 months (2–85 months) for hepatic metastases. While all primary liver cancers were controlled, nine local failures (3–19 months) of 51 metastases were observed resulting in an actuarial local control rate of 92% after 12 months and 66% after 24 months and later. A borderline significant correlation between dose and local control was observed (p = 0.077): the actuarial local control rate after 12 a...
Michael Flentje - One of the best experts on this subject based on the ideXlab platform.
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reliability of the bony anatomy in image guided Stereotactic Radiotherapy of brain metastases
International Journal of Radiation Oncology Biology Physics, 2007Co-Authors: Matthias Guckenberger, Kurt Baier, Juergen Wilbert, Iris Guenther, Anne Richter, Otto A Sauer, Dirk Vordermark, Michael FlentjeAbstract:Purpose: To evaluate whether the position of brain metastases remains stable between planning and treatment in cranial Stereotactic Radiotherapy (SRT). Methods and Materials: Eighteen patients with 20 brain metastases were treated with single-fraction (17 lesions) or hypofractionated (3 lesions) image-guided SRT. Median time interval between planning and treatment was 8 days. Before treatment a cone-beam CT (CBCT) and a conventional CT after application of i.v. contrast were acquired. Setup errors using automatic bone registration (CBCT) and manual soft-tissue registration of the brain metastases (conventional CT) were compared. Results: Tumor size was not significantly different between planning and treatment. The three-dimensional setup error (mean {+-} SD) was 4.0 {+-} 2.1 mm and 3.5 {+-} 2.2 mm according to the bony anatomy and the lesion itself, respectively. A highly significant correlation between automatic bone match and soft-tissue registration was seen in all three directions (r {>=} 0.88). The three-dimensional distance between the isocenter according to bone match and soft-tissue registration was 1.7 {+-} 0.7 mm, maximum 2.8 mm. Treatment of intracranial pressure with steroids did not influence the position of the lesion relative to the bony anatomy. Conclusion: With a time interval of approximately 1 week between planning and treatment, the bonymore » anatomy of the skull proved to be an excellent surrogate for the target position in image-guided SRT.« less
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Stereotactic Radiotherapy of primary liver cancer and hepatic metastases
Acta Oncologica, 2006Co-Authors: Joern Wulf, Matthias Guckenberger, Ulrich Haedinger, Ulrich Oppitz, Gerd Mueller, Kurt Baier, Michael FlentjeAbstract:The purpose was to evaluate the clinical results of Stereotactic Radiotherapy in primary liver tumors and hepatic metastases. Five patients with primary liver cancer and 39 patients with 51 hepatic metastases were treated by Stereotactic Radiotherapy since 1997. Twenty-eight targets were treated in a “low-dose”-group with 3×10 Gy (n = 27) or 4×7 Gy (n = 1) prescribed to the PTV-encl. 65%-isodose. In a “high-dose”-group patients were treated with 3×12 − 12.5 Gy (n = 19; same dose prescription) or 1×26 Gy/PTV-enclosing 80%-isodose (n = 9). Median follow-up was 15 months (2–48 months) for primary liver cancer and 15 months (2–85 months) for hepatic metastases. While all primary liver cancers were controlled, nine local failures (3–19 months) of 51 metastases were observed resulting in an actuarial local control rate of 92% after 12 months and 66% after 24 months and later. A borderline significant correlation between dose and local control was observed (p = 0.077): the actuarial local control rate after 12 a...
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Stereotactic Radiotherapy of primary liver cancer and hepatic metastases
Acta Oncologica, 2006Co-Authors: Joern Wulf, Matthias Guckenberger, Ulrich Haedinger, Ulrich Oppitz, Gerd Mueller, Kurt Baier, Michael FlentjeAbstract:The purpose was to evaluate the clinical results of Stereotactic Radiotherapy in primary liver tumors and hepatic metastases. Five patients with primary liver cancer and 39 patients with 51 hepatic metastases were treated by Stereotactic Radiotherapy since 1997. Twenty-eight targets were treated in a "low-dose"-group with 3 x 10 Gy (n = 27) or 4 x 7 Gy (n = 1) prescribed to the PTV-encl. 65%-isodose. In a "high-dose"-group patients were treated with 3 x 12 - 12.5 Gy (n = 19; same dose prescription) or 1 x 26 Gy/PTV-enclosing 80%-isodose (n = 9). Median follow-up was 15 months (2-48 months) for primary liver cancer and 15 months (2-85 months) for hepatic metastases. While all primary liver cancers were controlled, nine local failures (3-19 months) of 51 metastases were observed resulting in an actuarial local control rate of 92% after 12 months and 66% after 24 months and later. A borderline significant correlation between dose and local control was observed (p = 0.077): the actuarial local control rate after 12 and 24 months was 86% and 58% in the low-dose-group versus 100% and 82% in the high-dose-group. In multivariate analysis high versus low-dose was the only significant factor predicting local control (p = 0.0089). Overall survival after 1 and 2 years was 72% and 32% for all patients and was impaired due to systemic progression of disease. No severe acute or late toxicity exceeding RTOG/EORTC-score 2 were observed. Stereotactic irradiation of primary liver cancer and hepatic metastases offers a locally effective treatment without significant complications in patients, who are not amenable for surgery. Patient selection is important, because those with low risk for systemic progression are more likely to benefit from this approach.
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cone beam ct based image guidance for extracranial Stereotactic Radiotherapy of intrapulmonary tumors
Acta Oncologica, 2006Co-Authors: Matthias Guckenberger, Joern Wulf, Gerd Mueller, Kurt Baier, J Meyer, Juergen Wilbert, Michael FlentjeAbstract:Cone-beam CT (CB-CT) based image-guidance was evaluated for extracranial Stereotactic Radiotherapy of intrapulmonary tumors. A total of 21 patients (25 lesions: prim. NSCLC n = 6; pulmonary metastases n = 19) were treated with Stereotactic Radiotherapy (1 to 8 fractions). Prior to every fraction a CB-CT was acquired in treatment position, errors between planned and actual tumor position were measured and corrected. Intra- and inter-observer variability of manual evaluation of tumor position error was investigated and this manual method was compared with automatic image registration. Based on CB-CTs from 66 fractions the discrepancy (3-D vector) between planned and actual tumor position was 7.7 mm +/-1.3 mm. Tumor position error relative to the bony anatomy was 5.3 mm +/-1.2 mm, the correlation between bony anatomy and tumor position was poor. Intra-observer and inter-observer variability of manual evaluation of tumor position error was 0.9 mm +/-0.8 mm and 2.3 mm +/-1.1 mm, respectively. Automatic image registration showed highly reproducible results (<1 mm). However, compared with manual registration a systematic error was found in direction of predominant tumor breathing motion (2.5 mm vs 1.4 mm). Image-guidance using CB-CT was validated for high precision Radiotherapy of intrapulmonary tumors. It was shown that both the planning reference and the verification image study have to consider tumor breathing motion.
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Stereotactic Radiotherapy for primary lung cancer and pulmonary metastases a noninvasive treatment approach in medically inoperable patients
International Journal of Radiation Oncology Biology Physics, 2004Co-Authors: Joern Wulf, Ulrich Haedinger, Ulrich Oppitz, Gerd Mueller, Wibke Thiele, Michael FlentjeAbstract:Abstract Purpose The clinical results of dose escalation using Stereotactic Radiotherapy to increase local tumor control in medically inoperable patients with Stage I-II non–small-cell lung cancer or pulmonary metastases were evaluated. Methods and materials Twenty patients with Stage I-II non–small-cell lung cancer and 41 patients with 51 pulmonary metastases not amenable to surgery were treated with Stereotactic Radiotherapy at 3 × 10 Gy ( n = 19), 3 × 12–12.5 Gy to the planning target volume enclosing 100%–isodose, with normalization to 150% at the isocenter; n = 26) or 1 × 26 Gy to the planning target volume enclosing 80%–isodose ( n = 26). The median follow-up was 11 months (range, 2–61 months) for primary lung cancer patients and 9 months (range, 2–37 months) for patients with metastases. Results The actuarial local control rate was 92% for lung cancer patients and 80% for metastasis patients ≥1 year after treatment and was significantly improved by increasing the dose from 3 × 10 Gy to 3 × 12–12.5 Gy or 1 × 26 Gy ( p = 0.038). The overall survival rate after 1 and 2 years was 52% and 32%, respectively, for lung cancer patients and 85% and 33%, respectively, for metastasis patients, impaired because of systemic disease progression. After 12 months, 60% of patients with primary lung cancer and 35% of patients with pulmonary metastases were without systemic progression. No severe acute or late toxicity was observed, and only 2 patients (3%) developed symptomatic Grade 2 pneumonitis, which was successfully treated with oral steroids. Conclusion Stereotactic Radiotherapy for lung tumors offers a very effective treatment option locally without significant complications in medically impaired patients who are not amenable to surgery. Patient selection is important, because those with a low risk of systemic progression are more likely to benefit from this approach.
Frank J Lagerwaard - One of the best experts on this subject based on the ideXlab platform.
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stage i nonsmall cell lung cancer in patients aged 75 years outcomes after Stereotactic Radiotherapy
Cancer, 2010Co-Authors: Cornelis J A Haasbeek, Frank J Lagerwaard, Ben J Slotman, Marilisa E Antonisse, Suresh SenanAbstract:BACKGROUND: The number of patients aged ≥75 years who present with a stage I nonsmall cell lung cancer (NSCLC) is increasing. Elderly patients often have significant comorbidity and may be unfit for surgery. Furthermore, surgery in the elderly is associated with increased mortality and morbidity. In this study, the authors evaluated the outcomes of Stereotactic Radiotherapy (SRT) in elderly patients. METHODS: Since 2003, 203 tumors in 193 patients aged ≥75 years were treated using SRT (118 T1 tumors, 85 T2 tumors). The median patient age was 79 years, 80% of patients were considered medically inoperable, and 20% of patients declined surgery. The median Charlson comorbidity score was 4, and severe chronic obstructive pulmonary disease (Global Initiative for Chronic Obstructive Lung Disease Class III or greater) was present in 25% of patients. Risk-adapted SRT schemes were used with the same total dose of 60 grays in 3 fractions (33%), 5 fractions (50%), or 8 fractions (17% of patients), depending on the patient's risk for toxicity. RESULTS: SRT was well tolerated, and all but 1 patient completed treatment. Survival rates at 1 year and 3 years were 86% and 45%, respectively. Survival was correlated with performance score (P = .001) and pre-SRT lung function (P = .04). The actuarial local control rate at 3 years was 89%. Acute toxicity was uncommon, and late Radiation Therapy Oncology Group grade ≥3 toxicity was observed in <10% of patients. CONCLUSIONS: SRT achieved high local control rates with minimal toxicity in patients aged ≥75 years despite their significant medical comorbidities. These results indicated that more active diagnostic and therapeutic approaches are justified in elderly patients and that SRT should be considered and discussed as a curative treatment alternative. Cancer 2010. © 2010 American Cancer Society.
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recommendations for implementing Stereotactic Radiotherapy in peripheral stage ia non small cell lung cancer report from the quality assurance working party of the randomised phase iii rosel study
Radiation Oncology, 2009Co-Authors: Coen W Hurkmans, Frank J Lagerwaard, Johan P Cuijpers, Joachim Widder, Uulke A Van Der Heide, D Schuring, Suresh SenanAbstract:A phase III multi-centre randomised trial (ROSEL) has been initiated to establish the role of Stereotactic Radiotherapy in patients with operable stage IA lung cancer. Due to rapid changes in Radiotherapy technology and evolving techniques for image-guided delivery, guidelines had to be developed in order to ensure uniformity in implementation of Stereotactic Radiotherapy in this multi-centre study. A Quality Assurance Working Party was formed by radiation oncologists and clinical physicists from both academic as well as non-academic hospitals that had already implemented Stereotactic Radiotherapy for lung cancer. A literature survey was conducted and consensus meetings were held in which both the knowledge from the literature and clinical experience were pooled. In addition, a planning study was performed in 26 stage I patients, of which 22 were stage 1A, in order to develop and evaluate the planning guidelines. Plans were optimised according to parameters adopted from RTOG trials using both an algorithm with a simple homogeneity correction (Type A) and a more advanced algorithm (Type B). Dose conformity requirements were then formulated based on these results. Based on current literature and expert experience, guidelines were formulated for this phase III study of Stereotactic Radiotherapy versus surgery. These guidelines can serve to facilitate the design of future multi-centre clinical trials of Stereotactic Radiotherapy in other patient groups and aid a more uniform implementation of this technique outside clinical trials.
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recommendations for implementing Stereotactic Radiotherapy in peripheral stage ia non small cell lung cancer report from the quality assurance working party of the randomised phase iii rosel study
Radiation Oncology, 2009Co-Authors: Coen W Hurkmans, Frank J Lagerwaard, Johan P Cuijpers, Joachim Widder, Uulke A Van Der Heide, D Schuring, Suresh SenanAbstract:Background A phase III multi-centre randomised trial (ROSEL) has been initiated to establish the role of Stereotactic Radiotherapy in patients with operable stage IA lung cancer. Due to rapid changes in Radiotherapy technology and evolving techniques for image-guided delivery, guidelines had to be developed in order to ensure uniformity in implementation of Stereotactic Radiotherapy in this multi-centre study.
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outcomes of risk adapted fractionated Stereotactic Radiotherapy for stage i non small cell lung cancer
International Journal of Radiation Oncology Biology Physics, 2008Co-Authors: Frank J Lagerwaard, Cornelis J A Haasbeek, Ben J Slotman, Egbert F Smit, Suresh SenanAbstract:Purpose High local control rates can be achieved using Stereotactic Radiotherapy in Stage I non–small-cell lung cancer (NSCLC), but reports have suggested that toxicity may be of concern. We evaluated early clinical outcomes of "risk-adapted" fractionation schemes in patients treated in a single institution. Methods and Materials Of 206 patients with Stage I NSCLC, 81% were unfit to undergo surgery and the rest refused surgery. Pathologic confirmation of malignancy was obtained in 31% of patients. All other patients had new or growing 18F-fluorodeoxyglucose positron emission tomography positive lesions with radiologic characteristics of malignancy. Planning four-dimensional computed tomography scans were performed and fractionation schemes used (3 × 20 Gy, 5 × 12 Gy, and 8 × 7.5 Gy) were determined by T stage and risk of normal tissue toxicity. Results Median overall survival was 34 months, with 1- and 2-year survivals of 81% and 64%, respectively. Disease-free survival (DFS) at 1 and 2 years was 83% and 68%, respectively, and DFS correlated with T stage ( p = 0.002). Local failure was observed in 7 patients (3%). The crude regional failure rate was 9%; isolated regional recurrence was observed in 4%. The distant progression-free survival at 1 and 2 years was 85% and 77%, respectively. SRT was well tolerated and severe late toxicity was observed in less than 3% of patients. Conclusions SRT is well tolerated in patients with extensive comorbidity with high local control rates and minimal toxicity. Early outcomes are not inferior to those reported for conventional Radiotherapy. In view of patient convenience, such risk-adapted SRT schedules should be considered treatment of choice in patients presenting with medically inoperable Stage I NSCLC.
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is adaptive treatment planning required for Stereotactic Radiotherapy of stage i non small cell lung cancer
International Journal of Radiation Oncology Biology Physics, 2007Co-Authors: Cornelis J A Haasbeek, Frank J Lagerwaard, Johan P Cuijpers, Ben J Slotman, Suresh SenanAbstract:Purpose: Changes in position or size of target volumes have been observed during Radiotherapy for lung cancer. The need for adaptive treatment planning during Stereotactic Radiotherapy of Stage I tumors was retrospectively analyzed using repeat four-dimensional computed tomography (4DCT) scans. Methods and Materials: A planning study was performed for 60 tumors in 59 patients using 4DCT scans repeated after two or more treatment fractions. Planning target volumes (PTV) encompassed all tumor mobility, and dose distributions from the initial plan were projected onto PTVs derived from the repeat 4DCT. A dosimetric and volumetric analysis was performed. Results: The repeat 4DCT scans were performed at a mean of 6.6 days (range, 2-12 days) after the first fraction of Stereotactic Radiotherapy. In 25% of cases the repeat PTV was larger, but the difference exceeded 1 mL in 5 patients only. The mean 3D displacement between the center of mass of both PTVs was 2.0 mm. The initial 80% prescription isodose ensured a mean coverage of 98% of repeat PTVs, and this isodose fully encompassed the repeat internal target volumes in all but 1 tumor. "Inadequate" coverage in the latter was caused by a new area of atelectasis adjacent to the tumor on the repeat 4DCT. Conclusions: Limited "time trends" were observed in PTVs generated by repeated uncoached 4DCT scans, and the dosimetric consequences proved to be minimal. Treatment based only on the initial PTV would not have resulted in major tumor underdosage, indicating that adaptive treatment planning is of limited value for fractionated Stereotactic Radiotherapy.
Johan P Cuijpers - One of the best experts on this subject based on the ideXlab platform.
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recommendations for implementing Stereotactic Radiotherapy in peripheral stage ia non small cell lung cancer report from the quality assurance working party of the randomised phase iii rosel study
Radiation Oncology, 2009Co-Authors: Coen W Hurkmans, Frank J Lagerwaard, Johan P Cuijpers, Joachim Widder, Uulke A Van Der Heide, D Schuring, Suresh SenanAbstract:Background A phase III multi-centre randomised trial (ROSEL) has been initiated to establish the role of Stereotactic Radiotherapy in patients with operable stage IA lung cancer. Due to rapid changes in Radiotherapy technology and evolving techniques for image-guided delivery, guidelines had to be developed in order to ensure uniformity in implementation of Stereotactic Radiotherapy in this multi-centre study.
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recommendations for implementing Stereotactic Radiotherapy in peripheral stage ia non small cell lung cancer report from the quality assurance working party of the randomised phase iii rosel study
Radiation Oncology, 2009Co-Authors: Coen W Hurkmans, Frank J Lagerwaard, Johan P Cuijpers, Joachim Widder, Uulke A Van Der Heide, D Schuring, Suresh SenanAbstract:A phase III multi-centre randomised trial (ROSEL) has been initiated to establish the role of Stereotactic Radiotherapy in patients with operable stage IA lung cancer. Due to rapid changes in Radiotherapy technology and evolving techniques for image-guided delivery, guidelines had to be developed in order to ensure uniformity in implementation of Stereotactic Radiotherapy in this multi-centre study. A Quality Assurance Working Party was formed by radiation oncologists and clinical physicists from both academic as well as non-academic hospitals that had already implemented Stereotactic Radiotherapy for lung cancer. A literature survey was conducted and consensus meetings were held in which both the knowledge from the literature and clinical experience were pooled. In addition, a planning study was performed in 26 stage I patients, of which 22 were stage 1A, in order to develop and evaluate the planning guidelines. Plans were optimised according to parameters adopted from RTOG trials using both an algorithm with a simple homogeneity correction (Type A) and a more advanced algorithm (Type B). Dose conformity requirements were then formulated based on these results. Based on current literature and expert experience, guidelines were formulated for this phase III study of Stereotactic Radiotherapy versus surgery. These guidelines can serve to facilitate the design of future multi-centre clinical trials of Stereotactic Radiotherapy in other patient groups and aid a more uniform implementation of this technique outside clinical trials.
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is adaptive treatment planning required for Stereotactic Radiotherapy of stage i non small cell lung cancer
International Journal of Radiation Oncology Biology Physics, 2007Co-Authors: Cornelis J A Haasbeek, Frank J Lagerwaard, Johan P Cuijpers, Ben J Slotman, Suresh SenanAbstract:Purpose: Changes in position or size of target volumes have been observed during Radiotherapy for lung cancer. The need for adaptive treatment planning during Stereotactic Radiotherapy of Stage I tumors was retrospectively analyzed using repeat four-dimensional computed tomography (4DCT) scans. Methods and Materials: A planning study was performed for 60 tumors in 59 patients using 4DCT scans repeated after two or more treatment fractions. Planning target volumes (PTV) encompassed all tumor mobility, and dose distributions from the initial plan were projected onto PTVs derived from the repeat 4DCT. A dosimetric and volumetric analysis was performed. Results: The repeat 4DCT scans were performed at a mean of 6.6 days (range, 2-12 days) after the first fraction of Stereotactic Radiotherapy. In 25% of cases the repeat PTV was larger, but the difference exceeded 1 mL in 5 patients only. The mean 3D displacement between the center of mass of both PTVs was 2.0 mm. The initial 80% prescription isodose ensured a mean coverage of 98% of repeat PTVs, and this isodose fully encompassed the repeat internal target volumes in all but 1 tumor. "Inadequate" coverage in the latter was caused by a new area of atelectasis adjacent to the tumor on the repeat 4DCT. Conclusions: Limited "time trends" were observed in PTVs generated by repeated uncoached 4DCT scans, and the dosimetric consequences proved to be minimal. Treatment based only on the initial PTV would not have resulted in major tumor underdosage, indicating that adaptive treatment planning is of limited value for fractionated Stereotactic Radiotherapy.
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time trends in target volumes for stage i non small cell lung cancer after Stereotactic Radiotherapy
International Journal of Radiation Oncology Biology Physics, 2006Co-Authors: Rene W M Underberg, Frank J Lagerwaard, Johan P Cuijpers, Ben J Slotman, Harm Van Tinteren, Suresh SenanAbstract:Purpose: To identify potential time trends in target volumes and tumor mobility after Stereotactic Radiotherapy (SRT) for Stage I non–small-cell lung cancer. Patients and Methods: Repeat planning computed tomography (CT) scans were performed for 40 tumors during fractionated SRT delivered in either three ( n = 21), five ( n = 14), or eight fractions ( n = 5). The planning CT scans used to define internal target volumes (ITVs) consisted of either six multislice CT scans or a single four-dimensional CT scan. All repeat CT scans were coregistered with the initial (D 0 ) scan to determine volumetric or spatial changes in target volume, and tumor mobility vectors were determined from each scan. Results: A significant decrease in target volumes (ITVs and gross tumor volumes) relative to baseline values was observed starting at the fourth week of SRT ( p = 0.015). No trends in tumor mobility were detected during SRT. Significant positional shifts in the ITV, of more than 5 mm, were seen in 26–43% of patients at different times during SRT. Conclusion: Significant changes in target volumes can occur during SRT for Stage I non–small-cell lung cancer. A failure to account for such changes e.g., by repeat CT planning or verification using on-board volumetric imaging can lead to inadequate target coverage.
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four dimensional ct scans for treatment planning in Stereotactic Radiotherapy for stage i lung cancer
International Journal of Radiation Oncology Biology Physics, 2004Co-Authors: Rene W M Underberg, Frank J Lagerwaard, Johan P Cuijpers, Ben J Slotman, John R Van Sornsen De Koste, Suresh SenanAbstract:Purpose Hypofractionated Stereotactic Radiotherapy (SRT) for Stage I non–small-cell lung cancer requires that meticulous attention be paid toward ensuring optimal target definition. Two computed tomography (CT) scan techniques for defining internal target volumes (ITV) were evaluated. Methods and materials Ten consecutive patients treated with SRT underwent six "standard" rapid multislice CT scans to generate an ITV 6 CT and one four-dimensional CT (4DCT) scan that generated volumetric datasets for 10 phases of the respiratory cycle, all of which were used to generate an ITV 4DCT . Geometric and dosimetric analyses were performed for (1) PTV 4DCT , derived from the ITV 4DCT with the addition of a 3-mm margin; (2) PTV 6 CT , derived from the ITV 6 CT with the addition of a 3-mm margin; and (3) 6 PTV 10 mm , derived from each separate GTV 6 CT , to which a three-dimensional margin of 10 mm was added. Results The ITV 4DCT was not significantly different from the ITV 6 CT in 8 patients, but was considerably larger in 2 patients whose tumors exhibited the greatest mobility. On average, the ITV 6 CT missed on average 22% of the volume encompassing both ITVs, in contrast to a corresponding mean value of only 8.3% for ITV 4DCT . Plans based on PTV 4DCT resulted in coverage of the PTV 6 CT by the 80% isodose in all patients. However, plans based on use of PTV 6 CT led to a mean PTV 4DCT coverage of only 92.5%, with a minimum of 77.7% and 77.5% for the two most mobile tumors. PTVs derived from a single multislice CT expanded with a margin of 10 mm were on average twice the size of PTVs derived using the other methods, but still led to an underdosing in the two most mobile tumors. Conclusions Individualized ITVs can improve target definition for SRT of Stage I non–small-cell lung cancer, and use of only a single CT scan with a 10-mm margin is inappropriate. A single 4D scan generates comparable or larger ITVs than are generated using six unmonitored rapid CT scans, a finding related to the ability to account for all respiration-correlated mobility.
