#sbrt for liver metastasis

[drvineetagoeloncologist]

Dr. Vineeta Goel is best known for providing solitary brain metastases treatment in north delhi an delhi ncr; you can get in touch with her for solitary brain metastases treatment in east delhi, solitary brain metastases treatment in west delhi.

[irispublisherscancerresearch]

Emerging Role of Stereotactic Body Radiotherapy

Stereotactic Body Radiation Therapy (SBRT) also known as stereotactic ablative Radiotherapy (SABR) is a newer modality of delivering radiation therapy for many primary and secondary tumors, with good results. Multiple beams are focused to deliver high dose to single target so that tumour receive very high dose and normal tissue receive very limited dose. The aim is to deliver a high dose of radiation to a small tumour to achieve radio ablation. Patient is first immobilized and then a planning CT scan is taken. This scan is corelated with diagnostic CT, MRI and PET- CT to get the exact location and extension of tumour. Planning is then done with multiple beams focusing on tumour and with high dose per fraction aim is to achieve complete ablation. Treatment is delievered by Linacs, Cyberknife, Tomotherapy etc. Liver and lung metastases from colorectal, breast and Other cancer are most common. Studies focusing on SBRT for metastases from a single primary tumor type colorectal cancer have been published. Regardless of age, patients should have good performance status (Eastern Cooperative Oncology Group 0-1 or Karnofsky >70), with absent or stable extra hepatic disease and adequate hepatic volume and function. Number of metastasis should be less than three and size less than 6 cm. Prescribed dose is generally very high in range of 30 to 60 Gy in three fractions. The toxicity profile is generally low with a G3 toxicity rate of 1-10% and the incidence of Radiation Induced Liver disease less than 1%.

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[padansk]

A new hospital today in windy and wet Oxford. In advance of Nicola having #sbrt to treat the liver metastasis, we are at the Genesis medical centre in Oxford for a series of preparation scans. It’s been an exhausting few weeks deliberating on what the best treatment option would be for this latest hurdle, but I’m glad the process is now under way and things are moving forwards. She is a #warrior. #fuckcancer (at Oxford, Oxfordshire) https://www.instagram.com/p/CETwMJoFI52/?igshid=471rhecp4bcs

[juniperpublishers-oajnn-blog]

Use of Intraoperative Radiation Therapy in Skull Base Oncology Open Access Journal of Neurology & Neurosurgery-Juniper Publishers

Authored by  Akheel Mohammad 

Opinion

Management of advanced and recurrent head and neck cancers constitutes multimodality treatment therapy; surgery, chemotherapy and radiation. Loco-regional relapse comprises a major hurdle for disease free survival patient, the role of intraoperative radiation therapy (IORT) has added in improving overall survival (OS) and local control of the disease. IORT allows delivery of a single tumoricidal dose of radiation to areas of potential residual microscopic disease while minimizing doses to normal tissues. Head and neck cancers (HNC) constitute 8th leading cause of cancer deaths globally. In developing countries its incidence is high due to tobacco use (smoke and smokeless form) and drinking habits in combination with poor socioeconomic status. HNC's encompasses diverse tumor types but around 90% of these tumors are squamous cell carcinomas (SCC) with further diversification in respect to etilogical factors, pathogenesis, and clinical behaviour. The overall impact of management of HNC's on functional activities like swallowing, speech and cosmesis affects the patient both psychological and socially. Inspite of several recent advances in surgery, chemotherapy and radiation therapy, the overall 5- year survival rate is still not improved and mainly influenced by disease staging, tumor margins, nodal diseases, extracapsular spread, perineural/ lymphovascular invasion and invasion of vital structures. Failure or recurrence rate for T4 lesions may vary between 19% to 35%. They may be either primary tumor site failure or distant site metastasis such as lungs, liver, bone and spine.

The recommended management of locally advanced tumors of head and neck are surgery and chemo radiation with/ without targeted therapy. Recurrences after irradiation may be addressed by salvage surgery if resection is possible, plus additional chemo radiation. There can be severe complications for surgery after radiation to the tissues. Recently, new radiation techniques such as intensity modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT) have improved oncological results with reduced toxicities but specific indications have not been defined yet. Reirradiation still poses a major challenge for the radiation oncologist.

In this cases either advanced lesions extending to infratemporal fossa, pterygoids and skull base where 1cm-1.5cm oncologic free margins cannot be obtained, Intraoperative radiation therapy (IORT) is an very good alternative to be considered. It not only achieves local control of advanced tumors or residual disease, but also as an adjuvant therapy in salvage surgery. IORT was pioneered by the Japanese in 1960's for treatment of gastrointestinal tumors and introduced in the United States and Europe in the 1970s, initially for abdominal and gynaecologic malignancies. IORT can be used as a boost to external beam radiation (EBRT) or as the sole irradiation modality in a previously irradiated field. IORT allows rapid delivery of large single doses of radiation to a visible tumor bed margins with exclusion/ shielding of critical anatomic structures from the treatment field. IORT is generally delivered from a linear accelerator using mainly an electron beam field or in some cases a photon beam field. The field is well visualized, which allows for relatively easy placement of the electron beam or the photon beam cone on the tumor bed. This allows a steep dose fall off while sparing normal anatomic tissues. Occasionally, IORT is combined with external radiation therapy (EBRT) to provide the best combination of local and loco regional treatment. With this IORT radiation energy to the surrounding structures including neurovascular and bony structures, except for the suture line, anastomosis is also kept in minimum levels.

Advantages of IORT are the decreased possibility of geographical and anatomical miss when radiation is delivered during the surgery. . There is also increased biological efficacy per unit dose because of the administration of radiation as a single fraction with no time elapsing between multiple fractions and no time elapsing between surgical excision and RT. IORT decreases the overall treatment time by reducing tumor cell repopulation during overall treatment. It also allows to increase the dose because it is estimated that the single high dose given by IORT is biologically equivalent to 3- to 4-fold that of conventional EBRT. IORT toxicity does not overlap with that of EBRT and when properly combined with EBRT, it can be used for increasing the dose while potentially decreasing toxicity.

Delivered IORT dose ranged from 7.5 to 30Gy, and median was 20Gy. However, in most contemporary studies done so far, a trend to lower the delivered doses trying to reduce toxicity and complications was noticed. Reported local control rates with the addition of IORT modality appear as high as 90% in a 2-year follow-up in selected cases where no residual disease is noticed after surgical excision. The combination of EBRT postoperatively seems to further improve local control. Furthermore, the length of hospital stay is not appreciably prolonged when IORT is used as a treatment adjunct to surgery. A benefit of the 2-year DFS has been reported as well. However, long-term survival rates do not seem to conform in all series. Some studies shows patients with advanced disease with carotid involvement, have the most dismal median OS of 1 year accompanied by high complication rates of 50%. This group of patients is at high risk for posttreatment cerebrovascular events and neurologic sequelae. These patients receive greatest benefit of IORT with some short term pain relief despite high rates of loco-regional failure. A good palliative effect has been obtained in these patients treated for extensive recurrence in previously irradiated fields. IORT is generally well tolerated without significantly increasing the rate of complications and in addition for symptomatic patients who have undergone a near total/subtotal resection, IORT as a boost seems to be a reasonable palliative approach if it is available. Hence IORT can be one of a good multimodality treatment for management of advanced/unrespectable tumors.

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Open Access Journal of Neurology & Neurosurgery in Full text in Juniper Publishers

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[lybrate00-blog]

Gastrointestinal Malignancies  - How Radiosurgery Can Help?

Basic gastro-intestinal (GI) malignancies are colon tumor, carcinoma rectum and butt-centric waterway, pancreatic disease, cholangiocarcinoma, carcinoma stomach, hepatocellular carcinoma (HCC) and liver metastasis. Other unprecedented tumors incorporate gastrointestinal stromal tumor (GIST), klatskin tumor and neuroendocrine tumor. Medical procedure is the treatment choice in these tumors. Tragically, dominant part of these tumors are inoperable at introduction and treated with steady/palliative purpose. Larger part of these tumors are generally chemotherapy (CT) safe. Part of ordinary radiation treatment (RT) in gastrointestinal malignancies are additionally not very much characterized in a considerable lot of these tumors.

Reaction rate with conveyed dosage isn't adequate, and measurement heightening isn't conceivable with ordinary RT without bargaining in basic structure (small digestive system, duodenum) resilience. With present day stereotactic entire body RT (SBRT) higher measurement of radiation can be conveyed in shorter length and ordinary tissue resilience is regarded. SBRT has developed as of late and furthermore have guarantee to enhance nearby control in these relative safe tumors. Pre-agent and adjuvant RT is set up in carcinoma of rectum.

As of late, short course RT (hypofractionated RT, 25 Gy/5 Fr) had appeared to be similarly powerful as ordinary RT (1.8-2 Gy/Fr) in inoperable rectal growth. Part of ordinary RT in inoperable pancreatic tumor has been contended in the EORTC examine. While, short course RT (fractionated radiosurgery) is gradually being acknowledged as a choice to finish RT early, begin adjuvant CT at the most punctual and furthermore enhance personal satisfaction (QOL). In liver metastasis, radiosurgery is a non-obtrusive contrasting option to medical procedure. Higher equal radiation measurement conveyed with radiosurgery there may have similar survival work in chosen patients.

Radiosurgery is an alternative in liver tumor near porta, sub-diaphragmatic area (fragment VIII), nodal inclusion and in therapeutically inoperable patients. In hepatocellular carcinoma (HCC), fractionated radiosurgery is an alternative as 'connect treatment' for patients sitting tight for liver transplant, therapeutically inoperable patients, chemotherapy safe, post TACE remaining and in repetitive HCCs. Radiosurgery is additionally consider as essential treatment in reasonable patients. There is a progressing multicentric randomized preliminary looking at chemotherapy and radiosurgery in HCCs.

Words By: Dr. Debnarayan Dutta

MD, MBBS

Oncologist, Ernakulam. He  is one of the most acclaimed Oncologists in India who holds an experience of curing his patients for 18 years. Besides being a reputed Cancer Specialist, Dr. Dutta is also a Radiation Oncologist and Surgical Oncologist. He completed his MBBS (University of Calcutta) in 1999 and MD (University of Calcutta) in 2006. Dr. Dutta has been rewarded with? ASCO Merit Award? for Neuro-oncology. Also he is one of the best Oncologists in Teynampet Chennai. He is a professional member of AROI, IS NO and NSI. He is known for rendering valuable services like Chemotherapy treatment, treatment of Prostate Cancer, treatment of Brain Tumours, treatment of Lung Cancer, Gamma-Knife Radiosurgery and Cyberknife Cancer treatment. He is devoted to giving the best of treatments and is well acquainted with the newest advancements in medical science. He resorts to the latest health technologies to treat his patients with care.

In remarkable moderate developing tumors, for example, cholangiocarcinoma, neuroendocrine tumor and klatskin tumor fractionated radiosurgery have magnificent reaction rate and enhance side effects. Taking everything into account, current fractionated stereotactic radiosurgery is an alternative in a significant number of the GI malignancies enhances reaction rate and furthermore may enhance QOL. In coming a very long time with production of more developed information from randomized and imminent stage II thinks about the part of radiosurgery will be built up. our own , 2) require just thermoplastic veil, no requirement for obtrusive casing, 3) has reverse arranging framework, can save basic structure, 4) there is an 'intra-part' amendment innovation with imaging, 5) there is no compelling reason to change the source, henceforth might be more practical and 6) can be utilized to treat additional cranial tumors moreover. CyberKnife has a direct quickening agent connected with a robot and is equipped for treatment from different coplanar and non-coplanar field plans. CyberKnife has sub-millimeter precision and unmatched measurements dissemination.

The trend setting innovation behind CyberKnife utilizes picture direction innovation and PC controlled apply autonomy to convey and to a great degree exact measurement of radiation to targets, maintaining a strategic distance from the encompassing solid tissue, and modifying for patient and tumor development amid treatment. Taking everything into account, CyberKnife is an expansion of gamma knife radiosurgery conveyance framework. This machine has colossal guarantee to treat with short course regimens with high measurement and enhance neighborhood control without expanding toxicities.

[cancersfakianakis1]

Stereotactic Body Radiotherapy (SBRT) for liver metastasis – clinical outcomes from the international multi-institutional RSSearch® Patient Registry

Abstract

Background

Stereotactic body radiotherapy (SBRT) is an emerging treatment option for liver metastases in patients unsuitable for surgery. We investigated factors associated with clinical outcomes for liver metastases treated with SBRT from a multi-center, international patient registry.

Methods

Patients with liver metastases treated with SBRT were identified in the RSSearch® Patient Registry. Patient, tumor and treatment characteristics associated with treatment outcomes were assessed. Dose fractionations were normalized to BED10. Overall survival (OS) and local control (LC) were evaluated using Kaplan Meier analysis and log-rank test.

Results

The study included 427 patients with 568 liver metastases from 25 academic and community-based centers. Median age was 67 years (31–91 years). Colorectal adenocarcinoma (CRC) was the most common primary cancer. 73% of patients received prior chemotherapy. Median tumor volume was 40 cm3 (1.6–877 cm3), median SBRT dose was 45 Gy (12–60 Gy) delivered in a median of 3 fractions [1–5]. At a median follow-up of 14 months (1–91 months) the median overall survival (OS) was 22 months. Median OS was greater for patients with CRC (27 mo), breast (21 mo) and gynecological (25 mo) metastases compared to lung (10 mo), other gastro-intestinal (GI) (18 mo) and pancreatic (6 mo) primaries (p < 0.0001). Smaller tumor volumes (< 40 cm3) correlated with improved OS (25 months vs 15 months p = 0.0014). BED10 ≥ 100 Gy was also associated with improved OS (27 months vs 15 months p < 0.0001). Local control (LC) was evaluable in 430 liver metastases from 324 patients. Two-year LC rates was better for BED10 ≥ 100 Gy (77.2% vs 59.6%) and the median LC was better for tumors < 40 cm3 (52 vs 39 months). There was no difference in LC based on histology of the primary tumor.

Conclusions

In a large, multi-institutional series of patients with liver metastasis treated with SBRT, reasonable LC and OS was observed. OS and LC depended on dose and tumor volume, while OS varied by primary tumor. Future prospective trials on the role of SBRT for liver metastasis from different primaries in the setting of multidisciplinary management including systemic therapy, is warranted.

Trial registration

Clinicaltrials.gov: NCT01885299.

http://ift.tt/2CFyyPv

[drvineetagoeloncologist]

Get Solitary Brain Metastases Treatment in Delhi for Liver

Dr. Vineeta Goel is best known for providing solitary brain metastases treatment in north delhi an delhi ncr; you can get in touch with her for solitary brain metastases treatment in east delhi, solitary brain metastases treatment in west delhi.

[drvineetagoeloncologist]

Dr. Vineeta Goel is best known for providing solitary brain metastases treatment in north delhi an delhi ncr; you can get in touch with her for solitary brain metastases treatment in east delhi, solitary brain metastases treatment in west delhi.

[drvineetagoeloncologist]

Dr. Vineeta Goel is best known for providing solitary brain metastases treatment in north delhi an delhi ncr; you can get in touch with her for solitary brain metastases treatment in east delhi, solitary brain metastases treatment in west delhi.

[drvineetagoeloncologist]

Dr. Vineeta Goel is best known for providing solitary brain metastases treatment in north delhi an delhi ncr; you can get in touch with her for solitary brain metastases treatment in east delhi, solitary brain metastases treatment in west delhi.

[cancersfakianakis1]

Stereotactic Body Radiotherapy (SBRT) for liver metastasis – clinical outcomes from the international multi-institutional RSSearch® Patient Registry

Stereotactic body radiotherapy (SBRT) is an emerging treatment option for liver metastases in patients unsuitable for surgery. We investigated factors associated with clinical outcomes for liver metastases tre... http://ift.tt/2Et3d8c

[cancersfakianakis1]

Modelling the immunosuppressive effect of liver SBRT by simulating the dose to circulating lymphocytes: an in-silico planning study

Abstract

Background

Tumor immune-evasion and associated failure of immunotherapy can potentially be overcome by radiotherapy, which however also has detrimental effects on tumor-infiltrating and circulating lymphocytes (CL). We therefore established a model to simulate the radiation-dose delivered to CL.

Methods

A MATLAB-model was established to quantify the CL-dose during SBRT of liver metastases by considering the factors: hepatic blood-flow, −velocity and transition-time of individual hepatic segments, as well as probability-based recirculation. The effects of intra-hepatic tumor-location and size, fractionation and treatment planning parameters (VMAT, 3DCRT, photon-energy, dose-rate and beam-on-time) were analyzed. A threshold dose ≥0.5Gy was considered inactivating CL and CL0.5 (%) is the proportion of inactivated CL.

Results

Mean liver dose was mostly influenced by treatment-modality, whereas CL0.5 was mostly influenced by beam-on-time. 3DCRT and VMAT (10MV-FFF) resulted in lowest CL0.5 values of 16 and 19%. Metastasis location influenced CL0.5, with a mean of 19% for both apical and basal and 31% for the central location. PTV-volume significantly increased CL0.5 from 27 to 67% (10MV-FFF) and from 31 to 98% (6MV-FFF) for PTV-volumes ranging from 14cm3 to 268cm3.

Conclusion

A simulation-model was established, quantifying the strong effects of treatment-technique, tumor-location and tumor-volume on dose to CL with potential implications for immune-optimized treatment-planning in the future.

http://ift.tt/2mZEgG8

[cancersfakianakis1]

Title: Local control outcomes using stereotactic body radiation therapy for liver metastases from colorectal cancer

Publication date: Available online 31 July 2017 Source:International Journal of Radiation Oncology*Biology*Physics Author(s): Ji Hyeon Joo, Jin-hong Park, Jin Cheon Kim, Chang Sik Yu, Seok-Byung Lim, In Ja Park., Tae Won Kim, Yong Sang Hong, Kyu-pyo Kim, Sang Min Yoon, Jongmoo Park, Jong Hoon Kim PurposeTo evaluate the effective dose and patterns of recurrence after stereotactic body radiation therapy (SBRT) for hepatic metastases that arise from colorectal cancer.Methods and MaterialsA cohort of 70 patients with 103 colorectal liver metastases were treated with SBRT at a single institution. The prescribed doses were 45 – 60 Gy in 3–4 fractions, but these were modified based on the tolerance of the adjacent normal tissue. To allow for dose comparisons, a biological equivalent dose (BED) was calculated.ResultsThe median follow-up period was 34.2 months (range, 5.3–121.8). The 2-year overall survival and progression-free survival rates were 75% and 35%, respectively. In subgroups, the 2-year local control rates for BED ≤80 Gy (Group 1), 100-112 Gy (Group 2), and ≥ 132 Gy (Group 3) were 52%, 83%, and 89%, respectively. Cox proportional hazards model revealed a significant difference between groups (HR=0.44, P=0.03 for Group 2; HR=0.17, P=0.17 for Group 3; P=0.01 for total). The major pattern of failure was a new liver metastasis out-of the SBRT field. There was no ≥G3 toxicity.ConclusionsSBRT of liver metastases derived from colorectal cancer offers a locally effective treatment without significant complications. Longer local control can be expected if higher doses are used. Further studies will be needed to compare the efficacies of SBRT with those of surgical resection or radiofrequency ablation.

Teaser

The optimal stereotactic body radiation therapy (SBRT) dose and fractionation schedule for hepatic metastases from colorectal cancer has not yet been determined. Thus, we evaluated the effective dose by reviewing treatment results of 103 lesions. When compared with biological equivalent dose (BED), longer local control was expected if higher doses were used, with optimal BED greater than 132 Gy. http://ift.tt/2uVfqe6

[cancersfakianakis1]

Dosimetric Analysis of Liver Toxicity Post Liver Metastasis Stereotactic Body Radiotherapy

Publication date: Available online 9 March 2017 Source:Practical Radiation Oncology Author(s): A. Barry, A. McPartlin, P. Lindsay, L. Wang, J Brierley, J Kim, J Ringash, R Wong, R Dinniwell, T. Craig, L.A. Dawson PurposeThe aim of this study is to describe the incidence and type of liver toxicity seen following liver metastases stereotactic body radiotherapy (SBRT) and the corresponding clinical and dosimetric factors associated with toxicity.Methods and MaterialsBetween 2002 and 2009, 81 evaluable patients with liver metastases were treated on two prospective studies assessing SBRT, with prescription doses based on the effective liver volume irradiated evaluated. Toxicity was defined as grade≥2 classic or non-classic radiation induced liver disease (RILD). Specific toxicity endpoints evaluated were worsening transaminases and albumin levels, within 3months of SBRT.ResultsSeventy percent of patients had colorectal carcinoma, 55% had extra-hepatic disease, 1 patient had Hepatitis B and 54% had received prior chemotherapy. Baseline transaminases were elevated at CTCAE V4.0 grade 1, 2 and 3 levels in 33 (41%), 2 (2%) and 0 (0%) of patients. The mean prescription dose was 43Gy (27.7 – 60Gy) in 6 fractions. The mean liver (minus GTV) dose (MLD) was 16Gy (3–25.6Gy) in 6 fractions. No classic or non-classical ≥ grade 2 RILD was observed. Within 3months of SBRT, 49 (61%) patients had worsening of grade of transaminase and 23 (28%) patients had a reduction in albumin, all transient (majority grade≤2 toxicity) without subsequent clinical toxicity. Seventeen patients exceeded QUANTEC MLD guidelines (≤20Gy), 13 (76%) of whom had worsening of transaminase grade. On multivariate analysis, worsening of liver enzymes was more likely in patients with higher doses to the spared 700cc of liver (p=0.026), and reduction of albumin was more likely with higher effective liver volume (OR 1.53 (1.08, 2.16)) p=0.016).ConclusionLiver metastases SBRT is safe with a low risk of transient biochemical liver toxicity, more likely in patients with a higher effective liver volume and higher doses to the spared uninvolved liver volume. http://ift.tt/2m6cSE0