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SHR Neuro Cancer Cardio Lipid Metab Microb

Brunner, TB; Nestle, U; Adebahr, S; Gkika, E; Wiehle, R; Baltas, D; Grosu, AL.
Simultaneous integrated protection : A new concept for high-precision radiation therapy.
Strahlenther Onkol. 2016; 192(12):886-894 Doi: 10.1007/s00066-016-1057-x (- Case Report) [OPEN ACCESS]
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Leading authors Med Uni Graz: Brunner Thomas Baptist
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Abstract:: OBJECTIVE: Stereotactic radiotherapy near serial organs at risk (OAR) requires special caution. A novel intensity-modulated radiotherapy (IMRT) prescription concept termed simultaneous integrated protection (SIP) for quantifiable and comparable dose prescription to targets very close to OAR is described. MATERIALS AND METHODS: An intersection volume of a planning risk volume (PRV) with the total planning target volume (PTV) defined the protection volume (PTV_SIP). The remainder of the PTV represented the dominant PTV (PTV_dom). Planning was performed using IMRT. Dose was prescribed to PTV_dom according to ICRU in 3, 5, 8, or 12 fractions. Constraints to OARs were expressed as absolute and as equieffective doses at 2 Gy (EQD2). Dose to the gross risk volume of an OAR was to respect constraints. Violation of constraints to OAR triggered a planning iteration at increased fractionation. Dose to PTV_SIP was required to be as high as possible within the constraints to avoid local relapse. RESULTS: SIP was applied in 6 patients with OAR being large airways (n = 2) or bowel (n = 4) in 3, 5, 8, and 12 fractions in 1, 3, 1, and 1 patients, respectively. PTVs were 14.5-84.9 ml and PTV_SIP 1.8-3.9 ml (2.9-13.4 % of PTV). Safety of the plans was analyzed from the absolute dose-volume histogram (dose to ml). The steepness of dose fall-off could be determined by comparing the dose constraints to the PRVs with those to the OARs (Wilcoxon test p = 0.001). Constraints were respected for the corresponding OARs. All patients had local control at a median 9 month follow-up and toxicity was low. CONCLUSION: SIP results in a median dose of ≥100 % to PTV, to achieve high local control and low toxicity. Longer follow-up is required to verify results and a prospective clinical trial is currently testing this new approach in chest and abdomen stereotactic body radiotherapy.
Find related publications in this database (using NLM MeSH Indexing): Dose-Response Relationship, Radiation - administration & dosage; Humans - administration & dosage; Neoplasms - complications, radiotherapy; Organ Sparing Treatments - administration & dosage; Organs at Risk - radiation effects; Radiation Dose Hypofractionation - administration & dosage; Radiation Injuries - etiology, prevention & control; Radiation Protection - methods; Radiosurgery - adverse effects, methods; Radiotherapy Planning, Computer-Assisted - methods; Reproducibility of Results - administration & dosage; Sensitivity and Specificity - administration & dosage; Treatment Outcome - administration & dosage
Find related publications in this database (Keywords): Stereotactic body radiation therapy; Intensity-modulated radiotherapy; Efficacy; Toxicity; Organs at risk