Simultaneous Integrated Protection : A new Concept for High-precision Radiation Therapy

Overview

Journal Strahlenther Onkol

Specialties Oncology
Radiology

Date 2016 Oct 21

PMID 27757502

Citations 31

Authors

Thomas B Brunner

Ursula Nestle

Sonja Adebahr

Eleni Gkika

Rolf Wiehle

Dimos Baltas

Anca-Ligia Grosu

Affiliations

Soon will be listed here.

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). The remainder of the PTV represented the dominant PTV (PTV). Planning was performed using IMRT. Dose was prescribed to PTV 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 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 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.

Citing Articles

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Salas-Salas B, Ferrera-Alayon L, Espinosa-Lopez A, Perez-Rodriguez M, Afonso A, Vera-Rosas A Cancers (Basel). 2025; 17(2).

PMID: 39857973 PMC: 11763360. DOI: 10.3390/cancers17020191.

The role of ALBI score in patients treated with stereotactic body radiotherapy for locally advanced primary liver tumors: a pooled analysis of two prospective studies.

Gkika E, Radicioni G, Eichhorst A, Kirste S, Sprave T, Nicolay N Front Oncol. 2024; 14:1427332.

PMID: 39421444 PMC: 11484445. DOI: 10.3389/fonc.2024.1427332.

Dose prescription for stereotactic body radiotherapy: general and organ-specific consensus statement from the DEGRO/DGMP Working Group Stereotactic Radiotherapy and Radiosurgery.

Brunner T, Boda-Heggemann J, Burgy D, Corradini S, Dieckmann U, Gawish A Strahlenther Onkol. 2024; 200(9):737-750.

PMID: 38997440 PMC: 11343978. DOI: 10.1007/s00066-024-02254-2.

Dose-escalated SBRT for borderline and locally advanced pancreatic cancer. Feasibility, safety and preliminary clinical results of a multicenter study.

Salas B, Ferrera-Alayon L, Espinosa-Lopez A, Vera-Rosas A, Salcedo E, Kannemann A Clin Transl Radiat Oncol. 2024; 45:100753.

PMID: 38433951 PMC: 10907515. DOI: 10.1016/j.ctro.2024.100753.

Consolidatory ablative stereotactic body radiation therapy after induction chemotherapy for unresectable pancreatic cancer: A single center experience.

Lee H, Kang H, Chie E Front Oncol. 2022; 12:974454.

PMID: 36505838 PMC: 9733675. DOI: 10.3389/fonc.2022.974454.

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