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A forward planned treatment planning technique for non-small-cell lung cancer stereotactic ablative body radiotherapy based on a systematic review of literature

Published online by Cambridge University Press:  26 August 2015

Anne C. Marchant  and
Sheela M. Macwan
Anne C. Marchant
Affiliation:
North Wales Cancer Treatment Centre, Department of Medical Physics, Bodelwyddan, UK Faculty of Health & Wellbeing, Sheffield Hallam University, Sheffield, UK
Sheela M. Macwan*
Affiliation:
Faculty of Health & Wellbeing, Sheffield Hallam University, Sheffield, UK
*
Correspondence to: Anne Marchant, North Wales Cancer Treatment Centre, Glan Clwyd Hospital, North Wales, LL18 5UJ, UK. Tel: 01745 7830 (7353). Email: Anne.Marchant@wales.nhs.uk
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Abstract

Purpose and Method

A systematic literature review of six computerised databases was undertaken in order to review and summarise a forward planned lung stereotactic ablative body radiotherapy (SABR) treatment planning (TP) technique as a starting point for clinical implementation in the author’s department based on current empirical research. The data were abstracted and content analysed to synthesise the findings based upon a SIGN quality checklist tool.

Findings

A four-dimensional computed tomography scan should be performed upon which the internal target volume and organs at risk (OAR) are drawn. A set-up margin of 5 mm is applied to account for inter-fraction motion. The field arrangement consists of a combination of 7–13 coplanar and non-coplanar beams all evenly spaced. Beam modifiers are used to assist in the homogeneity of the beam, although a 20% planning target volume dose homogeneity is acceptable. The recommended fractionations by the UK SABR Consortium are 54 Gy in 3 fractions (standard), 55–60 Gy in 5 fractions (conservative) and 50–60 Gy in 8–10 fractions (very conservative). Conformity indices for both the target volume and OAR will be used to assess the planned distribution.

Conclusion

An overview of a clinically acceptable forward planned lung SABR TP technique based on current literature as a starting point, with a view to inverse planning with support from the UK SABR Consortium mentoring scheme.

Keywords

SABRSBRTStereotactic ablative body radiotherapyStereotactic ablative body radiation therapyStereotactic radiotherapy

Information

Type
Literature Review
Information
Journal of Radiotherapy in Practice , Volume 14 , Issue 4 , December 2015 , pp. 425 - 437
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Copyright
© Cambridge University Press 2015 

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References

1.Timmerman, R D, McGarry, R, Yiannoutsos, Cet al. Excessive toxicity when treating central tumours in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer. J Clin Oncol 2006; 24 (30): 4833–4839.CrossRefGoogle Scholar
2.Martel, M K, Ten Haken, R K, Hazuka, M Bet al. Estimation of tumor controlled probability model parameters from 3D dose distributions of non-small cell lung cancer patients. Lung Cancer 1999; 24 (1): 31–37.CrossRefGoogle Scholar
3.Lagerwaard, F J, Senan, S, Meerbeck, J P, Graveland, W J. Has 3-D conformal radiotherapy (3D CRT) improved the local tumour control for stage 1 non-small cell lung cancer? Radiother Oncol 2002; 63 (2): 151–157.CrossRefGoogle Scholar
4.Cheung, P C F, Mackillop, W J, Dixon, Pet al. Involved field radiotherapy alone for early stage non-small cell lung cancer. Int J Radiat Oncol Biol Phys 2000; 48 (3): 703–710.CrossRefGoogle ScholarPubMed
5.Kupelian, P A, Komaki, R, Allen, M P H. Prognostic factors in the treatment of node negative non small cell lung carcinomas with radiotherapy alone. Int J Radiat Oncol Biol Phys 1996; 36 (3): 607–613.CrossRefGoogle ScholarPubMed
6.Rosenzweig, K, Gupta, V, Laser, Bet al. Comparison of conventionally fractionated external beam radiation therapy and stereotactic body radiotherapy for early-stage non-small cell lung cancer. Int J Radiat Oncol Biol Phys 2009; 75 (3): S160.CrossRefGoogle Scholar
7.Timmerman, R D, Paulus, R, Galvin, Jet al. Stereotactic body radiation therapy for medically inoperable early-stage lung cancer patients: analysis of RTOG 0236. Int J Radiat Oncol Biol Phys 2009; 75 (3, suppl S3): (supplement abstract only)http://jama.jamanetwork.com/article.aspx?articleid=185547. Accessed on 30th March 2014.CrossRefGoogle Scholar
8.Lagerwaard, F, Haasbeek, C, Slotman, B, Senan, S. Clinical results and toxicity after 4D stereotactic radiotherapy for early stage non small cell lung cancer (NSCLC): B5-04. J Thorac Oncol 2007; 2 (4): S348 (supplement abstract only).CrossRefGoogle Scholar
9.Xia, T, Li, H, Sun, Qet al. Promising clinical outcome of stereotactic body radiation therapy for patients with inoperable stage I/II non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2006; 66 (1): 117–125.CrossRefGoogle ScholarPubMed
10.Lagerwaard, F J, Haasbeek, C J A, Smit, E F, Slotman, B J, Senan, S. Outcomes of risk-adapted fractionated stereotactic radiotherapy for stage I non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2008; 70 (3): 685–692.CrossRefGoogle ScholarPubMed
11.Timmerman, R D, Papiez, L, McGarry, R Cet al. Extracranial stereotactic radioablation: results of a phase I study in medically inoperable stage I non-small cell lung cancer. Int J Radiat Oncol Biol Phys 2003; 57 (2, suppl 1): S280–S281 (supplement abstract only).CrossRefGoogle Scholar
12.Fakiris, A J, McGarry, R C, Yiannoutsos, C Tet al. Stereotactic body radiation therapy for early-stage non–small-cell lung carcinoma: four-year results of a prospective phase II study. Int J Radiat Oncol Biol Phys 2009; 75 (3): 677–682.CrossRefGoogle ScholarPubMed
13.Onishi, H, Shirato, H, Hagata, Yet al. Stereotactic body radiotherapy (SBRT) for operable stage I non-small-cell lung cancer: can SBRT be comparable to surgery? Int J Radiat Oncol Biol Phys 2011; 81 (5): 1352–1358 (available online 16 July).CrossRefGoogle Scholar
14.Yu, H M, Liu, Y F, Yu, J Met al. Involved-field radiotherapy is effective for patients 70 years old or more with early stage non-small cell lung cancer. Radiother Oncol 2008; 87: 29–34.CrossRefGoogle ScholarPubMed
15.Qiao, X, Tullgren, O, Lax, I, Sirzen, F, Lewensohn, R. The role of radiotherapy in treatment of stage I non-small cell lung cancer. Lung Cancer 2003; 41: 1–11.CrossRefGoogle ScholarPubMed
16.Onishi, H, Araki, T, Shirato, Het al. Stereotactic hypo-fractionated high-dose irradiation for stage I non-small cell lung carcinoma: clinical outcomes in 245 subjects in a Japanese multi-institutional study. Cancer 2004; 101 (7): 1623–1631.CrossRefGoogle Scholar
17.Onishi, H, Shirato, H, Hagata, Yet al. Hypo-fractionated stereotactic radiotherapy (Hypo-FXSRT) for stage 1 non-small cell lung cancer: updated results of 257 patients in a Japanese multi-institutional study. J Thorac Oncol 2007; 2: S9–S10.CrossRefGoogle Scholar
18.Lagerwaard, F J, Verstegen, N E, Haasbeek, C Jet al. Outcomes of stereotactic ablative radiotherapy in patients with potentially operable stage I non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2012; 83 (1): 348–353.CrossRefGoogle ScholarPubMed
19.Hurkmans, C W, Cuijpers, J P, Lagerwaard, F Jet al. Recommendations for implementing stereotactic radiotherapy in peripheral stage 1A non-small cell lung cancer: report from the Quality Assurance Working Party of the randomised phase III ROSEL study. Radiat Oncol 2009; 4: 1–14.CrossRefGoogle ScholarPubMed
20.UK SBRT Consortium. Stereotactic body radiation therapy (SBRT) for patients with early stage non-small cell lung cancer: A resource. (Oct 2010).Google Scholar
21.Lung Consortium. Stereotactic ablative body radiotherapy (SABR): a resource. SABR UK Consortium, 2014. http://actionradiotherapy.org/wp-content/uploads/2014/03/UK-SABRConsortium-Guidelines.pdf. Accessed on 12th December 2014.Google Scholar
22.Distefano, G, Baker, A, Scott, A J D, Webster, G J. Survey of stereotactic ablative body radiotherapy in the UK by the QA group on behalf of the UK SABR Consortium. Br J Radiol 2014; 87 (1037): 0681.CrossRefGoogle Scholar
23.Blomgren, H, Lax, I, Naslund, I, Svanstrom, R. Stereotactic high dose fraction radiation therapy of extra-cranial tumors using an accelerator. Clinical experience of the first thirty-one patients. Acta Oncol 1995; 34 (6): 861–870.CrossRefGoogle Scholar
24.Rowell, N P, Williams, C J. Radical radiotherapy for stage I/II non-small cell lung cancer in patients not sufficiently fit for or declining surgery (medically inoperable). Cochrane database of systematic reviews. Lung Cancer 2001; 29 (1, suppl 1): 164–165 (supplement abstract only).CrossRefGoogle Scholar
25.Purdy, J A. Current ICRU definitions of volumes: limitations and future directions. Semin Radiat Oncol 2004; 14: 27–40.CrossRefGoogle ScholarPubMed
26.Underberg, R W M, Lagerwaard, F J, Cuijpers, J Pet al. Four-dimensional CT scans for treatment planning in stereotactic radiotherapy for stage I lung cancer. Int J Radiat Oncol Biol Phys 2004; 60 (4): 1283–1290.CrossRefGoogle ScholarPubMed
27.Jin, J Y, Ailouni, M, Chen, Qet al. A technique of using gated-CT images to determine internal target volume (ITV) for fractionated stereotactic lung radiotherapy. Radiother Oncol 2006; 78 (2): 177–184.CrossRefGoogle ScholarPubMed
28.Han, K, Cheung, P, Basran, P S. A comparison of two immobilization systems for stereotactic body radiation therapy of lung tumours. Radiother Oncol 2010; 95: 103–108.CrossRefGoogle Scholar
29.Li, W, Purdie, T G, Taremi, Met al. Effect of immobilisation and performance status on intra-fraction motion for stereotactic lung radiotherapy: analysis of 133 patients. Int J Radiat Oncol Biol Phys 2010; 81 (5): 1568–1575.CrossRefGoogle Scholar
30.Guckenberger, M, Meyer, J, Wilbert, Jet al. Intra-fractional uncertainties in cone-beam CT based image-guided radiotherapy (IGRT) of pulmonary tumour. Radiother Oncol 2007; 83: 57–64.CrossRefGoogle Scholar
31.McGarry, R C, Papiez, L, Williams, M, Whitford, T, Timmerman, R D. Stereotactic body radiation therapy of early-stage non-small cell lung carcinoma: phase 1 study. Int J Radiat Oncol Biol Phys 2005; 63: 1010–1015.CrossRefGoogle Scholar
32.Dvorak, P, Georg, D, Bogner, Jet al. Impact of IMRT and leaf width on stereotactic body radiotherapy of liver and lung lesions. Int J Radiat Oncol Biol Phys 2005; 61 (5): 1572–1581.CrossRefGoogle ScholarPubMed
33.Lagerwaard, F J, Van Sornsen de Koste, J R, Nijssen-Visser, M R Jet al. Multiple ‘Slow’ CT scans for incorporating lung tumor mobility in radiotherapy planning. Int J Radiat Oncol Biol Phys 2001; 51 (4): 932–937.CrossRefGoogle ScholarPubMed
34.Baumann, P, Nyman, J, Lax, Iet al. Factors important for efficacy of stereotactic body radiotherapy of medically inoperable stage I lung cancer. A retrospective analysis of patients treated in the Nordic countries. Acta Oncol 2006; 45 (7): 787–795.CrossRefGoogle Scholar
35.Timmerman, R D, Paulus, R, Galvin, Jet al. Toxicity analysis of RTOG 0236 using stereotactic body radiation therapy to treat medically inoperable early stage lung cancer patients. Int J Radiat Oncol Biol Phys 2007; 69 (3): S86 (supplement abstract only).CrossRefGoogle Scholar
36.Kong, C, Guo, W J, Zhaa, W Wet al. A new index comparable to BED for evaluating the biological efficacy of hypo-fractionated radiotherapy schemes on early stage non-small cell lung cancer: analysis of data from the literature. Lung Cancer 2014; 84: 7–12.CrossRefGoogle Scholar
37.Partridge, M, Ramos, M, Sardaro, A, Brada, M. Dose escalation for non-small cell lung cancer: analysis and modelling of published literature. Radiother Oncol 2011; 99: 6–11.CrossRefGoogle ScholarPubMed
38.Mehta, M, Scrimger, R, Rockie, Met al. A new approach to dose escalation in non-small cell lung cancer. Int J Radiat Oncol Biol Phys 2001; 49: 23–33.CrossRefGoogle ScholarPubMed
39.Nagata, Y, Negoro, Y, Aoki, Tet al. Clinical outcomes of 3D conformal hypo-fractionated single high-dose radiotherapy for one or two tumours using a stereotactic body frame. Int J Radiat Oncol Biol Phys 2002; 52 (4): 1041–1046.CrossRefGoogle ScholarPubMed
40.Nagata, Y, Takayama, K, Matsuo, Yet al. Clinical outcomes of a phase I/II study of 48 Gy of stereotactic body radiotherapy in 4 fractions for primary lung cancer using a stereotactic body frame. Int J Radiat Oncol Biol Phys 2005; 63 (5): 1427–1431.CrossRefGoogle ScholarPubMed
41.Haasbeek, C J A, Lagerwaard, F J, Cuijpers, J P, Slotman, B J, Senan, S. Is adaptive treatment planning required for stereotactic radiotherapy of stage I non-small cell lung cancer. Int J Radiat Oncol Biol Phys 2007; 67 (5): 1370–1374.CrossRefGoogle ScholarPubMed
42.Ong, C L, Palma, D, Verbakel, W F A R, Slotman, B J, Senan, S. Treatment of large stage I–II lung tumors using stereotactic body radiotherapy (SBRT): planning considerations and early toxicity. Radiother Oncol 2010; 97: 431–436.CrossRefGoogle ScholarPubMed
43.Xiao, Y, Papiez, L, Paulus, Ret al. Dosimetric evaluation of heterogeneity corrections for RTOG 0236: stereotactic body radiotherapy of inoperable stage I-II non-small cell lung cancer. Int J Radiat Oncol Biol Phys 2009; 73 (4): 1235–1242.CrossRefGoogle ScholarPubMed
44.Brock, J, Bedford, J, Partridge, Met al. Optimising stereotactic body radiotherapy for non-small cell lung cancer with volumetric intensity-modulated arc therapy: a planning study. Clin Oncol 2012; 24: 68–75.CrossRefGoogle ScholarPubMed
45.Nyman, J, Johansson, K A, Hulten, U. Stereotactic hypo-fractionated radiotherapy for stage I non-small cell lung cancer – mature results for medically inoperable patients. Lung Cancer 2006; 51 (1): 97–103.CrossRefGoogle Scholar
46.Boda-Heggemann, J, Mai, S, Fleckenstein, Jet al. Flattening-filter-free intensity modulated breath-hold image-guided SABR (stereotactic ablative radiotherapy) can be applied in a 15-min treatment slot. Radiother Oncol 2013; 109: 505–509.CrossRefGoogle Scholar
47.Schuring, D, Hurkmans, C W. Developing and evaluating stereotactic lung RT trials: what we should know about the influence of inhomogeneity corrections on dose. Radiat Oncol 2008; 28 (3): 21.CrossRefGoogle Scholar
48.Kim, G, Uhl, J, Sandhu, A, Pawlicki, T. A comparison of lung SBRT using volumetric modulated arc therapy with static field IMRT. Int J Radiat Oncol Biol Phys 2012; 84 (3): 871–872 (supplement abstract only.CrossRefGoogle Scholar
49.Verbakel, W F A R, Senan, S, Cuijpers, J P, Slotman, B J, Lagerwaarrd, F J. Rapid delivery of stereotactic radiotherapy for peripheral lung tumors using volumetric intensity-modulated arcs. Radiother Oncol 2009; 93: 122–124.CrossRefGoogle ScholarPubMed
50.Ong, C L, Verbakel, W F A R, Cuijpers, J Pet al. Stereotactic radiotherapy for peripheral lung tumors: a comparison of volumetric modulated arc therapy with 3 other delivery techniques. Radiother Oncol 2010; 97: 437–442.CrossRefGoogle ScholarPubMed
51.Navarria, P, Ascolese, A M, Mancosu, Pet al. Volumetric modulated arc therapy with flattening filter free (FFF) beams for stereotactic body radiation therapy (SBRT) in patients with medically inoperable early stage non small cell lung cancer (NSCLC). Radiother Oncol 2013; 107: 414–441.CrossRefGoogle ScholarPubMed
52.Van Sornsen de Koste, J R, Lagerwaard, F J, de Boer, H C J, Nijssen-Visser, M R J, Senan, S. Are multiple CT scans required for planning curative radiotherapy in lung tumours of the lower lobe? Int J Radiat Oncol Biol Phys 2003; 55 (5): 1394–1399.CrossRefGoogle Scholar