Stereotactic Body Radiation and Stereotactic Ablative Radiotherapy Therapy for Cancers

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Clinical Research of Cancer".

Deadline for manuscript submissions: 30 November 2024 | Viewed by 12282

Special Issue Editors


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Guest Editor
Director of Clinical Research, Department of Radiation Physics, Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
Interests: SBRT/SABR; motion mitigation; 3D scintillation dosimetry and in vivo dosimetry; proton radiography and CT; FLASH RT

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Guest Editor
Medical Director & Clinical Research Director, Department of Radiation Oncology, Miami Cancer Institute, Miami, FL 33176, USA
Interests: radiation oncology; radiotherapy

Special Issue Information

Dear Colleagues, 

Within the last decade, the radiation oncology community has witnessed increased adoption of hypo-fractionated, high-precision radiation therapy using stereotactic body radiation therapy (SBRT) or Stereotactic ablative radiotherapy (SABR) across many disease sites such as Liver, Pancreas, Lung, and Prostate on the basis of clinical evidence demonstrating both efficacy and safety.  The indication of SBRT/SABR is poised to greatly expand in coming years for the management of oligometastatic disease.  Technological advancements in precision patient alignment, in-room imaging, tumor motion management and treatment machine deliveries have also emerged and followed suit.

Therefore, this special issue aims to include articles on all types of Stereotactic modalities and treatments (SBRT, SABR and other) using ultra-hypofractionated and hypofractionated high-dose-per-fraction regimens, including original research describing clinical outcomes and also describing novel treatment planning and delivery approaches.

Submissions of papers on the potentials and use of AI and machine learning for SBRT/SABR treatment planning, tracking and alignment, and treatment delivery will also be welcome.

Prof. Dr. Sam Beddar
Dr. Michael D. Chuong
Guest Editors

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Keywords

  • radiation therapy (oncology)
  • stereotactic body radiation therapy (SBRT) and stereotactic ablative radiotherapy (SABR)
  • ultra-hypofractionated and hypofractionated studies
  • ablative/dose-escalated studies
  • SBRT, SABR, and Cyberknife technology
  • MRI guidance
  • tumor motion techniques and management
  • frame and frameless immobilization devices
  • SBRT/SABR dose constraints and toxicities
  • artificial intelligence/machine learning

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Published Papers (6 papers)

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Research

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14 pages, 2832 KiB  
Article
Radiomodulating Properties of Superparamagnetic Iron Oxide Nanoparticle (SPION) Agent Ferumoxytol on Human Monocytes: Implications for MRI-Guided Liver Radiotherapy
by Michael R. Shurin, Vladimir A. Kirichenko, Galina V. Shurin, Danny Lee, Christopher Crane and Alexander V. Kirichenko
Cancers 2024, 16(7), 1318; https://doi.org/10.3390/cancers16071318 - 28 Mar 2024
Cited by 1 | Viewed by 1386
Abstract
Superparamagnetic iron oxide nanoparticles (SPION) have attracted great attention not only for therapeutic applications but also as an alternative magnetic resonance imaging (MRI) contrast agent that helps visualize liver tumors during MRI-guided stereotactic body radiotherapy (SBRT). SPION can provide functional imaging of liver [...] Read more.
Superparamagnetic iron oxide nanoparticles (SPION) have attracted great attention not only for therapeutic applications but also as an alternative magnetic resonance imaging (MRI) contrast agent that helps visualize liver tumors during MRI-guided stereotactic body radiotherapy (SBRT). SPION can provide functional imaging of liver parenchyma based upon its uptake by the hepatic resident macrophages or Kupffer cells with a relative enhancement of malignant tumors that lack Kupffer cells. However, the radiomodulating properties of SPION on liver macrophages are not known. Utilizing human monocytic THP-1 undifferentiated and differentiated cells, we characterized the effect of ferumoxytol (Feraheme®), a carbohydrate-coated ultrasmall SPION agent at clinically relevant concentration and therapeutically relevant doses of gamma radiation on cultured cells in vitro. We showed that ferumoxytol affected both monocytes and macrophages, increased the resistance of monocytes to radiation-induced cell death and inhibition of cell activity, and supported the anti-inflammatory phenotype of human macrophages under radiation. Its effect on human cells depended on the duration of SPION uptake and was radiation dose-dependent. The results of this pilot study support a strong mechanism-based optimization of SPION-enhanced MRI-guided liver SBRT for primary and metastatic liver tumors, especially in patients with liver cirrhosis awaiting a liver transplant. Full article
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16 pages, 1897 KiB  
Article
And Yet It Moves: Clinical Outcomes and Motion Management in Stereotactic Body Radiation Therapy (SBRT) of Centrally Located Non-Small Cell Lung Cancer (NSCLC): Shedding Light on the Internal Organ at Risk Volume (IRV) Concept
by Felix-Nikolai Oschinka Jegor Habermann, Daniela Schmitt, Thomas Failing, David Alexander Ziegler, Jann Fischer, Laura Anna Fischer, Manuel Guhlich, Stephanie Bendrich, Olga Knaus, Tobias Raphael Overbeck, Hannes Treiber, Alexander von Hammerstein-Equord, Raphael Koch, Rami El Shafie, Stefan Rieken, Martin Leu and Leif Hendrik Dröge
Cancers 2024, 16(1), 231; https://doi.org/10.3390/cancers16010231 - 4 Jan 2024
Viewed by 1735
Abstract
The internal organ at risk volume (IRV) concept might improve toxicity profiles in stereotactic body radiation therapy (SBRT) for non-small cell lung cancer (NSCLC). We studied (1) clinical aspects in central vs. peripheral tumors, (2) the IRV concept in central tumors, (3) organ [...] Read more.
The internal organ at risk volume (IRV) concept might improve toxicity profiles in stereotactic body radiation therapy (SBRT) for non-small cell lung cancer (NSCLC). We studied (1) clinical aspects in central vs. peripheral tumors, (2) the IRV concept in central tumors, (3) organ motion, and (4) associated normal tissue complication probabilities (NTCPs). We analyzed patients who received SBRT for NSCLC (clinical aspects, n = 78; motion management, n = 35). We found lower biologically effective doses, larger planning target volume sizes, higher lung doses, and worse locoregional control for central vs. peripheral tumors. Organ motion was greater in males and tall patients (bronchial tree), whereas volume changes were lower in patients with a high body mass index (BMI) (esophagus). Applying the IRV concept (retrospectively, without new optimization), we found an absolute increase of >10% in NTCPs for the bronchial tree in three patients. This study emphasizes the need to optimize methods to balance dose escalation with toxicities in central tumors. There is evidence that organ motion/volume changes could be more pronounced in males and tall patients, and less pronounced in patients with higher BMI. Since recent studies have made efforts to further subclassify central tumors to refine treatment, the IRV concept should be considered for optimal risk assessment. Full article
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13 pages, 2059 KiB  
Article
Robotic Stereotactic Radiotherapy for Intracranial Meningiomas—An Opportunity for Radiation Dose De-Escalation
by Hanna Grzbiela, Elzbieta Nowicka, Marzena Gawkowska, Dorota Tarnawska and Rafal Tarnawski
Cancers 2023, 15(22), 5436; https://doi.org/10.3390/cancers15225436 - 16 Nov 2023
Cited by 1 | Viewed by 1225
Abstract
Objective: To evaluate the possibility of dose de-escalation, with consideration of the efficacy and safety of robotic stereotactic CyberKnife radiotherapy in patients diagnosed with intracranial meningiomas. Methods: The study group consisted of 172 patients (42 men and 130 women) treated in III Radiotherapy [...] Read more.
Objective: To evaluate the possibility of dose de-escalation, with consideration of the efficacy and safety of robotic stereotactic CyberKnife radiotherapy in patients diagnosed with intracranial meningiomas. Methods: The study group consisted of 172 patients (42 men and 130 women) treated in III Radiotherapy and Chemotherapy Clinic of Maria Sklodowska-Curie National Research Institute of Oncology in Gliwice between January 2011 and July 2018. The qualification for dose de-escalation was based on MRI (magnetic resonance imaging) features: largest tumor diameter less than 5 cm, well-defined tumor margins, no edema, and no brain infiltration. The age of patients was 21–79 years (median 59 years) at diagnosis and 24–80 years (median 62 years) at radiotherapy. Sixty-seven patients (Group A) were irradiated after initial surgery. Histopathological findings were meningioma grade WHO 1 in 51 and WHO 2 in 16 cases. Group B (105 patients) had no prior surgery and the diagnosis was based on the typical features of meningioma on MRI. All patients qualified for the robotic stereotactic CyberKnife radiotherapy, and the total dose received was 18 Gy in three fractions to reference isodose 78–92%. Results: Follow-up period was 18 to 124 months (median 67.5 months). Five- and eight-year progression free survival was 90.3% and 89.4%, respectively. Two patients died during the follow-up period. Progression of tumor after radiotherapy was registered in 16 cases. Four patients required surgery due to progressive disease, and three of them were progression free during further follow-up. Twelve patients received a second course of robotic radiotherapy, 11 of them had stable disease, and one patient showed further tumor growth but died of heart failure. Crude progression free survival after both primary and secondary treatment was 98.8%. Radiotherapy was well-tolerated: acute toxicity grade 1/2 (EORTC-RTOG scale) was seen in 10.5% of patients. We did not observe any late effects of radiotherapy. Conclusion: Stereotactic CyberKnife radiotherapy with total dose of 18 Gy delivered in three fractions showed comparable efficacy to treatment schedules with higher doses. This could support the idea of dose de-escalation in the treatment of intracranial meningiomas. Full article
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14 pages, 4359 KiB  
Article
Online Adaptive MRI-Guided Stereotactic Body Radiotherapy for Pancreatic and Other Intra-Abdominal Cancers
by Danny Lee, Paul Renz, Seungjong Oh, Min-Sig Hwang, Daniel Pavord, Kyung Lim Yun, Colleen Collura, Mary McCauley, Athanasios (Tom) Colonias, Mark Trombetta and Alexander Kirichenko
Cancers 2023, 15(21), 5272; https://doi.org/10.3390/cancers15215272 - 3 Nov 2023
Cited by 1 | Viewed by 1198
Abstract
A 1.5T MRI combined with a linear accelerator (Unity®, Elekta; Stockholm, Sweden) is a device that shows promise in MRI-guided stereotactic body radiation treatment (SBRT). Previous studies utilized the manufacturer’s pre-set MRI sequences (i.e., T2 Weighted (T2W)), which limited the visualization [...] Read more.
A 1.5T MRI combined with a linear accelerator (Unity®, Elekta; Stockholm, Sweden) is a device that shows promise in MRI-guided stereotactic body radiation treatment (SBRT). Previous studies utilized the manufacturer’s pre-set MRI sequences (i.e., T2 Weighted (T2W)), which limited the visualization of pancreatic and intra-abdominal tumors and organs at risk (OAR). Here, a T1 Weighted (T1W) sequence was utilized to improve the visualization of tumors and OAR for online adapted-to-position (ATP) and adapted-to-shape (ATS) during MRI-guided SBRT. Twenty-six patients, 19 with pancreatic and 7 with intra-abdominal cancers, underwent CT and MRI simulations for SBRT planning before being treated with multi-fractionated MRI-guided SBRT. The boundary of tumors and OAR was more clearly seen on T1W image sets, resulting in fast and accurate contouring during online ATP/ATS planning. Plan quality in 26 patients was dependent on OAR proximity to the target tumor and achieved 96 ± 5% and 92 ± 9% in gross tumor volume D90% and planning target volume D90%. We utilized T1W imaging (about 120 s) to shorten imaging time by 67% compared to T2W imaging (about 360 s) and improve tumor visualization, minimizing target/OAR delineation uncertainty and the treatment margin for sparing OAR. The average time-consumption of MRI-guided SBRT for the first 21 patients was 55 ± 15 min for ATP and 79 ± 20 min for ATS. Full article
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Review

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26 pages, 3242 KiB  
Review
Stereotactic Magnetic Resonance-Guided Adaptive and Non-Adaptive Radiotherapy on Combination MR-Linear Accelerators: Current Practice and Future Directions
by John Michael Bryant, Joseph Weygand, Emily Keit, Ruben Cruz-Chamorro, Maria L. Sandoval, Ibrahim M. Oraiqat, Jacqueline Andreozzi, Gage Redler, Kujtim Latifi, Vladimir Feygelman and Stephen A. Rosenberg
Cancers 2023, 15(7), 2081; https://doi.org/10.3390/cancers15072081 - 30 Mar 2023
Cited by 9 | Viewed by 3567
Abstract
Stereotactic body radiotherapy (SBRT) is an effective radiation therapy technique that has allowed for shorter treatment courses, as compared to conventionally dosed radiation therapy. As its name implies, SBRT relies on daily image guidance to ensure that each fraction targets a tumor, instead [...] Read more.
Stereotactic body radiotherapy (SBRT) is an effective radiation therapy technique that has allowed for shorter treatment courses, as compared to conventionally dosed radiation therapy. As its name implies, SBRT relies on daily image guidance to ensure that each fraction targets a tumor, instead of healthy tissue. Magnetic resonance imaging (MRI) offers improved soft-tissue visualization, allowing for better tumor and normal tissue delineation. MR-guided RT (MRgRT) has traditionally been defined by the use of offline MRI to aid in defining the RT volumes during the initial planning stages in order to ensure accurate tumor targeting while sparing critical normal tissues. However, the ViewRay MRIdian and Elekta Unity have improved upon and revolutionized the MRgRT by creating a combined MRI and linear accelerator (MRL), allowing MRgRT to incorporate online MRI in RT. MRL-based MR-guided SBRT (MRgSBRT) represents a novel solution to deliver higher doses to larger volumes of gross disease, regardless of the proximity of at-risk organs due to the (1) superior soft-tissue visualization for patient positioning, (2) real-time continuous intrafraction assessment of internal structures, and (3) daily online adaptive replanning. Stereotactic MR-guided adaptive radiation therapy (SMART) has enabled the safe delivery of ablative doses to tumors adjacent to radiosensitive tissues throughout the body. Although it is still a relatively new RT technique, SMART has demonstrated significant opportunities to improve disease control and reduce toxicity. In this review, we included the current clinical applications and the active prospective trials related to SMART. We highlighted the most impactful clinical studies at various tumor sites. In addition, we explored how MRL-based multiparametric MRI could potentially synergize with SMART to significantly change the current treatment paradigm and to improve personalized cancer care. Full article
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27 pages, 400 KiB  
Review
Radiotherapy of the Primary Disease for Synchronous Metastatic Cancer: A Systematic Review
by Youssef Ghannam, Adrien Laville, Youlia Kirova, Igor Latorzeff, Antonin Levy, Yuedan Zhou and Vincent Bourbonne
Cancers 2022, 14(23), 5929; https://doi.org/10.3390/cancers14235929 - 30 Nov 2022
Cited by 5 | Viewed by 1993
Abstract
In the case of synchronous metastatic disease, the local treatment of primary tumors by radiotherapy has long been reserved for palliative indications. The emergence of the concept of oligometastatic and oligopersistent diseases, the advent of new systemic therapies enabling longer overall survival with [...] Read more.
In the case of synchronous metastatic disease, the local treatment of primary tumors by radiotherapy has long been reserved for palliative indications. The emergence of the concept of oligometastatic and oligopersistent diseases, the advent of new systemic therapies enabling longer overall survival with an enhanced quality of life, a better understanding of the biologic history of metastatic spread, and technical advances in radiation therapy are revolutionizing the management of patients with de novo metastatic cancer. The prognosis of these patients has been markedly improved and many studies have investigated the survival benefits from the local treatment of various primary tumors in cases of advanced disease at the time of diagnosis or in the case of oligopersistence. This article provides an update on the place of irradiation of the primary tumor in cancer with synchronous metastases, and discusses its interest through published or ongoing trials. Full article
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