Journal of radiosurgery and SBRT最新文献

{"title":"Heterogeneity of study endpoints in stereotactic body radiation therapy studies for bone metastases: A systematic review.","authors":"Shing Fung Lee, Henry C Y Wong, Eva Oldenburger, Srinivas Raman, Gustavo N Marta, Adrian W Chan, Dirk Rades, Yvette M van der Linden, Joanne M van der Velden, Quynh-Nhu Nguyen, J Isabelle Choi, Caroline Hircock, Chiara Doccioli, Claudia Cosma, Saverio Caini, Agata Rembielak, Vassilios Vassiliou, Pierluigi Bonomo, Peter A S Johnstone, Sara Alcorn, Candice Johnstone, Charles B Simone Ii, Peter J Hoskin, Edward Chow, Samuel Ryu","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>This systematic review evaluated variability in study endpoints among stereotactic body radiation therapy (SBRT) studies for bone metastases. Heterogeneity in endpoint definitions and reporting may hinder cross-study comparability and the establishment of consistent treatment protocols.</p><p><strong>Methods: </strong>A comprehensive search of Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials identified prospective studies, including cohort studies, phase I/II trials, and randomised controlled trials (RCTs), published between 2014-01-01 and 2024-11-12. Studies were eligible if they: (1) included adult patients with bone metastases treated with SBRT, (2) were prospective, and (3) reported pre-defined clinical endpoints.</p><p><strong>Results: </strong>A total of 58 studies were included: eight cohort studies, 37 phase I/II trials, and 13 RCTs. Pain-related endpoints were the most frequently reported primary endpoints, with pain response reported in 28% (16 studies). Other primary endpoints included toxicities (22%, 13 studies), survival metrics (12%, seven studies), and local control (9%, five studies). Secondary endpoints varied, with survival-related endpoints reported in 60% (35 studies) and toxicity in 41% (24 studies). Endpoint selection differed by clinical scenario, reflecting distinct objectives such as symptom relief, local control, and progression-free survival. Variability in definitions for endpoints, particularly pain flare and vertebral compression fracture, along with inconsistent radiological response criteria, was noted.</p><p><strong>Conclusion: </strong>Considerable heterogeneity in endpoint selection, definitions, and measurement tools across SBRT reflects diverse clinical objectives. Consensus-driven standardisation of endpoints, response criteria, and follow-up schedules is essential to enhance comparability, facilitate evidence synthesis, and support integration of SBRT research findings into clinical practice.</p>","PeriodicalId":16917,"journal":{"name":"Journal of radiosurgery and SBRT","volume":"9 ","pages":"273-285"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12708003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing prostate cancer SBRT: Acute GU toxicity outcomes of urethral delineation methods.","authors":"Gargi Sharma, Susovan Banerjee, Tejinder Kataria, Richa Arunendu, Deepak Gupta, Shyam Bisht, Kushal Narang, Mayur Mayank, Sorun Shishak, Brij Bhushan, Susan K Abraham","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background and purpose: </strong>Precise urethral delineation is critical for minimizing genitourinary (GU) toxicity in prostate SBRT. This study compares acute toxicity outcomes between catheter-based and MRI-based urethral delineation methods.</p><p><strong>Materials and methods: </strong>In this prospective study (2023-2024), 40 patients were randomized to catheter-based (<i>n</i> = 20) or MRI-based (<i>n</i> = 20) urethral delineation prior to SBRT. IPSS, QOL scores, and RTOG toxicity were assessed at baseline, treatment completion, and 1/3-month follow-ups. Dosimetric analysis included urethral BED and bladder <i>V</i> _18 Gy.</p><p><strong>Results: </strong>Both methods achieved comparable dosimetric precision (urethral BED: 128 ± 12 Gy catheter vs 130 ± 10 Gy MRI, <i>p</i> = 0.42). Acute grade ≥2 GU toxicity rates were similar (40% catheter vs 30% MRI, <i>p</i> = 0.54). The catheter group showed transient QOL deterioration likely attributable to procedural discomfort, with all patients returning to baseline by 3 months. Multivariate analysis identified urethral BED ≥130 Gy (OR: 2.1, <i>p</i> = 0.03) and bladder <i>V</i> _18 Gy ≥ 30% (OR: 1.9, <i>p</i> = 0.04) as independent predictors of toxicity.</p><p><strong>Conclusion: </strong>Catheter-based and MRI-based delineation demonstrate equivalent dosimetric and clinical outcomes in prostate SBRT. While catheterization may cause temporary discomfort, both methods are equally effective when adhering to dose constraints (urethral BED: <130 Gy, bladder <i>V</i> _18 Gy < 30%). The choice between techniques may consider patient tolerance and institutional protocols, as both approaches provide excellent therapeutic outcomes.</p>","PeriodicalId":16917,"journal":{"name":"Journal of radiosurgery and SBRT","volume":"9 ","pages":"313-323"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12708005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stereotactic ablative radiation therapy for extracranial metastases from malignant melanoma: An international multi-institutional analysis.","authors":"Raj Singh, Sophia Bishop, Jan Jenkins, Joanne Davis, Eric J Lehrer, Sujith Baliga, Joshua D Palmer, John A Vargo, Christopher M McLaughlin, Emile Gogineni, Sanjeev Sharma","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To report on local control (LC), toxicity, and overall survival (OS) following stereotactic ablative radiation therapy (SABR) for extracranial metastases from malignant melanoma.</p><p><strong>Methods: </strong>The RSSearch^® Patient Registry was searched for patients with extracranial melanoma metastases treated with SABR. LC was defined as the time from completion of SABR to the date of last radiographic follow-up with either stability or decrease in size of the treated metastasis or the date at which lesion growth was radiographically confirmed per RECIST criteria. Kaplan-Meier analyses were utilized to evaluate potential prognostic factors on univariate analyses (UVA) with log-rank tests followed by use of a Cox proportional hazards multivariate (MVA) model.</p><p><strong>Results: </strong>There were 45 patients with 52 extracranial melanoma metastases treated with SABR. One- and 2-year LC rates were both 85.3% (95% CI: 67.9-93.7%) following SABR. On UVA, BED10 < 60 Gy was associated with poorer 1-year and 2-year LC (96% vs. 61.9%), which remained significant on MVA (hazard ratio [HR] = 7.06; p = 0.03). On UVA, pulmonary vs. non-pulmonary metastases were correlated with 1-year OS (84.5% vs. 57.4%; p = 0.05) and non-spinal vs. spinal metastases (74.3% vs. 56.3%; p = 0.02), though neither were significant on MVA. The incidence of treatment-related toxicity was 18.9%, all Grade 1-2.</p><p><strong>Conclusion: </strong>We recommend dose/fractionation schedules that meet or exceed BED10 ≥ 60 Gy when treating extracranial melanoma metastases with SABR.</p>","PeriodicalId":16917,"journal":{"name":"Journal of radiosurgery and SBRT","volume":"9 3","pages":"199-205"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PACE A and PACE B trial - What a radiation oncologist needs to know.","authors":"Shounak J Kamat, Trinanjan Basu, Jay P Sahu, Rohith R Menon, Ajinkya Gadekar, Ghazala K Roshan, Durva A Kurkure, Rohit Kabre, Riddhijyoti Talukdar","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":16917,"journal":{"name":"Journal of radiosurgery and SBRT","volume":"9 3","pages":"257-260"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term follow-up after stereotactic radiosurgery for recurrent subependymoma.","authors":"Claire M Lanier, Atilio E Palma, Michael D Chan, Stephen B Tatter","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":16917,"journal":{"name":"Journal of radiosurgery and SBRT","volume":"9 3","pages":"261-263"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Convolution-based Gamma Knife planning from ICON CBCT: Three-level stepwise electron density assignment versus Hounsfield Unit curve.","authors":"Peter B Fallows, Gavin Wright","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aims: </strong>To assess the suitability of CBCT images for dose calculation using the convolution algorithm.</p><p><strong>Methods: </strong>A CT to electron density curve was produced for the Gamma Knife ICON CBCT scanner. A three-level stepwise curve with fixed electron densities for air, brain tissue and bone was also produced. For 10 patients, the beam on time for shots in 11 locations within the brain was calculated using each of these curves and compared to beam on times calculated using the TMR10 algorithm, and the convolution algorithm with CT images.</p><p><strong>Results: </strong>The ratios of the average beam on time for convolution versus TMR10 were 1.058, 1.216 and 1.052 for CT images, CBCT images (Hounsfield unit electron density curve) and CBCT images (three-level stepwise curve with fixed electron densities) respectively.</p><p><strong>Conclusions: </strong>Using ICON CBCT images for dose calculation can result in an underestimation of the dose compared to convolution using CT images. However, using CBCT images along with a three-level stepwise electron density curve with fixed electron densities can provide good agreement with doses calculated using convolution with CT images.</p>","PeriodicalId":16917,"journal":{"name":"Journal of radiosurgery and SBRT","volume":"9 3","pages":"245-252"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12136681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dosimetric comparison of photon and proton radiosurgery for large arteriovenous malformations.","authors":"Roman L Travis, Travis J Atchley, Martha H Chadband, Michael H Soike, Michael C Dobelbower, Philip G R Schmalz","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>Radiosurgery for large arteriovenous malformations (AVMs) is limited by toxicity from dose spillage into normal brain, worsened by larger gradient indices in bigger targets. Proton radiosurgery theoretically reduces integral dose but has greater uncertainty due to robust planning constraints and fewer beam angles. This study evaluates whether pencil beam scanning radiosurgery (PBSR) improves normal brain dosimetry while maintaining comparable target coverage to photon radiosurgery.</p><p><strong>Methods: </strong>The 10 largest AVMs treated with photon radiosurgery at a single institution were re-planned for PBSR in Varian Eclipse. Proton plans incorporated a 2% computed tomography (CT) density correction and 2 mm range uncertainty, with 2-4 beams per institutional practice. Plans prioritized isotoxicity to organs at risk (OARs) before matching target coverage. Dosimetric metrics were compared using a paired <i>t</i>-test.</p><p><strong>Results: </strong>Median AVM size was 36.6 cc (24.3-60.1 cc). All plans prescribed 1750 cGy in one fraction. PBSR had higher gradient indices and reduced target coverage near OARs compared to photon radiosurgery. While PBSR lowered normal brain mean dose and <i>V</i> _5 Gy, it increased <i>V</i> _12 Gy, a known predictor of toxicity.</p><p><strong>Conclusions: </strong>PBSR, as planned with current institutional constraints, leads to greater high-dose spill into normal brain and inferior target coverage near OARs. Future improvements in PBSR, such as dual-energy CT, additional beam angles, and LET-based planning, may help mitigate these limitations.</p>","PeriodicalId":16917,"journal":{"name":"Journal of radiosurgery and SBRT","volume":"9 ","pages":"325-330"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12708002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of updated single-fraction SBRT spinal cord constraint for epidural spinal cord compression from metastatic sarcoma.","authors":"Jared Gregston, Santaram Vallurupalli, Kristen Linden, Raghavendiran Boopathy, Shearwood McClelland","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":16917,"journal":{"name":"Journal of radiosurgery and SBRT","volume":"9 ","pages":"331-334"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12708004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Gamma Knife radiosurgery: Analysis of gains achieved through upgradation of technology.","authors":"Arun Thimmarayappa, Nishanth Sadashiva, Subhas Kanti Konar, Abhinith Shashidhar, Vikas Vazhayil, A R Prabhuraj, Manish Beniwal, Arivazhagan Arimappamagan, Dwarakanath Srinivas, Harsh Deora, Bhanumathy Govindaswamy, Gyani Jail Singh Birua, Ponnusamy Natesan, Jeeva Balakrishnan, Nandakarthik Govindarajan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Gamma Knife radiosurgery (GKRS) using the 4C system faces challenges with treatment cancellations due to clearance issues, frame complications, and limited treatment space. Understanding cancellation factors is crucial for optimizing patient selection and workflow, particularly with technological advancements in newer systems.</p><p><strong>Aims and objectives: </strong>This study analyzed the factors associated with treatment feasibility and cancellation in Gamma Knife 4C (GK4C) radiosurgery and explored potential benefits of upgrading to Gamma Knife Icon (GKI) technology, incorporating evidence on clearance mechanisms and treatment improvements.</p><p><strong>Materials and methods: </strong>A retrospective analysis was conducted on 108 consecutive patients planned for GK4C treatment between 2006 and 2020. Data on demographics, tumor characteristics, treatment parameters, and reasons for cancellation were collected. Statistical analyses examined associations between variables and treatment feasibility. Hypothetical GKI plans assessed potential improvements. A PubMed review identified 69 studies that addressed treatment cancellation and technological improvements.</p><p><strong>Results: </strong>The main reasons for GK4C cancellation were clearance issues (41.7%), high organ-at-risk doses (35.2%), and large target volumes (23.1%). Associations were found between reason for cancellation and tumor volume, diagnosis, location, and prescribed dose. Multivariate analysis showed skull base and peripheral lesions had higher odds of clearance issues. Literature confirms that frame distortion, limited space, and inadequate collision detection are primary GK4C system limitations. GKI plans demonstrated improved target coverage and reduced organ-at-risk doses.</p><p><strong>Conclusion: </strong>Clearance is a major limitation of GK4C radiosurgery, particularly for certain tumor locations and volumes. Literature supports that GKI technology improves treatment feasibility through frameless options, cone-beam CT guidance, enhanced collision detection, and improved stability.</p>","PeriodicalId":16917,"journal":{"name":"Journal of radiosurgery and SBRT","volume":"9 ","pages":"295-303"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12708000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain parenchyma dose-volume predictors of toxicity following Gamma Knife radiosurgery for convexity, parasagittal, and falcine meningiomas.","authors":"Timoteo Almeida, Mary Mahoney, Omar Sey, Walter Hall, Lawrence Chin, Michael D Mix","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>This study evaluates the relationship between key dosimetric parameters and the risk of toxicity following Gamma Knife stereotactic radiosurgery (SRS) for convexity meningiomas, with a focus on refining brain parenchyma-specific dose-volume assessment. Traditionally, <i>V</i> ₁₂ - the volume of brain receiving at least 12 Gy - has included the entire intracranial volume, thus potentially overestimating the safe brain exposure. We hypothesized that contouring only the brain parenchyma adjacent to the tumor, excluding non-functional spaces such as cerebrospinal fluid, sulci, and vascular structures, provides a more accurate predictor of toxicity and may improve strategies to reduce symptomatic brain edema and radiation necrosis.</p><p><strong>Methods: </strong>In this retrospective analysis, 85 convexity meningioma lesions in 68 patients treated with SRS between 2004 and 2020 were evaluated. Detailed dosimetric parameters, including <i>V</i> ₁₀-<i>V</i> ₁₅, tumor volume, and surface area, were extracted from GammaPlan. Adjacent brain parenchyma was contoured as an organ at risk, excluding sulci and vascular structures. Statistical analyses, including receiver operating characteristic curve determination, logistic regression, and probability distribution analysis, were employed to identify dosimetric thresholds predictive of radiation-induced changes (RIC) and to compare outcomes across different prescription doses.</p><p><strong>Results: </strong>Increased brain parenchyma <i>V</i> ₁₂ significantly correlated with higher RIC incidence. A parenchyma-specific <i>V</i> ₁₂ threshold of 2.65 cc optimally predicted both asymptomatic (sensitivity 82%, specificity 71%) and symptomatic RIC (sensitivity 85%, specificity 75%), a notably smaller volume than traditionally reported thresholds.</p><p><strong>Conclusion: </strong>Our results support adopting brain parenchyma-specific <i>V</i> ₁₂ as a refined predictive dosimetric metric for assessing radiation-induced toxicity in convexity meningiomas. Implementing this refined, parenchyma-specific assessment can enhance safety in SRS, guide individualized treatment decisions, and serve as a practical reference for planning - particularly in eloquent cortical regions where minimizing high-dose brain exposure is critical.</p>","PeriodicalId":16917,"journal":{"name":"Journal of radiosurgery and SBRT","volume":"9 ","pages":"287-294"},"PeriodicalIF":0.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12707998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145774955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}