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05.09.2017 | Original Article

Breathing-motion-compensated robotic guided stereotactic body radiation therapy

Patterns of failure analysis

verfasst von: Susanne Stera, MD, Panagiotis Balermpas, MD, Mark K. H. Chan, PhD, Stefan Huttenlocher, MD, Stefan Wurster, MD, Christian Keller, MD, Detlef Imhoff, Dirk Rades, MD, Jürgen Dunst, MD, Claus Rödel, MD, Guido Hildebrandt, MD, Oliver Blanck, PhD

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 2/2018

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Abstract

Purpose

We retrospectively evaluated the patterns of failure for robotic guided real-time breathing-motion-compensated (BMC) stereotactic body radiation therapy (SBRT) in the treatment of tumors in moving organs.

Patients and methods

Between 2011 and 2016, a total of 198 patients with 280 lung, liver, and abdominal tumors were treated with BMC-SBRT. The median gross tumor volume (GTV) was 12.3 cc (0.1–372.0 cc). Medians of mean GTV BED_α/β = ₁₀ _Gy (BED = biological effective dose) was 148.5 Gy₁₀ (31.5–233.3 Gy₁₀) and prescribed planning target volume (PTV) BED_α/β = ₁₀ _Gy was 89.7 Gy₁₀ (28.8–151.2 Gy₁₀), respectively. We analyzed overall survival (OS) and local control (LC) based on various factors, including BEDs with α/β ratios of 15 Gy (lung metastases), 21 Gy (primary lung tumors), and 27 Gy (liver metastases).

Results

Median follow-up was 10.4 months (2.0–59.0 months). The 2‑year actuarial LC was 100 and 86.4% for primary early and advanced stage lung tumors, respectively, 100% for lung metastases, 82.2% for liver metastases, and 90% for extrapulmonary extrahepatic metastases. The 2‑year OS rate was 47.9% for all patients. In uni- and multivariate analysis, comparatively lower PTV prescription dose (equivalence of 3 × 12–13 Gy) and higher average GTV dose (equivalence of 3 × 18 Gy) to current practice were significantly associated with LC. For OS, Karnofsky performance score (100%), gender (female), and SBRT without simultaneous chemotherapy were significant prognostic factors. Grade 3 side effects were rare (0.5%).

Conclusions

Robotic guided BMC-SBRT can be considered a safe and effective treatment for solid tumors in moving organs. To reach sufficient local control rates, high average GTV doses are necessary. Further prospective studies are warranted to evaluate these points.

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Titel: Breathing-motion-compensated robotic guided stereotactic body radiation therapy
Patterns of failure analysis
verfasst von: Susanne Stera, MD
Panagiotis Balermpas, MD
Mark K. H. Chan, PhD
Stefan Huttenlocher, MD
Stefan Wurster, MD
Christian Keller, MD
Detlef Imhoff
Dirk Rades, MD
Jürgen Dunst, MD
Claus Rödel, MD
Guido Hildebrandt, MD
Oliver Blanck, PhD
Publikationsdatum: 05.09.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 2/2018
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-017-1204-z

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Results

Conclusions

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