CyberKnife Image-Guided SABR System: Volumetric Image-Guided or Real-Time Tracking SABR Systems, Treatment Delivery, Image Guidance, and Technical Considerations for Proton Therapy
Keywords:
CyberKnife, Real-Time Tracking SABR Systems, Treatment Delivery, Image Guidance, Technical Considerations for Proton TherapyAbstract
In recent years, stereotactic ablative radiation therapy (SABR), also known as stereotactic body radiation therapy (SBRT), has gained a lot of attention as a potential alternative to surgical resection for certain patients with early-stage non-small cell lung cancer (NSCLC) or patients who cannot tolerate it. When it comes to early stage NSCLC, data from many clinical trials and retrospective studies show that SABR/SBRT is a safe and effective treatment that can compete with surgical resection. Compared to less harsh fractionation methods, the toxicities caused by ablative radiation doses are far more severe and difficult to tolerate. In view of these facts, it is essential to take into account a number of factors in order to accomplish high-quality treatment. The correct selection of patients is based on solid published evidence. The treatment is carefully planned to reach enough tumour coverage while avoiding organs-at-risk. The ablative radiation is delivered with care, using reliable immobilisation, accurately targeting the tumour, and verifying the dose delivery precisely.
Downloads
References
Ambrogi MC, Lucchi M, Dini P, Melfi F, Fontanini G, Faviana P, Fanucchi O, Mussi A (2006) Percutaneous radiofrequency ablation of lung tumours: results in the mid-term. Eur J Cardiothorac Surg 30(1):177–183.
Ambrose JA, Barua RS (2004) The pathophysiology of cigarette smoking and cardiovascular disease: an update. J Am Coll Cardiol 43(10):1731–1737.
Auberger T, Seydl K, Futschek T, Sztankay A, Sweeney RA, Lukas P (2007) Photons or protons: precision radiotherapy of lung cancer. Strahlenther Onkol 183 Spec No 2:3–6.
Baumann P, Nyman J, Lax I, (2006) 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 45(7):787–795.
Brock MV, Hooker CM, Ota-Machida E, (2008) DNA methylation markers and early recurrence in stage I lung cancer. N Engl J Med 358(11):1118–1128.
Bush DA, Slater JD, Shin BB, Cheek G, Miller DW, Slater JM (2004) Hypofractionated proton beam radiotherapy for stage I lung cancer. Chest 126(4):1198–1203.
Chamogeorgakis TP, Connery CP, Bhora F, Nabong A, Toumpoulis IK (2007) Thoracoscore predicts midterm mortality in patients undergoing thoracic surgery. J Thorac Cardiovasc Surg 134(4):883–887.
Chamogeorgakis T, Toumpoulis I, Tomos P, Ieromonachos C, Angouras D, Georgiannakis E, Michail P, Rokkas C (2009) External validation of the modified Thoracoscore in a new thoracic surgery program: prediction of in-hospital mortality. Interact Cardiovasc Thorac Surg 9(3):463–466.
Chang JY, Roth JA (2007) Stereotactic body radiation therapy for stage I non-small cell lung cancer. Thorac Surg Clin 17(2):251–259.
Chang DT, Olivier KR, Morris CG, Liu C, Dempsey JF, Benda RK, Palta JR (2006a) The impact of heterogeneity correction on dosimetric parameters that predict for radiation pneumonitis. Int J Radiat Oncol Biol Phys 65(1):125–131.
Chang JY, Zhang X, Wang X, Kang Y, Riley B, Bilton S, Mohan R, Komaki R, Cox JD (2006b) Significant reduction of normal tissue dose by proton radiotherapy compared with three-dimensional conformal or intensity-modulated radiation therapy in Stage I or Stage III non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 65(4):1087–1096.
Chang JY, Balter PA, Dong L, Yang Q, Liao Z, Jeter M, Bucci MK, McAleer MF, Mehran RJ, Roth JA, Komaki R (2008a) Stereotactic body radiation therapy in centrally and superiorly located stage I or isolated recurrent non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 72(4):967–971.
Chang JY, Dong L, Liu H, Starkschall G, Balter P, Mohan R, Liao Z, Cox JD, Komaki R (2008b) Image-guided radiation therapy for non-small cell lung cancer. J Thorac Oncol 3(2):177–186.
Chen HY, Yu SL, Chen CH, Chang GC, Chen CY, Yuan A, Cheng CL, Wang CH, Terng HJ, Kao SF, Chan WK, Li HN, Liu CC, Singh S, Chen WJ, Chen JJ, Yang PC (2007) A five-gene signature and clinical outcome in non-small-cell lung cancer. N Engl J Med 356(1):11–20.
Crabtree TD, Denlinger CE, Meyers BF, El Naqa I, Zoole J, Krupnick AS, Kreisel D, Patterson GA, Bradley JD (2010) Stereotactic body radiation therapy versus surgical resection for stage I non-small cell lung cancer. J Thorac Cardiovasc Surg 140(2):377–386.
Das M, Abdelmaksoud MH, Loo BW Jr, Kothary N (2010) Alternatives to surgery for early stage non-small cell lung cancer-ready for prime time? Curr Treat Options Oncol 11(1–2):24–35.
Devereux G (2006) ABC of chronic obstructive pulmonary disease. Definition, epidemiology, and risk factors. BMJ 332(7550):1142–1144.
Dosoretz DE, Galmarini D, Rubenstein JH, Katin MJ, Blitzer PH, Salenius SA, Dosani RA, Rashid M, Mestas G, Hannan SE et al (1993) Local control in medically inoperable lung cancer: an analysis of its importance in outcome and factors determining the probability of tumor eradication. Int J Radiat Oncol Biol Phys 27(3):507–516.
Dunlap NE, Cai J, Biedermann GB, Yang W (2009) Chest wall volume receiving[30 Gy predicts risk of severe pain and/or rib fracture after lung stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 76(3):796–801.
Ezhil M, Vedam S, Balter P, Choi B, Mirkovic D, Starkschall G, Chang JY (2009) Determination of patient-specific internal gross tumor volumes for lung cancer using four-dimensional computed tomography. Radiat Oncol 4:4.
Fakiris AJ, McGarry RC, Yiannoutsos CT (2009) 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 75(3):677–682.
Falcoz PE, Conti M, Brouchet L (2007) The Thoracic Surgery Scoring System (Thoracoscore): risk model for in-hospital death in 15,183 patients requiring thoracic surgery. J Thorac Cardiovasc Surg 133(2):325–332.
Forquer JA, Fakiris AJ, Timmerman RD, Lo SS, Perkins SM, McGarry RC, Johnstone PA (2009) Brachial plexopathy from stereotactic body radiotherapy in early-stage NSCLC: dose-limiting toxicity in apical tumor sites. Radiother Oncol 93(3):408–413.
Chang et al. Ginsberg R, Rubinstein L (1995) Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg 60:615–622.
Goldberg SN, Hahn PF, Tanabe KK (1998) Percutaneous radiofrequency tissue ablation: does perfusion-mediated tissue cooling limit coagulation necrosis? J Vasc Interv Radiol 9(1 Pt 1):101–111.
Gomez FM, Palussiere J, Santos E, Tourdias T, Cornelis F, Saiz V, Montes H, Eker O (2009) Radiofrequency thermocoagulation of lung tumours. Where we are, where we are headed. Clin Transl Oncol 11(1):28–34.
Hara R, Itami J, Kondo T, Aruga T, Uno T (2006) Clinical outcomes of single-fraction stereotactic radiation therapy of lung tumors. Cancer 106(6):1347–1352.
Hata M, Tokuuye K, Kagei K, Sugahara S (2007) Hypofractionated high-dose proton beam therapy for stage I non-small-cell lung cancer: preliminary results of a phase I/II clinical study. Int J Radiat Oncol Biol Phys 68(3):786–793.
Henderson MA, Hoopes DJ, Fletcher JW, Lin PF (2009) A pilot trial of serial 18F-fluorodeoxyglucose positron emission tomography in patients with medically inoperable stage I non-small-cell lung cancer treated with hypofractionated stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 76(3):789–795.
Hiraki T, Gobara H, Iishi T, Sano Y, Iguchi T, Fujiwara H, Tajiri N, Sakurai J, Date H, Mimura H, Kanazawa S (2007) Percutaneous radiofrequency ablation for clinical stage I non-small cell lung cancer: results in 20 nonsurgical candidates. J Thorac Cardiovasc Surg 134(5):1306–1312.
Iakovou I, Schmidt T, Bonizzoni E, Ge L (2005) Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA 293(17):2126–2130.
Joyner M, Salter BJ, Papanikolaou N, Fuss M (2006) Stereotactic body radiation therapy for centrally located lung lesions. Acta Oncol 45(7):802–807.
Kaluza GL, Joseph J, Lee JR, Raizner ME, Raizner AE (2000) Catastrophic outcomes of noncardiac surgery soon after coronary stenting. J Am Coll Cardiol 35(5):1288–1294.
Kaskowitz L, Graham MV, Emami B, Halverson KJ, Rush C (1993) Radiation therapy alone for stage I non-small cell lung cancer. Int J Radiat Oncol Biol Phys 27(3):517–523.
Kelly P, Balter PA, Rebueno N, Sharp HJ, Liao Z, Komaki R, Chang JY (2010) Stereotactic body radiation therapy for patients with lung cancer previously treated with thoracic radiation. Int J Radiat Oncol Biol Phys 78(5):1387–1393.
Lagerwaard FJ, Haasbeek CJ, Smit EF, Slotman BJ, Senan S (2008) Outcomes of risk-adapted fractionated stereotactic radiotherapy for stage I non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 70(3):685–692.
Li X, Chang J, Liu W, Quan E, Balter P, Zhang X (2011) Significant improvement of plan quality, delivery efficiency and plan consistency by VMAT combined with automated inverse planning algorithm for stereotactic body radiation therapy in centrally/superiorly located stage I non-small-cell lung cancer. Med Phys 38:3866
Lim do H, Yi BY, Mirmiran A, Dhople A, Suntharalingam M, D’Souza WD (2009) Optimal beam arrangement for stereotactic body radiation therapy delivery in lung tumors. Acta Oncol 49(2):219–224.
Matsuo Y, Nakamoto Y, Nagata Y (2010) Characterization of FDG-PET images after stereotactic body radiation therapy for lung cancer. Radiother Oncol 97(2):200–204.
Nagata Y, Negoro Y, Aoki T, Mizowaki T (2002) Clinical outcomes of 3D conformal hypofractionated single high-dose radiotherapy for one or two lung tumors using a stereotactic body frame. Int J Radiat Oncol Biol Phys 52(4):1041–1046
Neri S, Takahashi Y, Terashi T, Hamakawa H, Tomii K, Katakami N, Kokubo M (2010) Surgical treatment of local recurrence after stereotactic body radiotherapy for primary and metastatic lung cancers. J Thorac Oncol 5:2003–2007
Nihei K, Ogino T, Ishikura S, Nishimura H (2006) High-dose proton beam therapy for Stage I non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 65(1):107–111.
Ong C, Verbakel WF, Cuijpers JP, Slotman BJ, Senan S (2011) Dosimetric impact of interplay effect on RapidArc lung stereotactic treatment delivery. Int J Radiat Oncol Biol Phys 79(1):305–311.
Onishi H, Araki T, Shirato H, Nagata Y (2004) Stereotactic hypofractionated high-dose irradiation for stage I nonsmall cell lung carcinoma: clinical outcomes in 245 subjects in a Japanese multiinstitutional study. Cancer 101(7):1623–1631
Onishi H, Shirato H, Nagata Y (2007) Hypofractionated stereotactic radiotherapy (HypoFXSRT) for stage I nonsmall cell lung cancer: updated results of 257 patients in a Japanese multi-institutional study. J
Onishi H, Shirato H, Nagata Y, Hiraoka M, Fujino M, (2011) Stereotactic body radiotherapy (SBRT) for operable stage I non-smallcell lung cancer: can SBRT be comparable to surgery? Int J Radiat Oncol Biol Phys 81(5):1352–1358.
Paganetti H, Niemierko A, Ancukiewicz M, Gerweck LE, Goitein M, Loeffler JS, Suit HD (2002) Relative biological effectiveness (RBE) values for proton beam therapy. Int J Radiat Oncol Biol Phys 53(2):407–421.
Palma D, Visser O, Lagerwaard FJ, Belderbos J, Slotman BJ, Senan S (2010) Impact of introducing stereotactic lung radiotherapy for elderly patients with stage I non-small-cell lung cancer: a population-based time-trend analysis. J Clin Oncol 28(35):5153–5159.
Pell JP, Haw S, Cobbe S, Newby DE (2008) Smokefree legislation and hospitalizations for acute coronary syndrome. N Engl J Med 359(5):482–491.
Pennathur A, Luketich JD, Abbas G, Chen M (2007) Radiofrequency ablation for the treatment of stage I non-small cell lung cancer in high-risk patients. J Thorac Cardiovasc Surg 134(4):857–864.
Ramsey C, Scaperoth D, Arwood D, Oliver A (1999) Clinical efficacy of respiratory gated conformal radiation therapy. Med Dosim 24(2):115–119.
Register SP, Zhang X, Mohan R, Chang JY (2011) Proton stereotactic body radiation therapy for clinically challenging cases of centrally and superiorly located stage I non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 80(4):1015–1022.
Rosenzweig K, Hanley J, Mah D, Mageras G, Hunt M, Toner S, Burman C, Ling C, Mychalczak B, Fuks Z, Leibel S (2000) The deep inspiration breath-hold technique in the treatment of inoperable non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 48(1):81–87.
Rusthoven KE, Kavanagh BD, Burri SH, Chen C, Cardenes H, Chidel MA, Pugh TJ, Kane M, Gaspar LE, Schefter TE (2009) Multi-institutional phase I/II trial of stereotactic body radiation therapy for lung metastases. J Clin Oncol 27(10):1579–1584.
Seike M, Yanaihara N, (2007) Use of a cytokine gene expression signature in lung adenocarcinoma and the surrounding tissue as a prognostic classifier. J Natl Cancer Inst 99(16):1257–1269.
Senan S, Palm D, Lagerwaard F (2011a) Stereotactic ablative radiotherapy for stage I NSCLC: recent advances and controversies. J Thorac Dis 3(3):189–196
Young RP, Hopkins RJ, Christmas T, Black PN, Metcalf P, Gamble GD (2009) COPD prevalence is increased in lung cancer, independent of age, sex and smoking history. Eur Respir J 34(2):380–386.
Zhang X, Li Y, Pan X, Xiaoqiang L, Mohan R, Komaki R, Cox JD, Chang JY (2009) Intensity-modulated proton therapy reduces the dose to normal tissue compared with intensitymodulated radiation therapy or passive scattering proton therapy and enables individualized radical radiotherapy for extensive stage IIIB non-small-cell lung cancer: a virtual clinical study. Int J Radiat Oncol Biol Phys 77(2):357–366
Zhang X, Balter P, Pan T, Allen P, Chuang H, Chang JY (2010) PET/CT and outcome in lung cancer treated with stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys 78(3):S16.
Zhu JC, Yan TD, Morris DL (2008) A systematic review of radiofrequency ablation for lung tumors. Ann Surg Oncol 15(6):1765–1774.

Downloads
Published
How to Cite
Issue
Section
License

This work is licensed under a Creative Commons Attribution 4.0 International License.
Current Clinical and Medical Education