Cancer Research and Treatment

Original Articles

Outcomes of Stereotactic Body Radiation Therapy for Large Uveal Melanoma: A Retrospective Analysis of Asian Population: Jong Won Park, Seowoong Jun, Ki Chang Keum, Christopher Seungkyu Lee, Kyung Hwan Kim; Received June 20, 2024 Accepted December 28, 2024 Published online December 31, 2024; DOI: https://doi.org/10.4143/crt.2024.580 [Accepted]

Abstract PDF: Purpose
To investigate the clinical outcomes of stereotactic body radiation therapy (SBRT) in patients with large uveal melanoma (UM).
Materials and Methods
We conducted a retrospective review of 64 consecutive patients with UM treated with Cyberknife at Yonsei Cancer Center from September 2015 to October 2021. The median radiation dose was 60 Gy (range 48-64 Gy) administered in four fractions every alternate day. The local failure-free rate (LFFR), distant metastasis-free rate (DMFR), progression-free survival (PFS), and overall survival (OS) were assessed using the Kaplan–Meier method and log-rank test. Cox regression analysis was performed to analyze the predictive factors affecting survival outcomes and the factors associated with vision loss.
Results
The median tumor diameter and height were 11.5 mm and 8.4 mm, respectively. After a median follow-up of 32.1 months (range 4.9–89.9), the 3-year LFFR, DMFR, PFS, and OS were 89.5%, 70.5%, 65.5%, and 89.4%, respectively. Enucleation was performed in 13 (20.3%) patients, with three cases attributed to disease progression. A larger tumor diameter was associated with significantly worse DMFR (HR=1.35, p=0.015) and OS (HR=1.49, p=0.026) in the multivariate analysis. Regarding visual prognosis, 41 (64.1%) patients had baseline visual acuity ≥20/200, but only 4 (6.3%) patients maintained visual acuity ≥20/200 by the final follow-up. Initial visual acuity ≥20/40 (HR 0.45, p=0.030) was the single favorable significant factor predicting visual retention ≥20/200 in multivariate analysis.
Conclusion
SBRT using CyberKnife demonstrated a comparable local control rate to that observed in historical studies for patients with large UM. Distant metastasis and treatment-related ocular toxicity remain the limitations of this treatment.

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Lung and Thoracic cancer

Upfront Stereotactic Radiosurgery or Fractionated Stereotactic Radiotherapy in Elderly Patients with Brain Metastases from Non–Small Cell Lung Cancer: A Retrospective Analysis of a 10-Year Bi-institutional Experience: Myungsoo Kim, Jihye Cha, Hun Jung Kim, Woo Chul Kim, Jeongshim Lee; Cancer Res Treat. 2025;57(1):47-56. Published online July 3, 2024; DOI: https://doi.org/10.4143/crt.2024.223

Abstract PDF PubReader ePub: Purpose
Stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT) are increasingly used as initial therapies for brain metastases (BM). We aimed to assess the outcomes of SRS/FSRT in patients aged ≥ 65 years who had 1-10 BM from non–small cell lung cancer (NSCLC).
Materials and Methods
We retrospectively reviewed 91 elderly NSCLC patients with 222 BM who were treated with SRS/FSRT at two institutions between 2010 and 2020. The primary endpoint was overall survival (OS) after SRS/FSRT. In addition, in-field local control (IFLC) within the treated field was evaluated. Statistical analysis was performed to identify the prognostic factors affecting OS and IFLC.
Results
During a median follow-up of 18 months, the median OS was 32 months. The 1- and 2-year survival rates were 69.8% and 56.1%, respectively. In multivariate analysis, the NSCLC-specific graded prognostic assessment (GPA) score (p=0.007) and administration of systemic therapy (p=0.039) were defined as prognosticators affecting OS. The median IFLC period was 31 months, and the 1- and 2-year IFLC rates were 75.9% and 57.6%, respectively. The total BM volume (p=0.042) significantly affected IFLC. No severe adverse events were reported after SRS/FSRT.
Conclusion
SRS/FSRT is an effective upfront treatment option for BM arising from NSCLC in elderly patients, with a good OS without severe side effects. Higher GPA score and active systemic treatment were associated with improved OS, indicating that elderly patients are significant candidates for SRS/FSRT.

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Aggressive Local Ablative Radiotherapy Mitigates Progression Risk in Oligometastatic Lung Adenocarcinoma: Gowoon Yang, Kyung Hwan Kim, Chang Geol Lee, Min Hee Hong, Hye Ryun Kim, Yeona Cho, Hong In Yoon; Cancer Res Treat. 2024;56(1):115-124. Published online August 29, 2023; DOI: https://doi.org/10.4143/crt.2023.600

Abstract PDF Supplementary Material PubReader ePub: Purpose
This study aimed to determine the role of local ablative radiotherapy (LART) in oligometastatic/oligoprogressive lung adenocarcinoma.
Materials and Methods
Patients (n=176) with oligometastatic lung adenocarcinoma treated with LART were identified, and those treated with LART at the initial diagnosis of synchronous oligometastatic disease (OMD group) or treated with LART when they presented with repeat oligoprogression (OPD group) were included.
Results
In the OMD group (n=54), the 1- and 3-year progression-free survival (PFS) were 50.9% and 22.5%, respectively, whereas the 1- and 3-year overall survival in the OPD group were 75.9% and 58.1%, respectively. Forty-one patients (75.9%) received LART at all gross disease sites. Tyrosine kinase inhibitor (TKI) use and all-metastatic site LART were significant predictors of higher PFS (p=0.018 and p=0.046, respectively). In patients treated with TKIs at the time of LART (n=23) and those treated with all-metastatic site LART, the 1-year PFS was 86.7%, while that of patients not treated with all-metastatic site LART was 37.5% (p=0.006). In the OPD group (n=122), 67.2% of the patients (n=82) maintained a systemic therapy regimen after LART. The cumulative incidence of changing systemic therapy was 39.6%, 62.9%, and 78.5% at 6 months, 1 year, and 2 years after LART, respectively.
Conclusion
Aggressive LART can be an option to improve survival in patients with oligometastatic disease. Patients with synchronous oligometastatic disease receiving TKI and all-metastatic site LART may have improved PFS. In patients with repeat oligoprogression, LART might potentially extend survival by delaying the need to change the systemic treatment regimen.

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Sublobar Resection versus Stereotactic Body Radiation Therapy for Clinical Stage I Non–Small Cell Lung Cancer: A Study Using Data from the Korean Nationwide Lung Cancer Registry: Jeonghee Yun, Jong Ho Cho, Tae Hee Hong, Kyungmi Yang, Yong Chan Ahn, Hong Kwan Kim, Korean Association for Lung Cancer, Korea Central Cancer Registry; Cancer Res Treat. 2023;55(4):1171-1180. Published online April 17, 2023; DOI: https://doi.org/10.4143/crt.2022.1581

Abstract PDF Supplementary Material PubReader ePub: Purpose
Stereotactic body radiotherapy (SBRT) had been increasingly recognized as a favorable alternative to surgical resection in patients with high risk for surgery. This study compared survival outcomes between sublobar resection (SLR) and SBRT for clinical stage I non–small cell lung cancer (NSCLC).
Materials and Methods
Data were obtained from the Korean Association of Lung Cancer Registry, a sampled nationwide database. This study retrospectively reviewed 382 patients with clinical stage I NSCLC who underwent curative SLR or SBRT from 2014 to 2016.
Results
Of the patients, 43 and 339 underwent SBRT and SLR, respectively. Patients in the SBRT group were older and had worse pulmonary function. The 3-year overall survival (OS) rate was significantly better in the SLR group compared with the SBRT group (86.6% vs. 57%, log-rank p < 0.001). However, after adjusting for age, sex, tumor size, pulmonary function, histology, smoking history, and adjuvant therapy, treatment modality was not an independent prognostic factor for survival (hazard ratio, 0.99; 95% confidence interval, 0.43 to 2.77; p=0.974). We performed subgroup analysis in the following high-risk populations: patients who were older than 75 years; patients who were older than 70 years and had diffusing capacity of lung for carbon monoxide ≤ 80%. In each subgroup, there were no differences in OS and recurrence-free survival between patients who underwent SLR and those who received SBRT.
Conclusion
In our study, there were no significant differences in terms of survival or recurrence between SBRT and SLR in medically compromised stage I NSCLC patients. Our findings suggest that SBRT could be considered as a potential treatment option for selected patients.

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Clinical Outcome of Stereotactic Body Radiotherapy in Patients with Early-Stage Lung Cancer with Ground-Glass Opacity Predominant Lesions: A Single Institution Experience: Jeong Yun Jang, Su Ssan Kim, Si Yeol Song, Young Seob Shin, Sei Won Lee, Wonjun Ji, Chang-Min Choi, Eun Kyung Choi; Cancer Res Treat. 2023;55(4):1181-1189. Published online March 21, 2023; DOI: https://doi.org/10.4143/crt.2022.1656

Abstract PDF Supplementary Material PubReader ePub

Purpose
The detection rate of early-stage lung cancer with ground-glass opacity (GGO) has increased, and stereotactic body radiotherapy (SBRT) has been suggested as an alternative to surgery in inoperable patients. However, reports on treatment results are limited. Therefore, we performed a retrospective study to investigate the clinical outcome after SBRT in patients with early-stage lung cancer with GGO-predominant tumor lesions at a single institution.
Materials and Methods
This study included 89 patients with 99 lesions who were treated with SBRT for lung cancer with GGO-predominant lesions that had a consolidation-to-tumor ratio of ≤0.5 at Asan Medical Center between July 2016 and July 2021. A median total dose of 56.0 Gy (range, 48.0–60.0) was delivered using 10.0–15.0 Gy per fraction.
Results
The overall follow-up period for the study was median 33.0 months (range, 9.9 to 65.9 months). There was 100% local control with no recurrences in any of the 99 treated lesions. Three patients had regional recurrences outside of the radiation field, and three had distant metastasis. The 1-year, 3-year, and 5-year overall survival rates were 100.0%, 91.6%, and 82.8%, respectively. Univariate analysis revealed that advanced age and a low level of diffusing capacity of the lungs for carbon monoxide were significantly associated with overall survival. There were no patients with grade ≥3 toxicity.
Conclusion
SBRT is a safe and effective treatment for patients with GGO-predominant lung cancer lesions and is likely to be considered as an alternative to surgery.

Citations

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Recent Advancements in Minimally Invasive Surgery for Early Stage Non-Small Cell Lung Cancer: A Narrative Review
Jibran Ahmad Khan, Ibrahem Albalkhi, Sarah Garatli, Marcello Migliore
Journal of Clinical Medicine.2024; 13(11): 3354. CrossRef
The clinical effect of thoracoscopic segmentectomy in the treatment of lung malignancies less than 2CM in diameter
Yafeng Zhang, Renzhong Shi, Xiaoming Xia, Kaiyao Zhang
Journal of Cardiothoracic Surgery.2024;[Epub] CrossRef
Impact of ground-glass component on prognosis in early-stage lung cancer treated with stereotactic body radiotherapy via Helical Tomotherapy
Jintao Ma, Shaonan Fan, Wenhan Huang, Xiaohong Xu, Yong Hu, Jian He
Radiation Oncology.2024;[Epub] CrossRef

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Gastrointestinal cancer

Tumor Control and Overall Survival after Stereotactic Body Radiotherapy for Pulmonary Oligometastases from Colorectal Cancer: A Meta-Analysis: Hoon Sik Choi, Bae Kwon Jeong, Ki Mun Kang, Hojin Jeong, Jin Ho Song, In Bong Ha, Oh-Young Kwon; Cancer Res Treat. 2020;52(4):1188-1198. Published online July 21, 2020; DOI: https://doi.org/10.4143/crt.2020.402

Abstract PDF Supplementary Material PubReader ePub

Purpose
In pulmonary oligometastases from colorectal cancer (POM-CRC), the primarily recommended local therapy is metastasectomy. Stereotactic body radiotherapy (SBRT) is another local therapy modality that is considered as an alternative option in patients who cannot undergo surgery. The purpose of this meta-analysis is to demonstrate the effects of SBRT on POM-CRC by integrating the relevant studies.
Materials and Methods
The authors explored MEDLINE, EMBASE, Cochrane Library, Web of Science, and SCOPUS, and selected studies including patients treated with SBRT for POM-CRC and availability of local control (LC) or overall survival (OS) rate. In this meta-analysis, the effect of SBRT was presented in the form of the LC and OS rates for 1, 2, 3, and 5 years after SBRT as pooled estimates, and the frequency of pulmonary toxicity of grade 3 or higher after SBRT (PTG3-SBRT).
Results
Fourteen full texts among the searched 4,984 studies were the objects of this meta-analysis. The overall number of POM-CRC patients was 495 as per the integration of 14 studies. The pooled estimate LC rate at 1, 2, 3, and 5 years after SBRT was 81.0%, 71.5%, 56.0%, and 61.8%, and the OS rate was 86.9%, 70.1%, 57.9%, and 43.0%, respectively. The LC and OS rates gradually declined until 3 years after SBRT in a similar pattern. Among the 14 studies, only two studies reported PTG3-SBRT as 2.2% and 10.8%, respectively.
Conclusion
For POM-CRC, SBRT is an ablative therapy with a benefit on LC and OS rates and less adverse effects on the lung.

Citations

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Treatment of Colorectal Lung Metastases: Two Centers Retrospective Study
Myrtle F. Krul, Jan M. van Rees, Amihan M. de Boer, Karlijn K. Neve, Cornelis Verhoef, Koert F.D. Kuhlmann, Tarik R. Baetens, Tineke E. Buffart, Joost L. Knegjens, Houke M. Klomp, Theo J.M. Ruers, Marianne de Vries, Joost Rothbarth, Esther van Meerten, Jo
Digestive Diseases.2024; 42(6): 538. CrossRef
Clinical outcomes and lung toxicities after lung SABR using dynamic conformal arc therapy: a single-institution cohort study
Emmanuel Mesny, Myriam Ayadi, Pauline Dupuis, Guillaume Beldjoudi, Ronan Tanguy, Isabelle Martel-Lafay
Radiation Oncology.2023;[Epub] CrossRef
Knowing When to Use Stereotactic Ablative Radiation Therapy in Oligometastatic Cancer
Davide Franceschini, Maria Ausilia Teriaca, Luca Dominici, Ciro Franzese, Marta Scorsetti
Cancer Management and Research.2021; Volume 13: 7009. CrossRef

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11 Web of Science
3 Crossref

SUVmax Predicts Disease Progression after Stereotactic Ablative Radiotherapy in Stage I Non-small Cell Lung Cancer: Yoo-Kang Kwak, Hee Hyun Park, Kyu Hye Choi, Eun Young Park, Soo Yoon Sung, Sea-Won Lee, Ji Hyun Hong, Hyo Chun Lee, Ie Ryung Yoo, Yeon Sil Kim; Cancer Res Treat. 2020;52(1):85-97. Published online May 17, 2019; DOI: https://doi.org/10.4143/crt.2019.007

Abstract PDF PubReader ePub

Purpose
Fluorodeoxyglucose positron emission tomography–computed tomography (PET-CT) is gaining evidence as a predictive factor in non-small cell lung cancer (NSCLC). Stereotactic ablative radiotherapy (SABR) is the standard treatment in early-stage NSCLC when a patient is unsuitable for surgery. We performed a study to assess the prognostic clinical significance of PET-CT after SABR in early-stage NSCLC.
Materials and Methods
Seventy-six patients with stage I NSCLC treated with SABR were investigated. Total radiation dose ranged from 36 to 63 Gy in three to eight fractions depending on tumor location and size. Respiratory motion control was implemented at simulation and during treatment. PET-CT prior to SABR was performed in 66 patients (86.8%).
Results
Median follow-up time was 32 months (range, 5 to 142 months). Local control rate at 1, 2, and 5 years were 95.9%, 92.8%, and 86.7%, respectively. Overall survival (OS) at 1, 2, and 5 years were 91.0%, 71.3%, and 52.1% respectively. Cause-specific survival at 1, 2, and 5 years were 98.6%, 93.1%, and 84.3% respectively. Tumor size and pre-SABR maximal standardized uptake value (SUVmax) demonstrated statistical significance in the Kaplan-Meier survival analyses with log-rank test. In multivariate analyses pre-SABR SUVmax remained statistically significant in correlation to OS (p=0.024; hazard ratio [HR], 3.2; 95% confidence interval [CI], 1.2 to 8.8) and with marginal significance in regards to regional progression-free survival (p=0.059; HR, 32.5; 95% CI, 2.6 to 402.5).
Conclusion
Pre-SABR SUVmax demonstrated a predictive power in statistical analyses. Tumors with SUVmax above 6 at diagnosis were associated with inferior outcomes.

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Enhanced NSCLC subtyping and staging through attention-augmented multi-task deep learning: A novel diagnostic tool
Runhuang Yang, Weiming Li, Siqi Yu, Zhiyuan Wu, Haiping Zhang, Xiangtong Liu, Lixin Tao, Xia Li, Jian Huang, Xiuhua Guo
International Journal of Medical Informatics.2025; 193: 105694. CrossRef
Invasive Nodal Staging via Endobronchial Ultrasound and Outcome in Patients Treated with Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer – Results from a Single Institution Study
Benjamin George, Atallah Baydoun, Samar Bhat, Lauryn Bailey, Theodore Arsenault, Yilun Sun, Yuxia Zhang, Yiran Zheng, Prashant Vempati, Tarun Podder, Tithi Biswas
Clinical Lung Cancer.2024; 25(4): e181. CrossRef
Prognostic value of consolidation-to-tumor ratio on computed tomography in NSCLC: a meta-analysis
Yongming Wu, Wenpeng Song, Denian Wang, Junke Chang, Yan Wang, Jie Tian, Sicheng Zhou, Yingxian Dong, Jing Zhou, Jue Li, Ziyi Zhao, Guowei Che
World Journal of Surgical Oncology.2023;[Epub] CrossRef
Tumor to liver maximum standardized uptake value ratio of FDG-PET/CT parameters predicts tumor treatment response and survival of stage III non-small cell lung cancer
Pengfei Zhang, Wei Chen, Kewei Zhao, Xiaowen Qiu, Tao Li, Xingzhuang Zhu, Peng Sun, Chunsheng Wang, Yipeng Song
BMC Medical Imaging.2023;[Epub] CrossRef
Evaluation of response to stereotactic body radiation therapy for nonsmall cell lung cancer: PET response criteria in solid tumors versus response evaluation criteria in solid tumors
Jixia Han, Qi Song, Feng Guo, Rui Du, Henghu Fang, Jingbo Kang, Zejun Lu
Nuclear Medicine Communications.2022;[Epub] CrossRef
Assessing tumor angiogenesis using dynamic contrast-enhanced integrated magnetic resonance-positron emission tomography in patients with non-small-cell lung cancer
Yu-Sen Huang, Jenny Ling-Yu Chen, Hsin-Ming Chen, Li-Hao Yeh, Jin-Yuan Shih, Ruoh-Fang Yen, Yeun-Chung Chang
BMC Cancer.2021;[Epub] CrossRef
Potential role of functional imaging in predicting outcome for patients treated with carbon ion therapy: a review
Giulia Riva, Sara Imparato, Giovanni Savietto, Mattia Pecorilla, Alberto Iannalfi, Amelia Barcellini, Sara Ronchi, Maria Rosaria Fiore, Chiara Paganelli, Giulia Buizza, Mario Ciocca, Guido Baroni, Lorenzo Preda, Ester Orlandi
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Jin Meng, Emmanuel Deshayes, Li Zhang, Wei Shi, Xiaomeng Zhang, Xingxing Chen, Xin Mei, Jinli Ma, Yizhou Jiang, Jiong Wu, Zhimin Shao, Xiaoli Yu, Zhaozhi Yang, Xiaomao Guo
Molecular Therapy - Oncolytics.2021; 23: 412. CrossRef
Parámetros cuantitativos de la PET/TC con 18F-FDG como factores pronósticos en el cáncer de pulmón localizado e inoperable
J.R. Infante, J. Cabrera, J.I. Rayo, C. Cruz, J. Serrano, M. Moreno, A. Martínez, P. Jiménez, A. Cobo
Revista Española de Medicina Nuclear e Imagen Molecular.2020; 39(6): 353. CrossRef
18F-FDG PET/CT quantitative parameters as prognostic factors in localized and inoperable lung cancer
J.R. Infante, J. Cabrera, J.I. Rayo, C. Cruz, J. Serrano, M Moreno, A. Martínez, P. Jiménez, A. Cobo
Revista Española de Medicina Nuclear e Imagen Molecular (English Edition).2020; 39(6): 353. CrossRef

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The Feasibility of Spinal Stereotactic Radiosurgery for Spinal Metastasis with Epidural Cord Compression: Yi-Jun Kim, Jin Ho Kim, Kyubo Kim, Hak Jae Kim, Eui Kyu Chie, Kyung Hwan Shin, Hong-Gyun Wu, Il Han Kim; Cancer Res Treat. 2019;51(4):1324-1335. Published online January 29, 2019; DOI: https://doi.org/10.4143/crt.2018.653

Abstract PDF PubReader ePub

Purpose
The purpose of this study was to investigate the effectiveness and safety of spinal stereotactic radiosurgery (SRS) in treating spinal metastasis with epidural spinal cord compression (ESCC).
Materials and Methods
During 2013-2016, 149 regions of spinal metastasis in 105 patients treated with singlefraction (12-24 Gy) spinal SRS were reviewed. Cord compression of Bilsky grade 2 (with visible cerebrospinal fluid [CSF]) or 3 (no visible CSF) was defined as ESCC. Local progression (LP) and vertebral compression fracture (VCF) rates after SRS were evaluated using multivariate competing-risk regression analysis.
Results
The 1-year cumulative incidences of LP for Bilsky grades 0 (n=80), 1 (n=39), 2 (n=21), and 3 (n=9) were 3.0%, 8.4%, 0%, and 24.9%, respectively. Bilsky grade 2 ESCC did not significantly increase the LP rate (no LP for grade 2). The 1-year cumulative incidences of VCF for Bilsky grades 0, 1, 2, and 3 were 6.6%, 5.2%, 17.1%, and 12.1%, respectively. ESCC may increase VCF risk (subhazard ratio [SHR] for grade 2, 5.368; p=0.035; SHR for grade 3, 2.215; p=0.460). Complete or partial pain response rates after SRS were 79%, 78%, 53%, and 63% for Bilsky grades 0, 1, 2, and 3, respectively (p=0.008). No neurotoxicity of grade ≥ 3 was observed.
Conclusion
Spinal SRS for spinal metastasis with Bilsky grade 2 ESCC did not increase the LP rate, was not associated with severe neurotoxicity, and showed moderate VCF and pain response rates. Bilsky grade 3 had a high LP rate.

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Efficacy and safety of SBRT for spine metastases: A systematic review and meta-analysis for preparation of an ESTRO practice guideline
R.S. Guninski, F. Cuccia, F. Alongi, N. Andratschke, C. Belka, D. Bellut, M. Dahele, M. Josipovic, T.E. Kroese, P. Mancosu, G. Minniti, M. Niyazi, U Ricardi, P. Munck af Rosenschold, A. Sahgal, Y. Tsang, W.F.A.R. Verbakel, M. Guckenberger
Radiotherapy and Oncology.2024; 190: 109969. CrossRef
Metastatic Spinal Lesion with Minimal Epidural Compression: Surgical Treatment or Stereotactic Radiotherapy?
O. I. Kit, D. E. Zakondyrin, A. A. Grin, E. E. Rostorguev, Y. V. Przhedetskiy, P. G. Sakun, V. I. Voshedskii, B. V. Matevosian, T. S. Shepelya
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Surgical Interventions Following Radiotherapy in Spinal Metastases with Intermediate Instability: A Risk Factor Analysis: The Korean Society of Spinal Tumor Multicenter Study (KSST 2022-02)
Se-Jun Park, Jin Ho Kim, Yong Chan Ahn, Woong Sub Koom, Hwa Kyung Byun, Young-Hoon Kim, Sang-Il Kim, Dong-Ho Kang
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Xuyong Cao, Weihao Jiang, Xiongwei Zhao, Haikuan Yu, Mingxing Lei, Yuncen Cao, Xiuyun Su, Yaosheng Liu
The Spine Journal.2023; 23(12): 1858. CrossRef
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Dong-Ho Kang, Wooseok Lee, Bong-Soon Chang, Hyoungmin Kim, Sam Yeol Chang, Seong Hwa Hong, Jin Ho Kim, Hee Jung Son
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Chengcheng Gui, Xuguang Chen, Khadija Sheikh, Liza Mathews, Sheng-Fu L. Lo, Junghoon Lee, Majid A. Khan, Daniel M. Sciubba, Kristin J. Redmond
Journal of Neurosurgery: Spine.2022; 36(2): 294. CrossRef
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Lanlan Guo, Lixin Ke, Ziyi Zeng, Chuanping Yuan, Ziwei Wu, Lei Chen, Lixia Lu
Medical Oncology.2022;[Epub] CrossRef
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High-Dose Thoracic Re-irradiation of Lung Cancer Using Highly Conformal Radiotherapy Is Effective with Acceptable Toxicity: Ji Hyun Hong, Yeon-Sil Kim, Sea-Won Lee, So Jung Lee, Jin Hyung Kang, Suk Hee Hong, Ju-Young Hong, GeumSeong Cheon; Cancer Res Treat. 2019;51(3):1156-1166. Published online November 29, 2018; DOI: https://doi.org/10.4143/crt.2018.472

Abstract PDF PubReader ePub

Purpose
Thoracic re-irradiation (re-RT) of lung cancer has been challenged by the tolerance doses of normal tissues. We retrospectively analyzed local control, overall survival (OS) and toxicity after thoracic re-RT using highly conformal radiotherapy, such as intensity modulated radiotherapy and stereotactic body radiotherapy.
Materials and Methods
Thirty-one patients who received high-dose thoracic re-RT were analyzed. Doses were recalculated to determine biologically equivalent doses. The median interval to re-RT was 15.1 months (range, 4.4 to 56.3 months), the median initial dose was 79.2 Gy₁₀ (range, 51.75 to 150 Gy₁₀), and the median re-RT dose was 68.8 Gy₁₀ (range, 43.2 to 132 Gy₁₀).
Results
Eighteen (58.1%) and eleven (35.5%) patients showed loco-regional recurrence and distant metastasis, respectively, after 17.4 months of median follow-up. The 1-year and 2-year local control rates were 60.2% and 43.7%, respectively. The median loco-regional recurrence-free-survival (LRFS) was 15.4 months, and the median OS was 20.4 months. The cumulative and re-RT biologically equivalent dose for α/β=10 (BED₁₀) doses were the most significant prognostic factors. Cumulative BED₁₀≥145 Gy₁₀ and re-RT BED₁₀≥68.7 Gy₁₀ were significantly associated with longer OS (p=0.029 and p=0.012, respectively) and LRFS (p=0.003 and p=0.000, respectively). The most frequent acute toxicity was grade 1-2 pulmonary toxicity (41.9%). No acute grade 3 or higher toxicities occurred.
Conclusion
Our results show that high-dose thoracic re-RT of lung cancer can be safely delivered using highly conformal radiotherapy with favorable survival and acceptable toxicity. An optimal strategy to select patients who would benefit from re-RT is crucial in extending the indications and improving the efficacy with a sufficiently high dose.

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Steven J. Frank, Indra J. Das, Charles B. Simone, Brian J. Davis, Curtiland Deville, Zhongxing Liao, Simon S. Lo, Susan L. McGovern, Rahul R. Parikh, Michael Reilly, William Small, Naomi R. Schechter
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Dorota Gabrys, Roland Kulik, Agnieszka Namysł-Kaletka
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Long-term Survival in Patients Treated with a Robotic Radiosurgical Device for Liver Metastases: Sebastian Stintzing, Jobst von Einem, Christoph Fueweger, Alfred Haidenberger, Michael Fedorov, Alexander Muavcevic; Cancer Res Treat. 2019;51(1):187-193. Published online April 16, 2018; DOI: https://doi.org/10.4143/crt.2017.594

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Purpose
The treatment of liver metastases with local procedures is a fast progressing field. For the most, long-term survival data is missing raising questions with regard to the efficacy of such modalities when compared to surgical resection. Radiosurgery using the CyberKnife device enables the treatment of liver lesions with a single-session approach. Here we present long-term survival data to explore the curative potential of this strategy.
Materials and Methods
Patients with oligo-metastatic disease limited to the liver have been treated with single-session or hypo-fractioned radiosurgery in curative intent and prospectively followed until death. Follow-up (FU) was performed using magnetic resonance imaging (MRI) 2 months after radiation and at 3-month intervals for the first 2 years. After that annual computed tomography or MRI scans were performed until 5 years post-treatment. Local recurrence in the radiated volume and recurrence outside the treated volume were used to define local and distant progression. Survival times were censored at the time of the last FU.
Results
One hundred twenty-six patients treated between 2005 and 2015 with 194 lesions were included into this study. Median FU was 30.0 months. According to Response Evaluation Criteria in Solid Tumors, 55.2% had a complete remission and 11.3% a partial remission. Seventy-two point two percent recurred outside the radiated lesion and median overall survival was 35.2 months with a 3-year survival rate of 47.7%.
Conclusion
This is currently the largest cohort of stereotactic body radiation therapy treated liver lesions with a median long-term follow of 30 months. Robotic radiosurgery using a single session approach has a high efficacy to control the radiated lesion with the potential to cure patients.

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Robotic Stereotactic Body Radiation Therapy for Oligometastatic Liver Metastases: A Systematic Review of the Literature and Evidence Quality Assessment
Ilektra Kyrochristou, Ilias Giannakodimos, Maria Tolia, Ioannis Georgakopoulos, Nikolaos Pararas, Francesk Mulita, Nikolaos Machairas, Dimitrios Schizas
Diagnostics.2024; 14(10): 1055. CrossRef
Stereotactic Body Radiation therapy for Liver Metastases: Systematic Review and Meta-Analysis With International Stereotactic Radiosurgery Society (ISRS) Practice Guidelines
Ciro Franzese, Alexander V. Louie, Rupesh Kotecha, Zhenwei Zhang, Matthias Guckenberger, Mi-Sook Kim, Alison C. Tree, Ben J. Slotman, Arjun Sahgal, Marta Scorsetti
Practical Radiation Oncology.2024;[Epub] CrossRef
Effectiveness of Robotic Stereotactic Radiotherapy in Patients Undergoing Re-irradiation: A Review
Ahamed Badusha Mohamed Yoosuf, Salem Alshehri, Mohd Zahri Abdul Aziz, Syahir Mansor, Gokula Kumar Appalanaido, Mamdouh Alqathami
Cureus.2023;[Epub] CrossRef
Stereotactic body radiation therapy in patients with liver oligometastases from colorectal cancer: a systematic review
A. N. Moskalenko, V. K. Lyadov, I. V. Sagaydak, M. V. Chernykh, N. N. Britskaya
Pelvic Surgery and Oncology.2022; 12(1): 49. CrossRef
Anti-EGFR Therapy Induces EGF Secretion by Cancer-Associated Fibroblasts to Confer Colorectal Cancer Chemoresistance
Colleen M. Garvey, Roy Lau, Alyssa Sanchez, Ren X. Sun, Emma J. Fong, Michael E. Doche, Oscar Chen, Anthony Jusuf, Heinz-Josef Lenz, Brent Larson, Shannon M. Mumenthaler
Cancers.2020; 12(6): 1393. CrossRef

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Hypofractionated Stereotactic Radiation Therapy in Recurrent High-Grade Glioma: A New Challenge: Pierina Navarria, Anna Maria Ascolese, Stefano Tomatis, Giacomo Reggiori, Elena Clerici, Elisa Villa, Giulia Maggi, Lorenzo Bello, Federico Pessina, Luca Cozzi, Marta Scorsetti; Cancer Res Treat. 2016;48(1):37-44. Published online February 23, 2015; DOI: https://doi.org/10.4143/crt.2014.259

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Purpose
The aim of this study was to evaluate outcomes of hypofractionated-stereotactic-radiationtherapy (HSRT) in patients re-treated for recurrent high-grade glioma. Materials and Methods From January 2006 to September 2013, 25 patients were treated. Six patients underwent radiation therapy alone, while 19 underwent combined treatment with surgery and/or chemotherapy. Only patients with Karnofsky Performance Status (KPS) > 70 and time from previous radiotherapy greater than 6 months were re-irradiated. The mean recurrent tumor volume was 35 cm3 (range, 2.46 to 116.7 cm3), and most of the patients (84%) were treated with a total dose of 25 Gy in five fractions (range, 20 to 50 Gy in 5-10 fractions).
Results
The median follow-up was 18 months (range, 4 to 36 months). The progression-free survival (PFS) at 1 and 2 years was 72% and 34% and the overall survival (OS) 76% and 50%, respectively. No severe toxicity was recorded. In univariate and multivariate analysis extent of resection at diagnosis significantly influenced PFS and OS (p < 0.01). Patients with smaller recurren tumor volume treated had better local control and survival. Indeed, the 2-year PFS was 40% (≤ 50 cm3) versus 11% (p=0.1) and the 2-year OS 56% versus 33% (> 50 cm3), respectively (p=0.26). Conclusion In our experience, HSRT could be a safe and feasible therapeutic option for recurrent high grade glioma even in patients with larger tumors. We believe that a multidisciplinary evaluation is mandatory to assure the best treatment for selected patients. Local treatment should also be considered as part of an integrated approach.

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Mustafa Aziz Hatiboglu, Kerime Akdur, Ayten Sakarcan, Mehmet Hakan Seyithanoglu, Haci Mehmet Turk, Georges Sinclair, Mustafa Namik Oztanir
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A longer time to relapse is associated with a larger increase in differences between paired primary and recurrent IDH wild-type glioblastomas at both the transcriptomic and genomic levels
Wei-Min Ho, Chia-Ying Chen, Tai-Wei Chiang, Trees-Juen Chuang
Acta Neuropathologica Communications.2024;[Epub] CrossRef
Dosimetric quality of HyperArc in boost radiotherapy for single glioblastoma: comparison with CyberKnife and manual VMAT
Mingyuan Pan, Wenqian Xu, Lei Sun, Chaozhuang Wang, Shengnan Dong, Yun Guan, Jun Yang, Enmin Wang
Radiation Oncology.2023;[Epub] CrossRef
MiR-493-5p inhibits the malignant development of gliomas via suppressing E2F3-mediated dysfunctions of P53 and PI3K/AKT pathways
Hong Liu, Zhen Li, Hu Sun
Clinical and Translational Oncology.2022; 24(2): 363. CrossRef
Role of Hyperbaric Oxygenation Plus Hypofractionated Stereotactic Radiotherapy in Recurrent High-Grade Glioma
Donatella Arpa, Elisabetta Parisi, Giulia Ghigi, Annalisa Cortesi, Pasquale Longobardi, Patrizia Cenni, Martina Pieri, Luca Tontini, Elisa Neri, Simona Micheletti, Francesca Ghetti, Manuela Monti, Flavia Foca, Anna Tesei, Chiara Arienti, Anna Sarnelli, Gi
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Peng Ren, JingYa Wang, Lei Li, XiaoWan Lin, GuangHan Wu, JiaYi Chen, ZhiRui Zeng, HongMei Zhang
Bioengineered.2021; 12(1): 3188. CrossRef
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Kyoung Su Sung, Tae Hoon Roh, Ju Hyung Moon, Eui Hyun Kim, Seok-Gu Kang, Se Hoon Kim, Jong Hee Chang
World Neurosurgery.2020; 135: e459. CrossRef
Interim Tumor Progression and Volumetric Changes of Surgical Cavities during the Surgery-to-Radiotherapy Interval in Anaplastic Gliomas: Implications for Additional Pre-radiotherapy Magnetic Resonance Imaging
Chan Woo Wee, Il Han Kim, Chul-Kee Park, Jin Wook Kim
Cancer Research and Treatment.2020; 52(2): 524. CrossRef
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Donatella Arpa, Elisabetta Parisi, Giulia Ghigi, Alessandro Savini, Sarah Pia Colangione, Luca Tontini, Martina Pieri, Flavia Foca, Rolando Polico, Anna Tesei, Anna Sarnelli, Antonino Romeo
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Andrey B. Gryazov, Yulia V. Medvedovska, Andrey A. Gryazov
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CNS & Neurological Disorders - Drug Targets .2020; 19(5): 374. CrossRef
Re-irradiation for recurrent high-grade gliomas: a systematic review and analysis of treatment technique with respect to survival and risk of radionecrosis
Mihir Shanker, Benjamin Chua, Catherine Bettington, Matthew C Foote, Mark B Pinkham
Neuro-Oncology Practice.2019; 6(2): 144. CrossRef
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Yan-jia Hu, Da Chen, Li-feng Zhang, Jing Chen
World Neurosurgery.2019; 127: 176. CrossRef
Hypofractionated stereotactic radiotherapy combined with chemotherapy or not in the management of recurrent malignant gliomas: A systematic review and meta-analysis
YJ Hu, LF Zhang, C Ding, D Chen, J Chen
Clinical Neurology and Neurosurgery.2019; 183: 105401. CrossRef
Re-irradiation in the Brain: Primary Gliomas
A.L.K. Ho, R. Jena
Clinical Oncology.2018; 30(2): 124. CrossRef
Timing of re-irradiation in recurrent high-grade gliomas: a single institution study
A. Zemlin, B. Märtens, B. Wiese, R. Merten, D. Steinmann
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Role of surgical resection in recurrent glioblastoma: prognostic factors and outcome evaluation in an observational study
Federico Pessina, Pierina Navarria, Luca Cozzi, Stefano Tomatis, Marco Riva, Anna Maria Ascolese, Armando Santoro, Matteo Simonelli, Lorenzo Bello, Marta Scorsetti
Journal of Neuro-Oncology.2017; 131(2): 377. CrossRef
Re-irradiation after gross total resection of recurrent glioblastoma
Christoph Straube, Greeshma Elpula, Jens Gempt, Julia Gerhardt, Stefanie Bette, Claus Zimmer, Friederike Schmidt-Graf, Bernhard Meyer, Stephanie E. Combs
Strahlentherapie und Onkologie.2017; 193(11): 897. CrossRef
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Kaleigh Fetcko, Rimas V. Lukas, Gordon A. Watson, Lingjiao Zhang, Mahua Dey
Medicine.2017; 96(43): e8293. CrossRef
Laser Ablation of Recurrent Malignant Gliomas
Analiz Rodriguez, Stephen B. Tatter
Neurosurgery.2016; 79(Supplement): S35. CrossRef

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A Survey of Stereotactic Body Radiotherapy in Korea: Sun Hyun Bae, Mi-Sook Kim, Won Il Jang, Chul-Seung Kay, Woochul Kim, Eun Seog Kim, Jin Ho Kim, Jin Hee Kim, Kwang Mo Yang, Kyu Chan Lee, A Ram Chang, Sunmi Jo; Cancer Res Treat. 2015;47(3):379-386. Published online November 24, 2014; DOI: https://doi.org/10.4143/crt.2014.021

Abstract PDF PubReader ePub

Purpose
The purpose of this study is to investigate the current status of stereotactic body radiotherapy (SBRT) in Korea. A nationwide survey was conducted by the Korean Stereotactic Radiosurgery Group of the Korean Society for Radiation Oncology (KROG 13-13).
Materials and Methods
SBRT was defined as radiotherapy with delivery of a high dose of radiation to an extracranial lesion in ≤ 4 fractions. A 16-questionnaire survey was sent by e-mail to the chief of radiation oncology at 85 institutions in June 2013.
Results
All institutions (100%) responded to this survey. Of these, 38 institutions (45%) have used SBRT and 47 institutions (55%) have not used SBRT. Regarding the treatment site, the lung (92%) and liver (76%) were the two most common sites. The most common schedules were 60 Gy/4 fractions for non-small cell lung cancer, 48 Gy/4 fractions for lung metastases, 60 Gy/3 fractions for hepatocellular carcinoma, and 45 Gy/3 fractions or 40 Gy/4 fractions for liver metastases. Four-dimensional computed tomography (CT) was the most common method for planning CT (74%). During planning CT, the most common method of immobilization was the use of an alpha cradle/vacuum-lock (42%).
Conclusion
Based on this survey, conduct of further prospective studies will be needed in order to determine the appropriate prescribed doses and to standardize the practice of SBRT.

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Carmelo Marino, Cristina Garibaldi, Ivan Veronese, Claudia Carbonini, Serenella Russo, Michele Stasi, Pietro Mancosu
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Si-Yuan Zhang, Guang-Ying Zhu, Gong Li, Yi-Bao Zhang, Jian-Hao Geng
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Practical patterns for stereotactic body radiotherapy to hepatocellular carcinoma in Korea: a survey of the Korean Stereotactic Radiosurgery Group
Sun Hyun Bae, Mi-Sook Kim, Won Il Jang, Chul-Seung Kay, Woochul Kim, Eun Seog Kim, Jin Ho Kim, Jin Hee Kim, Kwang Mo Yang, Kyu Chan Lee, A Ram Chang, Sunmi Jo
Japanese Journal of Clinical Oncology.2016; 46(4): 363. CrossRef
Radiotherapy in the multidisciplinary treatment of liver cancer: a survey on behalf of the Italian Association of Radiation Oncology
Francesco Dionisi, Alessia Guarneri, Veronica Dell’Acqua, Mariacristina Leonardi, Rita Niespolo, Gabriella Macchia, Tiziana Comito, Maurizio Amichetti, Pierfrancesco Franco, Savino Cilla, Luciana Caravatta, Filippo Alongi, Giovanna Mantello
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Review Articles

Stereotactic Body Radiotherapy for Early Stage Lung Cancer: Yasushi Nagata; Cancer Res Treat. 2013;45(3):155-161. Published online September 30, 2013; DOI: https://doi.org/10.4143/crt.2013.45.3.155

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Stereotactic body radiation therapy (SBRT) is a newly developed technique currently in clinical use. SBRT originated from stereotactic radiosurgery for intracranial tumors. SBRT has been widely used clinically for lung cancer. The practice of SBRT demands different kinds of patient fixation, breathing control, target determination, treatment planning, and verifications. The history and current standard technique are reviewed. Clinical studies of lung cancer showed high local control rates with acceptable toxicities. Past and on-going clinical trials are reviewed.

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The Role of Stereotactic Ablative Radiotherapy for Early-Stage and Oligometastatic Non-small Cell Lung Cancer: Evidence for Changing Paradigms: Max Dahele, Suresh Senan; Cancer Res Treat. 2011;43(2):75-82. Published online June 30, 2011; DOI: https://doi.org/10.4143/crt.2011.43.2.75

Abstract PDF PubReader ePub

A compelling body of non-randomized evidence has established stereotactic ablative lung radiotherapy (SABR) as a standard of care for medically inoperable patients with peripheral early-stage non-small cell lung cancer (NSCLC). This convenient outpatient therapy, which is typically delivered in 3-8 fractions, is also well tolerated by elderly and frail patients, makes efficient use of resources and is feasible using standard commercial equipment. The introduction of lung SABR into large populations has led to an increased utilization of radiotherapy, a reduction in the proportion of untreated patients and an increase in overall survival. In selected patients, the same ablative technology can now achieve durable local control of NSCLC metastases in a variety of common locations including the adrenal glands, bone, brain, and liver. At the same time as this, advances in prognostic molecular markers and targeted systemic therapies mean that there is now a subgroup of patients with stage IV NSCLC and a median survival of around 2 years. This creates opportunities for new trials that incorporate SABR and patient-specific systemic strategies. This selective mini-review focuses on the emerging role of SABR in patients with early-stage and oligometastatic NSCLC.

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Original Articles

Stereotactic Radiosurgery and Fractionated Stereotactic Radiotherapy for Intracranial Schwannoma: Dae Yong Kim, Yong Chan Ahn, Jung Il Lee, Do Hyun Nam, Jeong Eun Lee, Do Hoon Lim, Inhwan J Yeo, Seung Jae Huh, Young Joo Noh, Hyung Jin Shin, Kwan Park, Jong Hyun Kim; J Korean Cancer Assoc. 2001;33(1):27-33.

Abstract PDF: PURPOSE
To assess the radiologic response and cranial nerve morbidity in intracranial schwannoma patients treated with stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT).
MATERIALS AND METHODS
Twenty-six patients with intracranial schwannoma were treated with linear accelerator- based SRS or FSRT between February 1995 and October 1999. The origin of schwannoma was acoustic nerve in twenty-one patients, facial nerve in two, trigeminal nerve in two, and glossopharyngeal nerve in one. SRS were performed with the median peripheral dose of 14 Gy (range 12-16), and FSRT were done with the median peripheral dose of 25 2 Gy (range 50-60).
RESULTS
With a median follow-up period of 33 months (range 12-67), the local control rate was 100%. Tumorregression was noted in eleven patients, and tumor stabilization was found in the remaining fifteen. Useful hearing preservation was achieved in two of three patients. Facial nerve neuropathy was shown in two patients and one patients developed trigeminal nerve neuropathy.
CONCLUSION
Stereotactic radiotherapy including SRS and FSRT provided excellent local control in intracranial schwannoma. It shows the possibility of a high rate of hearing preservation and an acceptable neurotoxicity, although the number of patients are small and follow-up is relatively short.

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Stereotactic Radiotherapy for the Treatment of Brain Metastases: Dae Yong Kim, Yong Chan Ahn, Seung Jae Huh, Jung Il Lee, Do Hyun Nam, Seung Chyul Hong, Hyung Jin Shin, Kwan Park, Jong Hyun Kim; J Korean Cancer Assoc. 2000;32(1):148-155.

Abstract PDF: PURPOSE
To evaluate the clinical results of stereotactic radiosurgery (SRS) and frac- tionated stereotactic radiotherapy (FSRT) for metastatic brain tumors.
MATERIALS AND METHODS
Nineteen patients with brain metastases (34 lesions) were treated with LINAC-based SRS or FSRT with or without whole brain radiotherapy between October 1995 and February 1998. SRS was preferred to FSRT in cases with three or more lesions and poor performance status. FSRT was preferred to SRS in cases with lesions larger than 3 cm and lesions located near or at the eloquent areas such as thalamus, brain stem, and optic apparatus. Single isocenter was used both in SRS and FSRT, and the median peripheral dose in SRS was 15 Gy (range 13~20 Gy), while that in FSRT was 21 Gy (range 15~24 Gy) by 3 Gy per fraction.
RESULTS
Local control was achieved in 79% (27/34 treated lesions) and 1-year over- all survival rate was 58% with the median survival of 12 months. Lethal progressive brain metastases, both local and regional, were in four patients (27% of all deaths). No significant differences in local control and survival was observed with histology, age, sex, performance status, tumor volume, number of lesions, or treatment modality. Unacceptable acute or late complications did not occur.
CONCLUSION
Stereotactic radiotherapy including SRS and FSRT is effective, non-invasive therapy for brain metastases. This study suggests that stereotactic radiotherapy might be an alternative to surgical resection in selected patients of brain metastases.

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Linear Accelerator-Based Stereotactic Radiosurgery for Acoustic Neurinomas: Hong Seok Jang, Sei Chul Yoon, Tae Suk Suh, Mi Ryeong Ryu, Yeon Shil Kim, Moon Chan Kim, Jun Ki Kang, Kyung Sub Shinn; J Korean Cancer Assoc. 1997;29(6):992-999.

Abstract PDF: No abstract available

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