Abstract
Purpose:Brain metastases from renal cell carcinoma (RCC) have been successfully treated with stereotactic radiosurgery (SRS). Metastases to extra-cranial sites may be treated with similar success using stereotactic body radiation therapy (SBRT), where image-guidance allows for the delivery of precise high-dose radiation in a few fractions. This paper reports the authors’ initial experience with image-guided SBRT in treating primary and metastatic RCC.Materials and methods:The image-guided Brainlab Novalis stereotactic system was used. Fourteen patients with 23 extra-cranial metastatic RCC lesions (orbits, head and neck, lung, mediastinum, sternum, clavicle, scapula, humerus, rib, spine and abdominal wall) and two patients with biopsy-proven primary RCC (not surgical candidates) were treated with SBRT (24-40 Gy in 3-6 fractions over 1-2 weeks). All patients were immobilised in body cast or head and neck mask. Image-guidance was used for all fractions. PET/CT images were fused with simulation CT images to assist in target delineation and dose determination. SMART (simultaneous modulated accelerated radiation therapy) boost approach was adopted. 4D-CT was utilised to assess tumour/organ motion and assist in determining planning target volume margins.Results:Median follow-up was nine months. Thirteen patients (93%) who received SBRT to extra-cranial metastases achieved symptomatic relief. Two patients had local progression, yielding a local control rate of 87%. In the two patients with primary RCC, tumour size remained unchanged but their pain improved, and their renal function was unchanged post SBRT. There were no significant treatment-related side effects.Conclusion:Image-guided SBRT provides excellent symptom palliation and local control without any significant toxicity. SBRT may represent a novel, non-invasive, nephron-sparing option for the treatment of primary RCC as well as extra-cranial metastatic RCC.
Highlights
Intensity modulated radiotherapy (IMRT) utilises small beamlets of ionising radiation to provide a highKhamfongkhruea et al Biomed Imaging Interv J 2012; 8(1):e5This page number is not for citation purposes use a respiratory gating system
The measurements by MapCheck show the gamma index of the planned absolute dose distribution in static and moving targets with gating, resulting in more than 96% passing for all dose rates
The absolute dose distribution measured by film for the static target was agreeable with the value of moving target with gating
Summary
Intensity modulated radiotherapy (IMRT) utilises small beamlets of ionising radiation to provide a highKhamfongkhruea et al Biomed Imaging Interv J 2012; 8(1):e5This page number is not for citation purposes use a respiratory gating system. Chen et al [5] studied the dosimetric effects caused by the respiratory motion during IMRT by using Kodak EDR2 films. They concluded that, without the gating system, the dose distribution of the stationary phantom was different from the moving one. Duan et al [7] studied the dosimetric effect of respiration-gated beam with IMRT delivery Their results suggested that low dose rate can reduce the effect of delay and catch-up cycle. Lin et al [2] determined the effect of radiation dose rate with moving target and the gated treatment using step-and-shoot IMRT delivery. The high dose rate gated stepand-shoot IMRT was dosimetrically accurate, shortened the delivery time, and was safe to use clinically
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