TY - JOUR
T1 - Spatially fractionated stereotactic body radiation therapy (Lattice) for large tumors
AU - Duriseti, Sai
AU - Kavanaugh, James
AU - Goddu, Sreekrishna
AU - Price, Alex
AU - Knutson, Nels
AU - Reynoso, Francisco
AU - Michalski, Jeff
AU - Mutic, Sasa
AU - Robinson, Clifford
AU - Spraker, Matthew B.
N1 - Funding Information:
The authors thank Jessica Hilliard, Jennifer Harris, and Tammy Price-Warfield for their contributions to the dosimetry and treatment planning process reported in this manuscript. Sources of support: This work had no specific funding. Disclosures: Dr Knutson reports nonfinancial support from Varian Medical Systems outside of the submitted work. Dr Mutic reports grants and other support from Varian Medical Systems, Radialogica, and TreatSafely during the conduct of the study, as well as grants and other support from Varian Medical Systems outside of the submitted work. Dr Robinson reports grants and personal fees from Varian Medical Systems, personal fees from Astra Zeneca, Siemens Health care, and EMD Serono, as well as grants from Elekta and Merck outside of the submitted work. In addition, Dr Robinson has a patent (62/598,162) issued, as well as holds a leadership role and owns interest in Radialogica. Dr Spraker reports grants from Varian Medical Systems and the American College of Radiology, as well as personal fees from RadOncQuestions LLC outside of the submitted work. All other authors have no disclosures to declare.
Funding Information:
Disclosures: Dr Knutson reports nonfinancial support from Varian Medical Systems outside of the submitted work. Dr Mutic reports grants and other support from Varian Medical Systems, Radialogica, and TreatSafely during the conduct of the study, as well as grants and other support from Varian Medical Systems outside of the submitted work. Dr Robinson reports grants and personal fees from Varian Medical Systems, personal fees from Astra Zeneca, Siemens Health care, and EMD Serono, as well as grants from Elekta and Merck outside of the submitted work. In addition, Dr Robinson has a patent (62/598,162) issued, as well as holds a leadership role and owns interest in Radialogica. Dr Spraker reports grants from Varian Medical Systems and the American College of Radiology, as well as personal fees from RadOncQuestions LLC outside of the submitted work. All other authors have no disclosures to declare.
Publisher Copyright:
© 2020 The Author(s)
PY - 2021/5/1
Y1 - 2021/5/1
N2 - Purpose: Stereotactic body radiation therapy (SBRT) has demonstrated clinical benefits for patients with metastatic and/or unresectable cancer. Technical considerations of treatment delivery and nearby organs at risk can limit the use of SBRT in large tumors or those in unfavorable locations. Spatially fractionated radiation therapy (SFRT) may address this limitation because this technique can deliver high-dose radiation to discrete subvolume vertices inside a tumor target while restricting the remainder of the target to a safer lower dose. Indeed, SFRT, such as GRID, has been used to treat large tumors with reported dramatic tumor response and minimal side effects. Lattice is a modern approach to SFRT delivered with arc-based therapy, which may allow for safe, high-quality SBRT for large and/or deep tumors. Methods and Materials: Herein, we report the results of a dosimetry and quality assurance feasibility study of Lattice SBRT in 11 patients with 12 tumor targets, each ≥10 cm in an axial dimension. Prior computed tomography simulation scans were used to generate volumetric modulated arc therapy Lattice SBRT plans that were then delivered on clinically available Linacs. Quality assurance testing included external portal imaging device and ion chamber analyses. Results: All generated plans met the standard SBRT dose constraints, such as those from the American Association of Physicists in Medicine Task Group 101. Additionally, we provide a step-by-step approach to generate and deliver Lattice SBRT plans using commercially available treatment technology. Conclusions: Lattice SBRT is currently being tested in a prospective trial for patients with metastatic cancer who need palliation of large tumors (NCT04553471, NCT04133415).
AB - Purpose: Stereotactic body radiation therapy (SBRT) has demonstrated clinical benefits for patients with metastatic and/or unresectable cancer. Technical considerations of treatment delivery and nearby organs at risk can limit the use of SBRT in large tumors or those in unfavorable locations. Spatially fractionated radiation therapy (SFRT) may address this limitation because this technique can deliver high-dose radiation to discrete subvolume vertices inside a tumor target while restricting the remainder of the target to a safer lower dose. Indeed, SFRT, such as GRID, has been used to treat large tumors with reported dramatic tumor response and minimal side effects. Lattice is a modern approach to SFRT delivered with arc-based therapy, which may allow for safe, high-quality SBRT for large and/or deep tumors. Methods and Materials: Herein, we report the results of a dosimetry and quality assurance feasibility study of Lattice SBRT in 11 patients with 12 tumor targets, each ≥10 cm in an axial dimension. Prior computed tomography simulation scans were used to generate volumetric modulated arc therapy Lattice SBRT plans that were then delivered on clinically available Linacs. Quality assurance testing included external portal imaging device and ion chamber analyses. Results: All generated plans met the standard SBRT dose constraints, such as those from the American Association of Physicists in Medicine Task Group 101. Additionally, we provide a step-by-step approach to generate and deliver Lattice SBRT plans using commercially available treatment technology. Conclusions: Lattice SBRT is currently being tested in a prospective trial for patients with metastatic cancer who need palliation of large tumors (NCT04553471, NCT04133415).
UR - http://www.scopus.com/inward/record.url?scp=85108881815&partnerID=8YFLogxK
U2 - 10.1016/j.adro.2020.100639
DO - 10.1016/j.adro.2020.100639
M3 - Article
C2 - 34195486
AN - SCOPUS:85108881815
SN - 2452-1094
VL - 6
JO - Advances in Radiation Oncology
JF - Advances in Radiation Oncology
IS - 3
M1 - 100639
ER -