Stereotactic Body Radiation Therapy: Principles and Practices [2 ed.] 9819939771, 9789819939770

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Stereotactic Body Radiation Therapy Principles and Practices Yasushi Nagata Editor Second Edition

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Stereotactic Body Radiation Therapy

Yasushi Nagata Editor

Stereotactic Body Radiation Therapy Principles and Practices Second Edition

Editor Yasushi Nagata Department of Radiation Oncology Hiroshima University Hiroshima, Japan

ISBN 978-981-99-3977-0    ISBN 978-981-99-3978-7 (eBook) https://doi.org/10.1007/978-981-99-3978-7 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd. The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore Paper in this product is recyclable.

Preface

The first edition of this book was published in 2015. At that time, stereotactic body radiation therapy (SBRT) for lung cancer was just going to expand in the world. New technologies and new indications were on the verge of development. This book covered basic and clinical information of SBRT. Eight years after that, various new techniques and new indications were developed. Intensity-modulated radiotherapy (IMRT) technique became more widely available for SBRT. Various clinical trials were reported and are now ongoing. The indications of various organs and oligo-metastases have become more popular than before. I am very happy that we can publish the second edition of this book today. This article represents the most updated basic and clinical information of SBRT. I hope that this book will be helpful in facilitating clinical and research activities on SBRT. Finally, I would like to thank all of the authors for their contributions as well as Springer Japan for their efforts in publishing this book. Hiroshima, Japan May 2023

Yasushi Nagata

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Contents

Part I Introduction 1

I ntroduction and History of Stereotactic Body Radiation Therapy (SBRT)��������������������������������������������������������������������������������������    3 Yasushi Nagata

Part II Basic Principles 2

 adiobiology of Stereotactic Ablative Radiation Therapy������������������   13 R Chang W. Song, Sun Ha Paek, Mi-Sook Kim, Stephanie Terezakis, Yoichi Watanabe, and L. Chinsoo Cho

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 hysics of SBRT ��������������������������������������������������������������������������������������   35 P Teiji Nishio

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 uality Assurance in SBRT��������������������������������������������������������������������   55 Q Shuichi Ozawa

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 atient Immobilization, IGRT, Respiratory Motion Management ����   69 P Yu Kumazaki and Igari Mitsunobu

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Dose Calculation Algorithm��������������������������������������������������������������������   83 Satoru Sugimoto, Tatsuya Inoue, and Jun Takatsu

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Treatment Planning ��������������������������������������������������������������������������������   97 Mitsuhiro Nakamura

Part III Clinical Applications 8

Lung: Peripheral��������������������������������������������������������������������������������������  113 Masaki Kokubo

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Lung: Central ������������������������������������������������������������������������������������������  125 Takafumi Komiyama

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10 Lung: Toxicities����������������������������������������������������������������������������������������  137 Yukinori Matsuo, Noriko Kishi, Kazuhito Ueki, and Masahiro Yoneyama 11 L  iver����������������������������������������������������������������������������������������������������������  153 Yoshiko Doi 12 Kidney ������������������������������������������������������������������������������������������������������  171 Hiroshi Onishi 13 Spine����������������������������������������������������������������������������������������������������������  183 Kei Ito and Yujiro Nakajima 14 Oligomets��������������������������������������������������������������������������������������������������  199 Nobuki Imano 15 Other Indications ������������������������������������������������������������������������������������  215 Tomoki Kimura Part IV Development of Machines 16 V  ero4DRT System and Dynamic Tumor Tracking SBRT��������������������  233 Takashi Mizowaki, Yukinori Matsuo, and Masahiro Hiraoka 17 R  eal-Time Tumor-Tracking Radiotherapy (RTRT), SyncTraX����������  243 Naoki Miyamoto, Norio Katoh, Hiroshi Taguchi, Kentaro Nishioka, and Hidefumi Aoyama 18 CyberKnife®���������������������������������������������������������������������������������������������  255 Satoshi Kito 19 Tomotherapy��������������������������������������������������������������������������������������������  263 Hidetoshi Shimizu 20 M  R-LINAC: Elekta Unity ����������������������������������������������������������������������  277 Noriyuki Kadoya, Shohei Tanaka, Yoshiyuki Katsuta, Kiyokazu Sato, Noriyoshi Takahashi, and Keiichi Jingu 21 ViewRay MR-Linac ��������������������������������������������������������������������������������  285 Hiroyuki Okamoto, Takahito Chiba, Junichi Kuwahara, and Hiroshi Igaki Part V Future Perspectives 22 F  uture of SBRT with AI (Artificial Intelligence)����������������������������������  299 Daisuke Kawahara 23 F  uture of SBRT with Photon and Charged Particles ��������������������������  311 Tadamasa Yoshitake, Akira Matsunobu, and Yoshiyuki Shioyama Index������������������������������������������������������������������������������������������������������������������  323

Part I

Introduction

Chapter 1

Introduction and History of Stereotactic Body Radiation Therapy (SBRT) Yasushi Nagata

1.1 Introduction Intracranial Stereotactic Radiosurgery (SRS) was a new treatment method for brain tumor introduced in the twentieth century to deliver tight spatial/temporal distribution using a high precision technique. The clinical experience from intracranial SRS, together with the technical developments in conventional RT, initiated the development of Stereotactic Body Radiation Therapy (SBRT) for extracranial tumors characterized by a very high dose per fraction, delivered in a short time. This was started at the Swedish Karolinska University hospital in 1991 with tumors in the liver and lungs by Bromgren and Lax [1–3]. In parallel, this method was developed in Japan and clinically introduced in 1994 for lung tumors [4–6]. During the last 5 years of the 1990s, SBRT was introduced in several centers in Europe, Japan, and the USA. Wulf and Herfarth in Germany reported their clinical results on lung cancer in 2001, followed by Timmerman in the USA in 2003. In Japan, Japanese study group of stereotactic body radiation therapy was formed in 1999, and it expands annually. It then transformed into the Japan 3-D Conformal External Beam Radiotherapy Group (J-CERG) in 2002 and the Japan High-Precision External-­ beam Radiotherapy Group in 2016. The SBRT procedure was approved by the Japanese government to be covered by the health insurance in 2004. The early reports had already shown very promising results with regard to local control and toxicity for the hypofractionation schedules which were adopted with 10–15 Gy/ fraction given in 3–5 fractions during a short time . However, due to the new aspects introduced in SBRT, clinical experience was initially accumulated at a very slow rate, and it was only during the last decade that outcome data from several centers Y. Nagata (*) Department of Radiation Oncology, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan e-mail: [email protected] © The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023 Y. Nagata (ed.), Stereotactic Body Radiation Therapy, https://doi.org/10.1007/978-981-99-3978-7_1

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was available to confirm the initial promising results. In this session, the historical development of SBRT was reviewed.

1.2 Intracranial Radiosurgery The field of intracranial radiosurgery was mainly developed between 1950 and 1970. The treatment was named as radiosurgery by Leksell as an alternative to neurosurgery [7, 8]. Thereafter, the terminology of stereotactic radiosurgery meant single high dose with accurate spatial precision. The system named the Gamma Knife is a system with a metal helmet and multiple holes attached to a capsule of 201 multiple gamma sources. The Gamma Knife system developed from the original system up to a modern new system. The new system has an automatic beam shaped modification with multi-leaf collimators. Metallic ring attached to a patient is currently replaced with noninvasive plastic mask with the development of cone-beam CT. The radiosurgery technique was also possible using a conventional linear accelerator with a threedimensional radiosurgery systems. This system included metallic ring to be attached to a patient and fixation system attached to a couch. The three-­dimensional coordinates were essential for SRS. The accuracy of linear accelerator was essential.

1.3 Principles and Methods To extend the intracranial radiosurgery technology to extracranial tumors, two problems should be solved. First, most extracranial tumors move with or without respiratory motion. With tumor motions, wide ITV margins prevent delivering high dose to the tumor. The other difficulty is the unknown normal tissue toxicity using single high dose. Previous experiences with clinical radiotherapy are based on daily 2 Gy radiotherapy up to 60 or 70 Gy. Therefore, 48–60 Gy in 3–5 fractions are unknown areas. Therefore, initial SBRT was based on stereotactic coordinates using the Stereotactic Body Frame. Patients were stored within a plastic frame with three-­ dimensional coordinates. After the setup with these coordinates, single high dose was irradiated with non-coplanar beams. The other concern is the respiratory tumor movement. To regulate respiratory movement, various methods were used. Initially, abdominal press techniques or breath-hold techniques were most popular methods, thereafter, developed into respiratory gating and chasing methods. Geometric verification at each treatment is essential for SBRT, it is because single dose setup error will consequently make local tumor recurrence. Therefore, AP and lateral portal verifications using films were essential before each treatment, which now developed into EPID technology and cone-beam CT technology. The indications of SBRT expanded from lung cancer, liver cancer, renal cancer, prostate cancer, adrenal cancer, pancreatic cancer, vertebral bone tumor, lymph nodal tumors and other indications. The details of clinical application will be presented in this book [9–68].

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1.4 Dose Fractionation and Normal Tissue Dose Constraints Even now, the best dose fractionation schedule for lung and liver tumors could not be determined. Various dose fractionation schedules are used at different countries and at different institutions by now. The dose constraints for normal tissue are still finalized, and different dose constraints are used in different clinical trials. Previously in Japan, 50 Gy in 10 fractions, 60 Gy in 8 fractions, 48Gy in 4 fractions were prescribed at the isocenter. In the USA and Europe, 60 Gy in 3 fractions, 54 Gy in 3, and 48–50 Gy in 4 were prescribed at D95. We must be careful that these doses were prescribed at different points. The normal tissue dose constraints were set by JCOG (Japan Clinical Oncology Group) first proposed by Dr. Shirato and modified by JCOG1408.

1.5 Terminology The name of SBRT was introduced by Timmerman in 2002. He originally used Stereotactic Ablative Radiosurgery for this treatment. However, there were several oppositions from radiation oncologists because this treatment is completely different from radiofrequency ablation (RFA). In 2005, SBRT was used as a code of radiation therapy in the USA.  Extracranial stereotactic radiation therapy (ESRT) was used in Europe in the late 1990s and pin-pointed radiation therapy was used in Japan in the late 1990s. In 2010, stereotactic ablative radiotherapy (SABR) was introduced by Loo et al. It was because the pronunciation of SBRT was difficult. Currently, the terminology of SBRT and SABR are both used and are confusing.

1.6 Survey of SBRT in Japan and Its Current Status The Japan 3-D conformal external beam radiotherapy group (J-CERG) developed into the Japan High-Precision External Beam Radiotherapy Group of the JASTRO in 2016. J-CERG and the JASTRO group continuously conducted a survey of the SBRT in Japan since 2006. Figure 1.1 is the accumulated number of cases for SBRT in Japan. The number of institutions where SBRT is performed increased from 58 in 2006 to 310 in 2020. The indications of SBRT were lung cancer (70%), followed by liver cancer (13%), prostate cancer (6%), head and neck cancer, vertebral bone tumor, oligo-mets, adrenal tumor, renal cancer, and others as shown in Fig. 1.2. Grade 5 sequela are listed in Table  1.1 by the same survey. Radiation pneumonitis was the most common Grade 5 toxicity followed by pulmonary bleeding, liver damage, radiation esophagitis, and GI bleeding. The frequency of Grade 5 toxicity is 0.2 % on average.

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NSCLC:T1N0M0

Fig. 1.1  Accumulated number of SBRT cases in Japan

Fig. 1.2 Accumulated number of major cases for SBRT as in 2021

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Table 1.1  Accumulated Grade 5 sequela of SBRT by 2020 (by 2018, 2016, 2014, 2010, 2008) 1. Radiation pneumonitis 2. Pulmonary bleeding 3. Liver damage 4. Radiation esophagitis 5. GI bleeding 6. Others 76 cases/36,557 total cases = 0.2% 0.2% (0.2%, 0.2%, 0.5%, 0.5%, 0.6%)

55 (43, 40, 41, 42, 28) 6 (5, 4, 3, 3, 3) 4 (7, 0, 2, 0, 0) 4 (1, 2, 1, 1, 1) 4 (3, 3, 0, 0, 0) 3 (4, 3, 6, 5, 4)

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